IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Friday, the 30th day of September, 2016
Filed on 08..06..2016
Present
1) Smt. Elizabeth George (President)
2) Sri. Antony Xavier (Member)
3) Smt. Jasmine D (Member)
in
CC/No.188/2016
Between
Complainant:- Opposite party:-
Sri. Muraleedharan Nair The Manager
Sumangali, Kakketh House Reliance General Insurance Co Ltd
Kuttamperoor .P.O No. 28, 5th Floor, Southern Portio
Chenganurr East Wing Centenary Building
Alappuzha-689 623 M.G.Road, Banglore- 560 001
O R D E R
SRI. ANTONY XAVIER (MEMBER)
The complainant’s case precisely is as follows:-
The complainant was an employee in Unit Jaypee Cement Corporation Limited, and the complainant and his wife have availed Group Mediclaim Insurance from the opposite party. The said policy had been in force since 17th March 2011 to 16th March 2015 seeing that the same being renewed from time to time. While the insurance policy was in force, the complainant’s wife was afflicted with an ailment as to hypertension, and she was constrained to undergo treatment in Sanjeevani Hospital, Chenganur from 15th October 2014 to 16th October 2014. On being discharged from the hospital, the complainant put forth the claim amount of Rs. 10, 318/- before the opposite party. The opposite party repudiated the claim on contending that the treatment undergone was for psychic ailment. The complainant’s wife never under treatment for psychic disorder. She went through medication for physical illness. The complainant sent as many letters to the opposite party calling upon them to disburse the policy amount to them which yielded no results. The complainant and his wife are entitled to the claim amount. The opposite party has been yet disinclined to hand out the policy amount to the complainant. The opposite party committed deficiency of service. The complainant on being aggrieved on this approached this Forum for compensation and other relief.
2. Though notice was served, the opposite party did not make it a point to turn up before this Forum to challenge the complainant’s case. Resultantly, the opposite party was set ex-parte.
3. The complainant filed proof affidavit, and the documents Exts A1 to A8 were marked. As has been already observed the opposite party neither appeared nor did adduce any evidence.
4. Holding in view, the contentions of the complainant, the questions that come up for consideration are:-
(a) Whether the opposite party’s service is deficient?
(b) If the complainant is entitled to any relief?
5. We meticulously went through the complaint, proof affidavit, and other materials placed on record before us. Exts A1 to A8 evidently resoundingly reveal that the complainant’s contentions regarding his spouse’s sickness are probable and convincing. At the same time, it is worthwhile to notice that the opposite party on one pretext or other was keeping away from handing out the claim amount to the complainant. The complainant had to run from pillar to post in vain to get the policy amount delivered to them. As we have observed, the opposite party neither turned up before the Forum nor let in any evidence to challenge the complainant’s case. In the context of the complainant’s plausible and trustworthy case and in the premise of the opposite party not denying or disputing the same, we are of the strong view that the complainant is entitled to relief. It goes without saying that the service of the opposite party is deficient. We hold that the opposite parties are liable to disburse the claim amount to the complainant.
6. In the wake of what have been discussed hereinabove, the opposite party is directed to give the complainant an amount of Rs.10, 318/-(Rupees Ten Thousand Three Hundred and Eighteen only) with 12% interest per annum till the delivery of the same. The opposite party is further directed to pay an amount of Rs. 1,000/-(Thousand Rupees only) as compensation and Rs.500/- (Five Hundred Rupees only) as cost of the complainant. The opposite party shall comply with the order within thirty days of receipt of this order.
The complaint is disposed of accordingly.
Pronounced in Open Forum on this the 30th day of September, 2016.
Sd/-Sri. Antony Xavier (Member)
Sd/-Smt. Elizabeth George (President)
Sd/-Smt. Jasmine D (Member)
APPENDIX
Evidence of the Complainant:
Ext. A1 - ID Card No.12542877JAL issued by Reliance General Insurance in favour
Of Sushama. M. Nair
Ext. A2 - Policy No.1301352812000270 Group Mediclaim Insurance Shedule
Showing the name of Sushama M. Nair at Serial No. 4853(SHAH414)
Ext.A3 - Copy of Claim form together with expenses treatment
Ext.A4 - Copy of E-mail dated 23/03/2015
Ext.A5 - Copy of letter Dtd. 24/03/2015 addressed to Paramount Health Services
TPA Private Ltd.
Ext.A6 - Copy of letter Dtd. 16/05/2015 addressed Grievance Cell Reliance
General Insurance Company Ltd.
Ext.A7 - Copy of letter Dtd. 06/09/2015 addressed Grievance Cell Reliance
General Insurance Company Ltd.
Ext.A8 Discharge Summary Dtd. 16/10/2014 from Sanjeevani Multi Speciality
Hospital.
Evidence of the opposite party:- Nil.
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite party/SF
Typed by:-Br/-
Compared by:
