State Consumer Disputes Redressal Commission
The Managing Partner, vs Bini Sunil Kumar, D/O K.S.Vinodini on 15 June, 2011
Daily Order
First Appeal No. 577/2006 (Arisen out of Order Dated null in Case No. of District ) 1. The Managing Partner,Hill Valley Corporation, MSC Complex,Thrissur BEFORE: Sri.M.V.VISWANATHAN PRESIDING MEMBER PRESENT: ORDER
KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.
APPEAL No: 577/2006
JUDGMENT DATED: 15-06-2011
PRESENT:
SHRI. M.V. VISWANATHAN : JUDICIAL MEMBER
SRI.M.K.ABDULLA SONA : MEMBER
The Managing Partner,
Hill Valley Corporation,
MSC Complex, Regd.No.4760/96, : APPELLANT
Thirur.P.O, M.G.Kavu, Thrissur.
(By Adv:Sri.N.Satheesh Kumar)
Vs.
1. Bini Sunil Kumar, D/o K.S.Vinodini,
Soorya, Kunnath, Shoranur,
Pin - 679 121.
(By Adv:Sri.R.Jagatheesh Kumar)
: RESPONDENTS
2. The Divisional Manager,
The United India Insurance Co. Ltd.,
Divisional Office, Park House,
Round North, Thrissur.
JUDGMENT
SHRI. M.V. VISWANATHAN : JUDICIAL MEMBER Appellant herein is the 2nd opposite party and the respondents 1 and 2 are the complainant and 1st opposite party respectively in OP.468/02 on the file of CDRF, Thrissur. The complaint therein was filed against the opposite parties 1 and 2 alleging deficiency of service and unfair trade practice on their part in denying the insurance benefit to the complainant. The opposite parties entered appearance and filed separate written versions denying the alleged deficiency of service and unfair trade practice. They contended that the complainant is not entitled to get the benefit under the insurance coverage because of the fact that the complainant had conceived and admitted to the hospital prior to the effective date of the insurance policy. Thus, the opposite parties denied their liability to pay the insurance claim under the policy which was issued by the 1st opposite party/United India Insurance Company Limited under a group insurance policy.
2. Before the Forum below Ext.P1 to P4 and R1 to R6 documents were produced from the side of the parties to the complaint in OP.468/00. On an appreciation of the evidence on record, the Forum below passed the impugned order dated:20th October 2004 directing the 2nd opposite party (appellant) to pay the insurance claim amount of Rs.14,918/- with interest at the rate of 12% per annum and compensation of Rs.5000/- and cost of Rs.800/-. Aggrieved by the said order, the present appeal is preferred by the 2nd opposite party. First opposite party, the United India Insurance Company Limited was exonerated from the liability to pay the insurance claim and compensation sought for.
3. When this appeal was taken up for final hearing, there was no representation for the respondents 1 and 2 (complainant and the 1st opposite party). We heard the learned counsel for the appellant/2nd opposite party. He submitted his arguments based on the grounds in the memorandum of the present appeal and argued for the position that the complainant was bound by the terms and conditions of the group insurance policy and that the complainant is not entitled to the benefits of mediclaim policy because of the fact that the complainant was admitted for delivery, prior to the effective date of the policy. Thus, the appellant prayed for setting aside the impugned order passed by the Forum below.
4. There is no dispute that the 1st respondent/complainant joined the kuri which was run by the appellant/2nd opposite party as the Foreman. It is the definite case of the 1st respondent/complainant that she joined the said kuri because of the insurance coverage offered by the appellant/2nd opposite party, the Foreman of the said kuri. Ext.P4 is the notice cum advertisement published by the appellant/2nd opposite party attracting the subscribers to the kuri including the offer to provide insurance coverage Ext.P4 advertisement would make it abundantly clear that the subscribers were provided the benefit of insurance coverage including medical expenses incurred in connection with the delivery. Issuance of P4 notice is not disputed by the appellant/2nd opposite party. There can be no doubt that the appellant/2nd opposite party, the Foreman of the kuri is bound by terms and conditions specified in P4 advertisement. It is on the basis of P4 advertisement, the complainant joined the kuri which was run by the appellant/2nd opposite party. As per P4 offer, the appellant/Foreman of the said kuri offered the insurance benefit. So, the complainant is justified in claiming the expenses which she incurred in connection with her delivery. Ext.P2 claim form with medical reports and bills would justify the claim preferred by the 1st respondent/complainant. So, the Forum below can be justified in fastening the liability on the appellant/2nd opposite party, the Foreman of the said kuri.
5. The 1st opposite party/insurance company entered into the contract with the 2nd opposite party for providing insurance coverage for the subscribers of the kuri run by the 2nd opposite party. But the complainant, the subscriber to the said kuri was not a party to the insurance contract entered into between the 2nd opposite party, the Foreman of the kuri and the 1st opposite party, the divisional manager of the United India Insurance Company Limited. The terms and conditions of the said contract will bind the 1st and 2nd opposite party. It is also to be noted that the insurance coverage was provided to the subscribers of the kuri under a group insurance policy. As per the terms and conditions of the said policy, the 1st opposite party/insurance company is not bound to pay the insurance claim preferred by the complainant because of the fact that the complainant had conceived before joining the said kuri. But as far as P4 advertisement cum notice there is no such stipulation restricting the insurance claim. Thus, the 1st opposite party has been rightly exonerated from the liability. But the 2nd opposite party (appellant), the Foreman of the said kuri is bound by the terms and conditions incorporated in P4 advertisement. So, the Forum below has rightly directed the appellant/2nd opposite party to pay the insurance claim with interest at the rate of 12% per annum and cost of Rs.800/-.
6. The Forum below also awarded a sum of Rs.5000/- by way of compensation, over and above the interest on the claim amount of Rs.14,918/-. We are of the view that the compensation of Rs.5000/- ordered by the Forum below is unwarranted. The awarding claim amount of Rs.14,918/- with 12% interest from the date of the claim till realization is sufficient to compensate the loss suffered by the complainant. So, this commission is pleased to set aside the award directing payment of compensation of Rs.5000/- to the complainant. In all other respects, the impugned order passed by the Forum below is upheld.
In the result, the appeal is allowed in part. The impugned order dated:20/10/2004 passed by CDRF, Thrissur in OP.468/02 is modified and thereby the impugned order passed by the Forum below directing payment of compensation of Rs.5000/- to the complainant is deleted; but the impugned order directing payment of Rs.14,918/- being the claim amount with interest at the rate of 12% per annum from the date of the claim till realization and cost of Rs.800/- is confirmed. As far as the present appeal is concerned there will be no order as to costs.
M.V. VISWANATHAN : JUDICIAL MEMBER M.K.ABDULLA SONA : MEMBER VL.
[ Sri.M.V.VISWANATHAN] PRESIDING MEMBER