State Consumer Disputes Redressal Commission
Muridhar Tatyasaheb Dahifale vs The Branch Manager, Star Health & Allied ... on 27 September, 2022
1 A/256/2019
Date of filing : 30.01.2019
Date of order : 27.09.2022
MAHARASHTRA STATE CONSUMER DISPUTE
REDRESSAL COMMISSION,MUMBAI, BENCH AT
AURANGABAD.
FIRST APPEAL NO. : 256 OF 2019
IN COMPLAINT CASE NO.: 101 OF 2016
DISTRICT CONSUMER FORUM : AHMADNAGAR.
Murlidhar Tatyaba Dahifale,
R/o Jadamba Krupa Nathnagar Pathardi,
Tq. Pathardi, Dist. Ahmadnagar. APPELLANT
VERSUS
The Branch Manager,
Star Health & Allied Insurance Company Ltd,.
Vilco Centre 1st floor Subash road 8,
Near Garware House, Vile Parle(E),
Mumbai 400057 RESPONDENT
CORAM :Smt.S.T.Barne, Hon'ble Presiding Judicial Member.
Mr.K.M.Lawande, Hon'ble Member.
Present : Adv.S.R.Andhale for appellant,
Adv.S.A.Pradhan for respondent.
JUDGMENT
(Delivered on 27/09/2022) Per Smt.S.T.Barne, Hon'ble Presiding Judicial Member.
1. The appellant Murlidhar Tatyaba Dahifale has preferred this appeal against the judgment and order of District Consumer Forum, Ahmadnagar in C.C.No.101/2016 decided on 26.11.2018. The appellant is the complainant and respondent is the opponent in the 2 A/256/2019 original complaint. They are hereinafter referred as per their status in the complaint.
2. The complainant Murlidhar had filed complaint against respondent Star Health & Allied Insurance Company Ltd,. claiming the amount of medical expenses of Rs. 1,58,545/- and monthly medical expenses @ Rs.5,000/- incurred by him. Thus, total claim of Rs. 1,93,545/- along with amount of mental agony and cost of proceeding. It is the case of complainant that, he is a senior citizen and he has obtained medical policy from the opponent for himself and his family members and it was renewed from time to time. On 08.05.2015 the complainant was admitted in Dinanath Mangeshkar hospital and research centre, Pune. He was operated for his problem out of hernia. At that time it was detected that he was also suffering from kidney problem and he was operated for the same. It was informed to opponent and therefore, opponent has asked him to admit in the hospital. He was operated on 08.05.2015 as well as on 14.07.2015 and incurred expenses of Rs. 1,58,545/- for said treatment. After his discharge he was required to spend Rs.5,000/- per month. He has submitted his claim to opponent. However, the opponent has repudiated his claim. Thereafter, in spite of issuance of notice to opponent his said claim was not complied. Hence, he constrained to file the consumer complaint.
3. The complaint is proceeded without written statement against the opponent and District Consumer Forum has awarded amount of Rs. 23,274/- payable by opponent within 30 days from the order and on failure to deposit amount within 30 days, he was entitled for 9 % 3 A/256/2019 interest from the date of filing of complaint. The District Consumer Forum has also awarded Rs.5,000/- towards mental agony and Rs.5,000/- towards cost of proceeding to the complaint. Being aggrieved by said order the complainant has preferred this appeal for setting aside the order and to allow him total claim as claimed in the complaint. After issuance of notice to opponent, the opponent has submitted that, said complaint was proceeded without w.s. against opponent. However, opponent has submitted written notes of argument before District Consumer Forum on 18.08.2018. He further admitted that, as per the order of District Consumer Forum the opponent was ready to comply the order to the extent of claim allowed and accordingly as per the order of District Consumer Forum the D.D. was forwarded to the complainant.
4. However, the complainant has refused to accept the same. Hence, the opponent on his appearance before this Commission submitted the copy of his written notes of argument and the documents produced by the complainant himself along with the complaint and he submitted that, the District Consumer Forum has allowed the complaint to the extent of medical expenses on the basis of documents.
