By: Sri. Mohamed Ismayil C.V., Member
The grievances of the complainants as follows:-
1. The first complainant is working in New India Assurance Co Ltd and second complainant is a retired sub inspector of police. They are husband and wife. The complainants availed an insurance policy coverage known as Corona Rakshak Policy on 23/07/2020 from the opposite parties for Rs 2,50,000/-. On 08/10/2020 the second complainant tested positive for covid-19 from Government Medical College Hospital, Manjeri and admitted to First Line Treatment Centre located at Muttipalam on the same day. After undergoing treatment of medication, he was discharged on 12/10/2020. He was treated for Covid-19 more than 96 hours. So the second complainant applied for reimbursement of medical bills to the opposite parties. But the opposite parties repudiated claim application on frivolous grounds. On 04/02/2021 the second complainant issued a lawyer notice on email and followed with registered notice. On 10/03/2021 complainant’s advocate received a reply notice from the opposite parties negating the claim with untenable grounds. According to the complainants, they were lured to subscribe above said policy on the basis of tall claims , the lofty and perfunctory promises made by the opposite parties. It is averred in the complaint that the opposite parties are repudiating claim applications of the insured persons on flimsy and frivolous grounds. The complainants raised the contention that they were complied with all terms and conditions of the policy and so the opposite parties are bound to honour and reimburse the claim made by the complainants.The negation of the same tantamount breach of trust. So the complainants prayed for a directions to the opposite parties to pay Rs 2,50,000/- as the insured amount to the complainants and also prayed to pay cost of the proceedings.
2. The complaint was admitted on file and issued notices to the opposite parties on 13/08/2021. The second opposite party received notice on 07/09/2021 and did not appear before the Commission when the case was hold on 30/09/2021 . So the Commission made him to set ex parte. Even though the first opposite party appeared before the Commission but did not file their version. There was appearance of counsel for the opposite parties from 22/11/2021 onwards. On 25/05/2022 the case was posted for filing affidavit of the complaint in lieu of examination- in- chief. On 29/08/2022 both opposite parties filed version along with IA No 611/2022 to set aside the ex parte order made against the second opposite party. But the Commission did not allow the IA No 611/2022 in the light of provision of the Consumer Protection Act and decisions made by the Hon’ble Apex Court . As per section 38 (3) (a) of the Act the opposite parties were liable to file their version within 30 days from the date of receipt of copy of complaint. This Commission also empowered to grant 15 more additional days for filing of version by the opposite parties. But the opposite parties did not take any step to contest the matter as seriously as alleged in the complaint. So the Commission not accepted the version filed by the opposite parties as the opposite parties already got sufficient time to file their version is this case.
.3. The complainant filed affidavit and produced documents. The documents produced by the Complainant marked as Ext A1 to A6. Ext A1 document is the copy of the policy certificate dated 23/07/2020 issued by the opposite parties to the complainant. Ext A2 document is the original discharge card issued from Government Medical College Hospital, Manjeri showing the date of discharge as on 12/10/2020. Ext A3 document is the original medical certificate issued by the junior resident doctor of Government Medical College Hospital, Manjeri showing the second complainant was affected by the Covid-19.Ext A4 document is the copy of legal notice dated 04/02/-2021 send to the opposite parties by the complainant. Ext A5 document is the original reply notice dated 03/03/2021 sends by the opposite parties to the complainant. Ext A6 document is the claim form dated 15/10/2020 issued by the first complainant to the opposite parties.
4. Heard the complainants. Perused affidavit and documents produced by the complainants. The Commission need not appreciate the version filed by the opposite parties as it was filed after statutory period.
5. The case put forward by the complainants are that they availed insurance policy coverage for a sum of Rs 2,50,000/- as per Ext A1 document . The second complainant admitted in the Hospital due to Covid-19. He was admitted for treatment on 08/10/2020 and discharged on 12/10/2020. The complainant produced Ext A2 discharge card to show the date of discharge. Ext A3 document is the medical certificate issued by the doctor who treated the second complainant for Covid-19. Ext A3 document shows that he was suffered the disease about 17 days. Ext A2 and A3 document clearly shows that second complainant was undergone treatment for Covid-19. There was no contra evidence against the averments made out in the complaint. The Commission need not look into the entire aspect explained in Ext A5 reply notice. Thus the case of the complainant stands proved. So the Commission allows the complaint as follows:-
- The opposite parties are directed to pay Rs 2,50,000/- to the complainant as the insured amount as per Ext A1 document.
- The opposite parties are directed to pay Rs 50,000/- as compensation for the mental agony and hardship suffered due to the act of the opposite parties.
- The opposite parties are also directed to pay Rs 10,000/- to the complainants as the cost of the proceedings.
The opposite parties shall comply this order within one month from the date of receipt of this order, otherwise the entire amount shall bear 9% of interest per annum from the date of the order till realisation.
Dated this 17th day of November, 2022.
Mohandasan K., President
PreethiSivaraman C., Member
Mohamed Ismayil C.V., Member
APPENDIX
Witness examined on the side of the complainant:
Documents marked on the side of the complainant: Ext.A1to A
Ext.A1: Copy of the policy certificate dated 23/07/2020 issued by the opposite parties
to the complainant.
Ext.A2: Original discharge card issued from Government College, Manjeri showing
the date of discharge as on 12/10/2020.
Ext A3: Original medical certificate issued by the junior resident doctor Government
Medical College Hospital, Manjeri showing the second complainant was
affected by the Covid-19.
Ext A4: Copy of legal notice dated 04/02/-2021 send to the opposite parties by the
complainant.
Ext A5: Original reply notice dated 03/03/2021 send by the opposite parties to the
complainant.
Ext A6: Claim form dated 15/10/2020 issued by the first complainant to the opposite
parties
Witness examined on the side of the opposite party: Nil
Documents marked on the side of the opposite party: Nil
Mohandasan K., President
PreethiSivaraman C., Member
Mohamed Ismayil C.V., Member
VPH
