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Reliance General Insurance Co. Ltd. and Others Vs. Satheesh Mathew Zacharias - Court Judgment

LegalCrystal Citation
CourtKerala State Consumer Disputes Redressal Commission SCDRC Thiruvananthapuram
Decided On
Case NumberFirst Appeal No. 741 of 2012 (Arisen out of Order Dated 20/06/2012 in Case No. CC/11/251 of District Kottayam)
Judge
AppellantReliance General Insurance Co. Ltd. and Others
RespondentSatheesh Mathew Zacharias
Excerpt:
.....protection act, 1986 challenging the order of the forum dated, june 20, 2012 directing the opposite parties to pay rs.22,380/- with interest. 2. the case of the complainant as detailed in the complaint before the forum in brief is this:- the complainant had joined in a medi claim policy issued by the opposite parties, reliance general insurance company. the policy amount was rs.1,00,000/- and the premium was rs.6,139/-. the complainant met with a motor accident on january 02, 2011 and was under going treatment in carithas hospital, kottayam till january 07, 2011. the claim put forward by the complainant was repudiated by the opposite parties on the ground that there was delay of 93 days in submitting the claim. therefore complainant filed the complaint for recovery of rs.22,380/-.....
Judgment:

P.Q. Barkathali: President

This is an appeal filed by the opposite parties 1 to 3 in CC.251/11 on the file of CDRF, Kottayam under section 15 of Consumer Protection Act, 1986 challenging the order of the Forum dated, June 20, 2012 directing the opposite parties to pay Rs.22,380/- with interest.

2. The case of the complainant as detailed in the complaint before the Forum in brief is this:-

The complainant had joined in a medi claim policy issued by the opposite parties, Reliance General Insurance Company. The policy amount was Rs.1,00,000/- and the premium was Rs.6,139/-. The complainant met with a motor accident on January 02, 2011 and was under going treatment in Carithas Hospital, Kottayam till January 07, 2011. The claim put forward by the complainant was repudiated by the opposite parties on the ground that there was delay of 93 days in submitting the claim. Therefore complainant filed the complaint for recovery of Rs.22,380/- being the treatment expenses incurred by him.

3. First opposite party is Reliance General Insurance Company, Mumbai and 2nd opposite party is its branch office at Kottayam. Third opposite party Medi Assistant India Private Limited, an agency of the opposite parties 1 and 2. Opposite parties 1 and 2 filed a joint version before the Forum contending thus:-

The claim was submitted before the 3rd opposite party, Administrator with a delay of 93 days. Further the cheque issued by the complainant towards the premium was returned for want of sufficient funds in the account of the complainant. Therefore complainant is not entitled to the claim amount.

4. On the side of the complainant Exts.A1 to A5 were marked. On the side of the opposite parties Exts.B1 to B3 were marked before the Forum. On an appreciation of evidence the Forum found that there was deficiency of service on the part of the opposite parties 1 and 2 and directed them to pay Rs.22,380/- being the treatment expenses incurred by the complainant. Opposite parties 1 to 3 have come up in appeal challenging the said order of the Forum.

5. Heard both the counsels.

6. The following points arise for consideration:-

1. Whether the opposite parties are justified in repudiating the claim of the complainant?

2. Whether the impugned order of the Forum can be sustained?

7. In the repudiation letter Ext.A3, opposite parties repudiated the claim of the complainant on the ground that there was a delay of 93 days. In the version filed by the opposite parties they have further contended that the cheque issued by the complainant Ext.B1 dated:13.11.2010 was returned dishonoured for want of sufficient funds in the account of the complainant and therefore there is no existing policy infavour of the complainant. It is true that there was some delay in submitting the claim of the complainant as the complainant was laid up in the hospital. We are of the view that there is sufficient cause for condoning the said delay.

8. As regards the dishonor of the cheque issued by the complainant towards the premium in Ext.A5 copy of the pass book it is seen that there was sufficient fund in the account of the complainant at that time. The opposite parties have not intimated the dishonor of the cheque to the complainant. If they had intimated the said fact that the complainant could have verified about them and paid the premium. Further they did not raise such a contention in the reply notice. That being so the Forum is perfectly justified in holding that the opposite parties are not justified in repudiating the claim of the complainant and that there is deficiency of service on the part of the opposite parties. The finding of the Forum on this point is confirmed.

9. Forum has ordered refund of payment of Rs.22,380/- being the amount spent by the complainant for treatment with interest. We find no ground to interfere with the said finding of the Forum.

In the result we find no merit in this appeal and the same is hereby dismissed with a cost of Rs.5000/-.


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