Date of filing: 04.06.2020

                                                        Date of Disposal:25.01.2023

 BEFORE THE III ADDITIONAL BANGALORE URBAN

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BENGALURU – 560 027.

DATED THIS THE 25^th DAY OF JANUARY, 2023

CONSUMER COMPLAINT NO.341/2020

PRESENT:

SRI. RAJU K.S:MEMBER

                    SMT.REKHA SAYANNAVAR,:MEMBER

Sri. Rahul D.Jain,
S/o Dinesh Kumar Jain

Aged about 27 Years,

R/at No.58, Survivor Street,

F-2, Basavanagudi

Bengaluru.                              ……          COMPLAINANT

(Represented by Sri.V.Anand, Adv)

V/s

Star Health and Allied

Insurance Company Ltd.,

No.1, New Tank road

Nungambakam

Chennai 600 034.

Represented by its Manager              ……OPPOSITE PARTY

*****

//JUDGEMENT//

BY SMT. REKHA SAYANNAVAR, MEMBER

        The present complaint is filed under Section 12 of Consumer Protection Act 1986  with a prayer to direct the Opposite Party to reimburse the medical bill amount of Rs.2,04,411/-, to the complainant in the interest of justice and equity.

2.     Brief facts of the complaint is that; the counsel for the complainant submits that Opposite Party is the insurance company. The complainant had taken the insurance policy under family health Optima insurance plan bearing number B/141135/01/ 2020/001713 from the opposite party insurance company on 10/07/2019 and paid the premium of Rs.10,680/-and the insured amount is five lakh rupees and the period of the Insurance is  from 10/07/2019 to 09/07/2020.

3.     The counsel for the complainant submits that due to his ill-health he admitted to the St.Philomena hospital on 03/10/2019 and he was there for eight days as an inpatient and discharged and paid the medical bill of Rs.2,04, 411/- Further the complainant submits that he visited the OP insurance company on 0910 2019 and claimed reimbursement of his hospital bill mentioned above but the OP didn't respond properly and rejected his re-reimbursement claim on the ground of non-disclosure of pre-existing decease.

        4.     Further the complainant submits that, he was treated for Pituitary Macro Adenoma, which is benign tumour. In the discharge summary it is mentioned that the complainant was developed headache 2 months back which the neurosurgeon has clearly mentioned in discharge summary. The op rejected his claim on this point only. Hence the reasons taken by the insurance company is false one. The complainant submits that due to the negligent acts of the opposite party he was made to suffer mentally and financially. He left with no other alternatives to approach this Hon’ble Commission for redressal of his grievances under the Consumer Protection Act 1986 for the deficiency of services of the opposite party. Hence, this complaint.

5.     The notice of this complaint was duly served upon the opposite party, remained absent and placed ex-parte.

6.     The points that would arise for consideration are as under:

i) Whether the complainant has proved the deficiency in service on the part of the Opposite Party?

ii) If so, to what relief the complainant is entitled for?

iii) What order ?

      7.  Our findings on the aforesaid points are as follows:

Point No.1 & 2:  In the Negative.

Point No.3 :  As per the final order for the following;

REASONS

8.     POINT NO.1 & 2:-

To avoid the repetition of the facts of the complaint we have discussed both points together. The complainant had filed this present complaint for the deficiency of services of the opposite party.

9.     The point to be noted here is that this commission has observed that the notice of this complaint was duly served upon the opposite party and opposite party remained absent and placed ex-parte. Further on perusal of the order sheet, it appears that the complaint is posted for the evidence affidavit of the complainant on 26/11/2020.

10.   Since 26/11/2020 till this day the complainant remained absent and didn't let his affidavit evidence. It is the burden on the complainant to prove his complaint through his affidavit evidence and documentary evidence as contemplated under Section 13(2)(b)(i) Consumer Protection Act, 1986.  The complainant did not file any affidavit in the form of his evidence.

11.      In addition Section 13(4)(iii) of Consumer Protection Act 1986 which contemplates that the district commission shall have the same powers as are vested in a civil court under the code of civil procedure, while trying a suit in respect of reception of evidence as affidavits. Therefore, the complainant shall tender the sworn affidavit evidence by entering into witness box. That has not been complied by the complainant in this present complaint in hand. The complainant had failed to prove the burden casted on him. Hence, the complainant has failed to prove the deficiency of services as alleged.  Accordingly, we answer Point No.1 and 2 in negative.

12. POINT NO.3:- In the result, for the foregoing reasons, we proceed to pass the following;

ORDER

The complaint is dismissed.  No order as to costs.

  Supply free copy of this order to both the parties and return extra copies of the pleading and evidence to the parties.

Applications pending, if any, stand disposed of in terms of the aforesaid judgement. 

  (Dictated to the Stenographer, typed by him, the transcript corrected, revised and then pronounced in the open Commission on 25th day of JANUARY, 2022)                                            

(REKHA SAYANNAVAR) (RAJU K.S)  (SHIVARAMA, K)    

//ANNEXURE//

Witness examined for the complainant side:

        Sri. Rahul D.Jain, who being the

           complainant has filed his affidavit.

Documents marked for the complainant side:

  1) Copy of the bond of Star Health and Allied Insurance Company Limited

  2) Copy of the Discharge summary of St. Philomenas Hospital. 

3.   Copy of the bill of St. Philominas Hospital

 Witness examined for the opposite party side: 

Documents marked for the Opposite Parties side:

• REKHA SAYANNAVAR)    (RAJU K.S)         (SHIVARAMA, K)    
•