State Consumer Disputes Redressal Commission
M/S Oriental Insurance Co. Ltd., vs K.S. Saseendran, S/O Sankaran, on 1 October, 2010
Daily Order
First Appeal No. 248/2006
(Arisen out of order dated in Case No. of District )
The Branch Manager,The Oriental Insurance Co Ltd
Vs.
K.S.Saseendran
BEFORE :
HONARABLE MR. JUSTICE SHRI.K.R.UDAYABHANU
, PRESIDENT PRESENT:
None for the Appellant None for the Respondent Dated the 01 October 2010 ORDER Disposed as Allowed KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.APPEAL No. 248/2006
JUDGMENT DATED: 01-10-2010 PRESENT:
JUSTICE SHRI. K.R. UDAYABHANU : PRESIDENT APPELLANT M/s Oriental Insurance Co. Ltd., Rep. by Branch Manager, Branch Office-2, K.P. Namboodiri's Shopping Complex, Shornur Road, Thrissur-1. (Rep. by Adv. Sri. S.S. Kalkura, Sri. R.S. Kalkura & Sri. G.S. Kalkura) Vs RESPONDENT K.S. Saseendran, S/o Sankaran, Kottekkathil House, Athaniparambu, Pazhayannur, Thrissur. JUDGMENT JUSTICE SHRI. K.R. UDAYABHANU: PRESIDENT
Appellants are the opposite parties in OP No. 224/2004 in the file of CDRF, Thrissur. The appellants/Insurance Company is under orders to pay a sum of Rs. 20,000/- with interest at 12% per annum from 22-04-2002 and compensation of Rs. 4,000/- and costs of Rs. 500/-.
2. The case of the complainant is that he had availed a medi-claim/Group Insurance Policy through the Health Club of Aswini Hospital, Thrissur and that during the period of coverage of the policy he had underwent a surgery for removal of stone at Aswini Hospital and was an impatient from 22-04-2002 to 01-05-2002. The claim submitted was repudiated alleging that he had preexisting illnesses.
3. The opposite parties have admitted the policy coverage but contended that the complainant had undergone treatment a number of times earlier and that the same was not disclosed and further he had stomach pain and urinary problems from 21-08-2001.
4. Evidence adduced consisted of Exts. P1 to P3 and R1 to R13.
5. The opposite parties have relied on Ext.R6 investigation report submitted by the Investigator. The same was not proved as the investigator was not examined. It is also seen form the documents produced that the complainant had only illnesses like fever, vomiting etc. on earlier occasions and further there was no inpatient treatment. It is particularly noted in Ext.R7 OP ticket produced by the opposite parties to establish previous illnesses the medicines prescribed are Paracetamol tablets, B Complex, Avil etc. Hence it was held that there were no preexisting illnesses as such that led to any indications of kidney stone which was removed by surgery. In the circumstances, we find that no interference in the finding of the Forum that the opposite parties could not establish that the complainant concealed preexisting illnesses, is called for. All the same, the Counsel for the appellant has pointed out that as per Ext.A12 claim submitted the total amount claimed is only Rs. 11124.95. Further as evident from Ext.R1 policy copy the coverage is confined to Rs. 15,000/-. In the circumstances, we find that the complainant is not entitled for any amount more than the amount claimed. Hence the order of the Forum is modified to the effect that the opposite parties are liable to pay a sum of Rs. 11,125/- with interest, compensation and costs as ordered by the Forum. The order of the Forum is modified accordingly.
In the result, the appeal is allowed in part as above.
The office will forward the LCR to the Forum along with a copy of this order.
JUSTICE K.R. UDAYABHANU: PRESIDENT Sr. [HONARABLE MR. JUSTICE SHRI.K.R.UDAYABHANU] PRESIDENT