5. The opponent has produced copy of document along with written notes of arguments at Sr.No.1to25, which were before District Consumer Forum and those documents are also produced by complainant in appeal. However, the documents at page no.38, 39, 66, 67, 76to79 were not before District Consumer Forum. hence, he has prayed for dismissal of complaint.
4 A/256/2019
6. Both the parties have submitted their written notes of argument. The appellant during pending the appeal has produced the application for permission to adduce evidence by way of tendering the additional documents and he has submitted that, as per the contention of opponent the documents produced by this complainant in appeal at Sr.No.38, 39, 66, 67, 76to79 were not before the District Consumer Forum at the time of final hearing which resulted in the impugned order and the appellant was required to prefer this appeal and to produce those documents before this Commission. It is the contention of complainant that, after exercising due diligence the appellant could produce the documents. Due to his old age and bad health the appellant was in mental depression and as consequences he could not take utmost care to produce documents at the time of hearing before District Consumer Forum. He was not having knowledge absolutely as to how to produce documents. After getting advice from the Advocate he could procure the documents. Hence, with this application he has requested to allow him to adduce additional evidence and to produce documents which were produced at page no. 38, 39, 66to68, 71to79.
7. Heard ld. Adv. for appellant and subsequently the Adv. for respondent. The ld. Adv. for appellant has submitted that, since beginning the complainant is claiming that he was admitted in the Mangeshkar Hospital and operated twice. However, the complainant could not produce all the documents due to his bad health, old age and depression out of medical treatment. Hence, he has produced all such available documents during appeal with utmost efforts.
5 A/256/2019 Therefore, he be permitted to adduce additional evidence. The District Consumer Forum has awarded only amount of Rs.23,274/- against the medical expenses. However, the appellant has incurred huge expenses. The contention to that effect is already on record in the complaint that the complainant has incurred expenses of Rs. 1,58,545/-. If he is not allowed to adduce evidence the complainant would sustain irreparable loss and hardship. Hence, he has requested for remand of the complaint. On the other hand ld. Adv. S.A.Pradhan for respondent has submitted that, the opponent has admitted the legal claim awarded to the complainant and was ready to comply the said order. The opponent could not get opportunity before District Consumer Forum to submit their written statement and evidence. However, their defence by way of written notes of argument was before the District Consumer Forum. Hence, beyond the awarded claim the opponent has opposed the prayer of complainant. In the event of remanding the case the opponent be permitted to defend the case and to adduc evidence.
8. Considering the respective submissions of the parties, it reveals that the consumer complaint is in respect of medical expenses based on medical policy. The quantum of claim is already pleaded in the complaint submitted before District Consumer Forum. But the complainant could not produce the documents due to his old age, ill health and as he was under depression. Therefore, he could not get the quantum claimed. Therefore, considering the aforesaid submission, it will be just and proper to give opportunity to the complainant / present appellant to produce additional evidence. At the same it can not be ignored that the opponent was ready to 6 A/256/2019 comply the order of District Consumer Forum to the extent of amount awarded and the opponent in order to comply the order, sent D.D. to complainant, but he has refused it. Therefore, if the complainant is permitted to give additional evidence, it will be just and proper to give opportunity to the opponent to lead evidence in that context. Hence, in the interest of justice it will be just and proper to remand back the matter. Hence, the order.
ORDER
1. The appeal is partly allowed. The judgment and order in C.C.No.101/2016 dated26.11.2018 is hereby set aside.
2. The matter is remanded back to District Consumer Forum to hear fresh by giving opportunity to both the parties to submit their respective pleadings and evidence or additional evidence and to decide the matter afresh in accordance with law.
3. The parties shall cooperate the District Consumer Forum to expedite the matter within 3 months on appearance of both the parties.
4. Parties to appear before District Consumer Forum on 27.10.2022.
5. Inform the order to the parties and concerned District Consumer Forum.
Mr.K.M.Lawande Smt.S.T.Barne, Member Presiding Judicial Member UNK