DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION ERNAKULAM
Dated this the 24th day of January 2023
Filed on: 27/12/2021
PRESENT
Shri.D.B.Binu President
Shri.V.Ramachandran Member Smt.Sreevidhia.T.N Member
C.C. NO.518/2021
Between
COMPLAINANT
Tomy Mathews, Malekudiyil House, Kadalikkad P.O., Vazhakkulam, Muvattupuzha
(Rep. by Adv. K.M. Sanu, Sreekrishna Building, Temple Road, Thodupuzha)
VS
OPPOSITE PARTIES
1. Manager, Medi Assist, 4th Floor, Chicago Plaza, Rajaji Road, Cochin 682035.
2. Manager, Manipal Sigma Health Insurance, Mathew & Sons Centre, Mamangalam P.O., Ernakulam 682025
F I N A L O R D E R
D.B.Binu, President.
1) A brief statement of facts of this complaint is as stated below:
The complaint was filed under section 35 of the Consumer Protection Act, 2019. The complaint is regarding a major portion of the medical payment of the expense incurred by the complainant as an aftermath of the injuries sustained by him in a motor vehicle accident. The complainant is the holder of the health insurance policy of the second opposite party for the period from 22/11/2019 to 21/11/2020. The complainant was insured for Rs. 4 lakhs. The complainant met with an accident on 04.09.2020. He was treated at Rajagiri Hospital, Aluva, and the Chazhkkatu Hospital. The opposite parties have disbursed only Rs.5,000/- as against Rs.2,97,381. Hence, an amount of Rs.2,50,182/- is due from the opposite parties.
The complainant had approached the Commission seeking an order directing the opposite parties to pay Rs.2,50,182/- towards due from the opposite parties as the expense incurred by the complainant, Rs.1,00,000/- towards compensation for the mental agony, financial loss, and hardships suffered by the complainant and the cost of the proceedings.
2) Notice
Notice was issued from the Commission to the opposite parties. The opposite parties received the notice but did not appear before the Commission and not filed versions. Consequently, the opposite parties are set ex-parte.
3) . Evidence
The complainant had filed a Proof affidavit and 5 documents that were marked as Exhibits-A-1- to A-5.
Exhibit A-1: Copy of the policy.
Exhibit A-2- Copy of F I R.
Exhibit A-3- Copy of the discharge summary.
Exhibit A-4- Copy of the deposit/advance recent.
Exhibit A-5-Copy of the medical records from the Chazhkkatu Hospital.
6) The main points to be analysed in this case are as follows:
i) Whether the complaint is maintainable or not?
ii) Whether there is any deficiency in service or unfair trade practice from the side of the opposite party to the complainant?
iii) If so, whether the complainant is entitled to get any relief from the side of the opposite party?
iv) Costs of the proceedings if any?
7) The issues mentioned above are considered together and are answered as follows:
The complaint was filed under section 35 of the Consumer Protection Act, 2019. The complaint is regarding a major portion of the medical payment of the expense incurred by the complainant as an aftermath of the injuries sustained by him in a motor vehicle accident.
According to Section 2 (7) of the Consumer Protection Act, 2019, "CONSUMER" means any person who buys any goods or hires or avails of any services for a consideration which has been paid or promised or partly paid and partly promised, or under any system of deferred payment. The complainant produced a copy of the policy. (Exhibit A-1). Therefore, we are only to hold that the complainants are consumers as defined under the Consumer Protection Act,2019 (Point No. i) goes against the opposite parties Copies of the receipts issued by the opposite parties.
The counsel for the complainant submitted that the evidence, though notice from this Commission was served on the opposite parties has remained absent and consequently the opposite parties were set ex parte.
