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State Consumer Disputes Redressal Commission

Suresh Raikar vs National Insurance Company Ltd. on 25 November, 2015

                                   1




       BEFORE THE GOA STATE CONSUMER DISPUTES
               REDRESSAL COMMISSION,
                    PANAJI - GOA


                           FA No. 83/2015
Suresh K. Raikar
Kamakshi Vihar, 145 G/1,
Fatima Colony
Alto Dabolim Goa.                                     .........Appellant

            V/s.

1) National Insurance Company
   Ltd.; (A Govt. of India Undertaking);
   Divisionla Office:
   24, 2 & 3; Central Market,
   1st Floor, West Punjabi Bagh,
   New Delhi - 110026.

2)   The Zuari Holdings Ltd.,
     Jai Kisaan Bhawan
     Zuarinagar Goa-403 726.                      ........Respondents



                   Coram: Shri. Justice N.A. Britto, President
                          Smt. Vidhya R. Gurav, Member

                                                   Dated: 25/11/2015
                                ORDER

[Per Justice Shri. N. A. Britto, President] We have heard Adv. Shri. Raikar, the complainant in person at the stage of admission of this appeal. OP No. 1 though duly served with notice has chosen to remain absent.

2. The complainant as an ex-employee of OP No. 2 was covered by the group insurance policy obtained by OP No. 2 from OP No. 1. By virtue of the said policy, the complainant was entitled for reimbursement of hospitalization expenses for illness/diseases or injuries sustained. The policy also had certain exclusion clauses.

3. The complainant was admitted in an Ayurvedic hospital namely Kamakshi Arogya Dhama, Shiroda, for Ayurvedic Panchakarma treatment for tiredness and general debility for two days from 2/8/12 to 4/8/12. The complainant raised a claim of Rs. 5,446/- for the said treatment against the OPs and sent a notice dated 26/9/13, not only claiming the said amount of Rs. 5,446/- but also claiming costs of Rs. 5000/- of a complaint which was yet to be filed and compensation of Rs. 10,000/- and costs of the notice of Rs. 1,500/-.

4. The complainant's claim came to be repudiated by OP No. 1 by letter dated 16/10/12.

5. The consumer complaint filed by the complainant to recover a sum of Rs. 1 lac came to be rejected by order dated 29/7/15 by the Lr. South Goa District Forum, observing, inter alia, that there was no evidence on record produced by the complainant to show that the tiredness was the result or a pre-symptom of an existing disease. The Lr. District Forum also observed that the tiredness of the complainant was not a symptom of any illness or disease nor was it directly or indirectly caused or associated with any illness of the complainant.

6. The Complainant would submit that the said tiredness and general debility if not treated in time by panchakarma would have resulted in a disease in the complainant and therefore the complainant was entitled to the expenditure incurred by him.

7. We are not impressed with the said submission. Panchakarma in Ayurveda means five procedures. These five cleansing procedures remove accumulated waste materials in the body. It is meant for both healthy and the sick. It is not the sick persons only who get tired or suffer from general debility. Healthy persons also get tiredness due to various reasons. The complainant was not suffering from any 3 disease but must have undergone Panchakarma with a view to remove the accumulated waste material in his body. Moreover, treatment for conditions such as convalescence, general debility 'Run Down' condition, etc. are excluded from the policy by virtue of exclusion clause No. 4.8. Further, treatment by Naturopathy, unproven procedure/treatment, experimental or alternative medicine/treatment including acupuncture, acupressure, magneto- therapy etc. are also excluded by virtue of clause 4.13 of the policy. Ayurveda till now has been considered as alternative system of medicine. The complainant, therefore, was not entitled to the expenditure incurred by him for Ayurvedic Panchakarma, and, in this view of the matter also, the dismissal of the complaint cannot be faulted. Complainant is an advocate. He should have read the policy carefully before filing the complaint. FA No. 83/15, therefore, is hereby dismissed at the stage of admission with costs of Rs. 500/- to be paid by the complainant in the account of Consumer Welfare Fund within a period of two weeks. The costs are imposed because we find that the complainant is getting into the habit of filing frivolous complaints. In case the costs are not paid, the same shall be recovered in accordance with law.

   [Smt. Vidhya R. Gurav]                [Justice Shri N. A. Britto]
          Member                                  President
sp/-