State Consumer Disputes Redressal Commission
National Insurance Co. Ltd., Rep. By ... vs R.Loganathan, S-1, Priyadarshini ... on 21 March, 2012
THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI. BENCH - II Present: Thiru. J.Jayaram, M.A., M.L., Presiding Judicial Member
Tmt. Vasugi Ramanan, M.A., B.L., Member F.A.No. 215/2009 & 488/2010 [Against order in C.C.Nos.360/2007 on the file of the DCDRF, Chennai (South)] WEDNESDAY THE 21st DAY OF MARCH 2012.
F.A.No.215/2009National Insurance Co. Ltd., Rep. by Branch Head, (Divisional Manager), Divisional office, 1, Greams Road, Chennai 600 006. .. Appellant/2nd opposite party Vs.
1. R.Loganathan, S-1, Priyadarshini Apartment, No.92-A, High School Road, Ambattur, Chennai-53. .. 1st Respondent/Complainant
2. T.T.K.Healthcare Services Pvt. Ltd., Rep. by its Manager, Mr.Balamurugan, Anmol Palani, No.88, G.N.Chetty Road, L 2, T.Nagar, Chennai-17. .. 2nd Respondent/1st opp.party The 1st respondent as complainant filed a complaint before the District Forum, Chennai (South), alleging deficiency against the opposite parties and prayed for a direction against them to pay Rs.2,650/- being the difference in the bill, to pay compensation of Rs.1,00,000/- and costs of the complaint. The District Forum allowed the complaint, directing the opposite parties jointly and severally directed to pay Rs.2,650/- being the difference amount to pay Rs.1,00,000/- as compensation for mental agony and Rs.3,000/- as costs. Against the said order, this appeal is preferred by the 2nd opposite party to set aside the order of the District Forum, Chennai (South), dated 2.3.2009 in C.C.No.360/2007.
This appeal coming before us for final hearing on 1.3.2012 and on hearing the arguments of both sides and upon perusing the material records, this Commission made the following Order :
Counsel for the Appellant/2nd opposite party : M/s.N.Vijayaraghavan, Advocate.
Counsel for the 1st Respondent/complainant :
M/s. K.Rajasekar, Advocate.
Counsel for the 2nd Respondent/1st opp.party : Absent.F.A.No.488/2010
R.Loganathan, S-1, Priyadarshini Apartment, No.92-A, High School Road, Ambattur, Chennai-53. .. Appellant/Complainant / Vs/
1.
T.T.K.Healthcare Services Pvt. Ltd., Rep.
by its Manager, Mr.Balamurugan, Anmol Palani, No.88, G.N.Chetty Road, L 2, T.Nagar, Chennai-17. ..
1st Respondent/1st opp.party
2. National Insurance Co. Ltd., Rep. by Branch Head, (Divisional Manager), Divisional office, 1, Greams Road, Chennai 600 006. .. 2nd Respondent/2nd opp.party The Appellant as complainant filed a complaint before the District Forum, Chennai (South), alleging deficiency against the opposite parties and prayed for a direction against them to pay Rs.2,650/- being the difference in the bill, to pay compensation of Rs.1,00,000/- and costs of the complaint. The District Forum allowed the complaint, directing the opposite parties jointly and severally directed to pay Rs.2,650/- being the difference amount to pay Rs.1,00,000/- as compensation for mental agony and Rs.3,000/- as costs. Against the said order, this appeal is preferred by the complainant/appellant praying to set aside the order of the District Forum, Chennai (South) dated 2.3.2009 in C.C.No.360/2007.
This appeal coming before us for final hearing on 1.3.2012 and on hearing the arguments of both sides and upon perusing the material records, this Commission made the following Order :
Counsel for the Appellant/Complainant :
M/s. K.Rajasekar, Advocate.
Counsel for the 1st Respondent/1st opp.party : Steps not taken.
Counsel for the 2nd Respondent/2nd opp.party : M/s. N.Vijayaraghavan, Advocate.
COMMON ORDER TMT.VASUGI RAMANAN, MEMBER :F.A.No.215/2009
2nd opposite party is the appellant.F.A.No.488/2010
Complainant as appellant.
2. The case of the complainant is as follows: - The complainant held insurance policy with the 2nd opposite party for health care expenses. The 1st opposite party is the contact point for the complainant as they were processing the procedures and formalities. The complainant underwent an operation in June 2006 in his left eye. The complainant had to spend Rs.17,650/-. But the opposite party sanctioned only Rs.15,000/- instead of settling the entire amount. The complainant wrote a letter on 15.1.2007 stating that he went through a similar treatment in May 2006. The complainant alleged that in May 2006 the opposite party sanctioned Rs.18,150/- to the complainant as claimed and so the opposite party band to sanction the bill amount. The complainant sent another reminder, asking for Rs.2650/- and also a legal notice was sent on 4.7.2007. Hence he prayed for a direction against them to pay Rs.2,650/-
being the difference in the bill, to pay compensation of Rs.1,00,000/- and costs of the complaint.
4. The case of the 2nd opposite party is as follows :- The opposite party admitted the policy. The opposite party averred that under the terms and conditions of policy only Rs.15,000/- was admissible and the said amount was paid and so there was no deficiency. The 1st opposite party alleged that the complainant claimed under two heads Rs.1450/- towards lab expenses alleged to he Rs.7500/- and Rs.1200/- under other heads. The opposite party alleged that the permitted amount towards lab was Rs.6,050/- only and so the opposite party denied payment of Rs.2,650/-, disallowing Rs.1200/- also as the complainant is not entitled.
5. The opposite party denied deficiency in service and prayed for dismissal of the complainant. The District Forum allowed the complaint on the basis that the complainant had filed all the medical bills paid in Guest Hospital on 11.5.2007. The observation of the District Forum is that the opposite party is liable to pay Rs.2,650/- and a compensation of rupees since the opposite party has not filed any document to establish their case.
6. After perusing the documents available and also hearing both side arguments we make the following observations. The complaint filed the bill Exhibit A7 for Rs.17,650/- out which Rs.2,650/- was also paid the complainant. The counsel for respondent Insurance company had not produced any document to prove that the permitted limit was Rs.15,000/- only.
7. In the result, both the appeals in F.A.No.215/2009 and F.A.No.488/2010 are dismissed, confirming the order of the District Forum in Chennai (South) C.C.No.360/2007, dated 2.3.2009. No order as to costs in these appeals.
VASUGI RAMANAN, J.JAYARAM MEMBER PRESIDING JUDL.MEMBER INDEX : YES / NO sg/B-II/VR//Nat.
Ins.