The complainant is the holder of the health insurance policy of the second opposite party for the period from 22.11. 2019 to 21 11:2020 for Rs. 4 lakhs as evidenced by Exhibit A-1. The complainant met with an accident on 04.09.2020 as evidenced by FIR (Exhibit A-2). The complainant was treated at Rajagiri Hospital, Aluva (Exhibit A-3), and a copy of the medical records from Chazhkkatu Hospital (Exhibit A-5). The complainant spent Rs. 2,97,381/- as evidenced by (Exhibit A-4). The opposite parties have disbursed only Rs.5,000/- as against Rs.2,97,381/-. Hence, an amount of Rs. 2,50,182/- is due from the opposite parties.
The complainant who had availed the services of both the opposite parties was made to suffer due to the deficiency of service on part of the opposite parties. The opposite parties are liable to compensate the complainant for the deficiency of service on their part.
We have also noticed that notices were issued from the Commission to the opposite parties but did not file their version. Hence the opposite parties set ex-parte. The complainant has filed the Proof Affidavit and 5 documents which are marked as Exbt.A-1 to A-5. All in support of his case. But the Opposite Parties did not make any attempt to appear in the case and participate in the above proceedings before this commission and did not make any attempt to set aside the ex-prate order passed against it.
The opposite parties’ conscious failure to file their written versions in spite of their having received the Commission’s notice to that effect amounts to an admission of the allegations levelled against them. The Hon’ble NC held a similar stance in its order cited 2017(4) CPR page 590 (NC).
It was further stated that this illegal, arbitrary and unjustified act of the opposite parties amounted to deficiency in service, indulgence into unfair trade practice, and caused mental agony and physical harassment to the complainant. Despite due service, none appeared on behalf of the opposite parties, hence, they proceeded against ex parte vide order dated 02.08.2022.
The opposite party Nos. 1 and 2 has inadequately performed the service as contracted with the complainant and hence there is a deficiency in service, negligence, and failure on the part of Opposite Party Nos. 1 and 2 in failing to provide the Complainant desired service which in turn has caused mental agony and hardship, and financial loss, to the Complainant.
We find the issue Nos. (II), (III) and (IV) are found in favour of the complainants for the serious deficiency in service that happened on the side of the opposite parties. Naturally, the complainants had suffered a lot of inconvenience, mental agony, hardships, financial loss, etc. due to the negligence on the part of the opposite parties.
In view of the above facts and circumstances of the case, we are of the opinion that the opposite parties are liable to compensate the complainant.
Hence the prayer is partly allowed as follows:
i. The Opposite Parties shall pay Rs. 2,50,182/- (Rupees two lakhs fifty thousand one hundred eighty two only) to the complainant due from the opposite parties as the expense incurred by the complainant.
ii. The Opposite Parties shall pay the complainant Rs.10,000/- (Rupees ten thousand only) as compensation for loss caused to the complainant due to the deficiency in service and unfair trade practices of the opposite parties.
iii. The Opposite Parties shall also pay Rs.5,000/- (Rupees five thousand only) to the complainant towards the cost of the proceedings.
The opposite parties shall be jointly and severally liable for the above-mentioned directions which shall be complied with by the opposite parties within 30 days from the date of the receipt of a copy of this order. Failing which the amount ordered vide (i) and (ii) above shall attract interest @7.5% from the date of receipt of a copy of this order till the date of realization.
Dictated to the Confidential Assistant Smt. K.P. Liji transcribed and typed by her corrected by me and pronounced in the Open Commission this 24th day of January, 2023.
Sd/-
D.B.Binu, President
Sd/- V.Ramachandran, Member
Sd/-
Sreevidhia.T.N, Member
Forwarded/by Order
Assistant Registrar
APPENDIX
Complainant’s evidence:
Exhibit A-1: Copy of the policy.
Exhibit A-2- Copy of F I R.
Exhibit A-3- Copy of the discharge summary.
Exhibit A-4- Copy of the deposit/advance recent.
Exhibit A-5-Copy of the medical records from the Chazhkkatu Hospital.
Opposite parties’ evidence:
Nil
Despatch date:
By hand: By post
kp/
CC No. 518/2021
Order Date: 24/01/2023
