Date of Filing :14.12.2015

Date of Disposal :10.03.2022

BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BENGALURU (PRINCIPAL BENCH)

DATED:10.03.2022

PRESENT

HON’BLE Mr JUSTICE HULUVADI GRAMESH : PRESIDENT

Mr K B SANGANNANAVAR: JUDICIAL MEMBER

Mrs DIVYASHREE M:LADY MEMBER

APPEAL No 3164/2016

1.  The Branch Manager

     LIC of India
     Opp :Bhavanishankar Temple Road
     Puttur D K District

2.  The Manager

     LIC of India
     Divisional Office
     Jeevan Krishnad PB No.8,
     Ajjarkad, Udupi
     D K District.
     
     Both are represented by their
     Authorized Representative
     Mr T K Padiyar
     Manager (Legal & HPF)
     LIC of India
     Divisional Office No.1,
     J C Road at Bengaluru – 560 002                             Appellant   
     (By Mr Rohith Gowda, Advocate)
 

                                                  -Versus-

Mr Sathyashankar K
S/o Sri Gopalkrishna Bhat K
Age: 52 years
R/at Sukritha, Samethadka
Puttur, Taluk
D K District.                                                                   Respondent

:ORDER:

Mr JUSTICE HULUVADI GRAMESH : PRESIDENT

1.       This is an Appeal filed under Section 15 of Consumer Protection Act 1986 by the OPs, aggrieved by the Order dated 09.11.2016 passed in Consumer Complaint No.425/2014 by District Consumer Disputes Redressal Forum, Mangalore, DK District. (for short, the District Forum).

2.       Heard the arguments.  Perused the Impugned Order, Records and Grounds of Appeal.    It is an admitted fact that the Complainant had obtained the Health plus Insurance Policy from OP1 which was issued by OP2.   On 14.04.2014, he underwent ORIF under General Anaesthesia in Mangala Hospital and he was discharged on 16.04.2014 and spent more than Rs.50,000/-.  OP on receipt of claim for reimbursement repudiated it on the ground that the treatment taken by the Complainant does not include maxillary part and facial part.  District Forum recorded affirmative findings and noted that the Complainant sustained injury on lower jaw on the part of face and not on the face.  Further, the treatment covers the list of surgical procedure as listed in the last page of the Policy document and to disprove the same, OP has not produced any cogent evidence to show that the treatment taken by the Complainant is not covered under the Policy and so also the period of hospitalisation. Accordingly, awarded Rs.21,405/- with interest @ 8% p.a from 25.04.2014 and cost of Rs.10,000/-.In our considered opinion, since the rate of interest awarded by the District Forum is not reasonable, hence, it is reduced to 6% p.a.   In view of this observation, Appeal is allowed.   Consequently, the Impugned Order dated 09.11.2016 passed in Consumer Complaint No.425/2014 by District Consumer Disputes Redressal Forum, Mangalore, DK District is modified, in so far as interest part is concerned and reduced it to 6% p.a on Rs.21,405/- from 25.04.2014 till payment. Further Appellants/OPs are directed to comply this Order within 3 months from the date of receipt of this Order.  Rest of the Order passed by the District Forum remains un-disturbed.

3.       Amount in Deposit is ordered to be transferred to the District Commission for disbursement to the Complainant.

4.       Send a copy of this Order to the District Commission as well as to the parties concerned, immediately.

Lady Member                Judicial Member                       President

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