Kerala State Commission Upholds Order Against Reliance Insurance Company To Pay Treatment Expenses To Complainant
Aryan Raj
28 Nov 2024 1:50 PM IST
While upholding the decision of the Kasaragod District Consumer Disputes Redressal Commission (District Commission), the Kerala State Consumer Disputes Redressal Commission (State Commission) bench comprising of Mr. Justice B. Sudheendra Kumar (President), Mr. Ajith Kumar (Judicial Member) and Mr. Radhakrishnan K.R. (Member) held Reliance Insurance Company liable and directed it to pay Rs. 1,39,614 to the complainant as treatment expenses.
Previously, District Commission had held Reliance Insurance liable for the deficiency of service for not paying the claim of the complainant who had taken coverage of Rs. 2 lakhs for 3 years.
Background Facts
The complainant had taken an insurance policy called "Reliance Care for You Plan" from the Reliance Life Insurance. The policy insured a sum of Rs. 2,00,000 for a period of three years starting from September 7, 2013. The first installment premium of Rs. 13,491 and subsequent premiums were paid regularly.
Further, Complainant's wife was hospitalized at Father Mullers Hospital, Mangalore, on July 10, 2015 for treatment of a polypoidal growth in the sigmoid. For better treatment she was discharged on July 11, 2015 and admitted to MIMS Hospital, Kozhikode on July 23, 2015. After treatment, she was discharged on July 29, 2015.
The complainants spent Rs. 10,205 at Father Mullers Hospital and Rs. 1,29,459 at MIMS Hospital for the treatment, totaling Rs. 1,39,664. They submitted all required documents to the insurance company for the claim.
As the insurance company failed to pay the claim amount complainant filed complaint before the district commission seeking Rs. 1,39,664 for treatment expenses, Rs. 2,00,000 as compensation.
District Commission through its order dated 17.02.2020, directed Reliance Life Insurance to pay Rs. 1,39,664 as settlement money with 6% interest, Rs. 25000 as compensation and Rs. 5000 for litigation cost. Being aggrieved by the district commission order Reliance Insurance Company Limited filed appeal before the State Commission.
Contentions of Reliance Insurance
Reliance Insurance contended that the complainant did not submit the essential documents required for settling the claim. Additionally, they mentioned that the complainant did not respond to their letters indicating the necessary requirements.
Due to this lack of documentation the claim was closed as 'No claim' since settlement is only possible upon receipt of all required documents as per the policy terms and conditions.
Observation and Direction by State Commission
The State Commission noted that the complainant produced the discharge summary from Father Mullers Hospital, Mangalore and bills from the same hospital. He also produced the discharge summary and discharge bill for Rs. 1,29,459.
State Commission observed that these documents show the complainant's wife was treated for polypoidal growth sigmoid and spent a total amount of Rs. 1,39,614 for treatment expenses. She was treated at Father Mullers Hospital from July 10, 2015 to July 11, 2015 and at MIMS Hospital from July 23, 2015 to July 29, 2015.
State Commission noted that the documents provided by the complainant are sufficient to conclude that she was treated for the illness and spent the claimed amount.
Therefore, State Commission concurred with the finding of the District Commission that there was a deficiency in service on the part of the opposite party. Hence, State commission dismissed the appeal of Reliance Life Insurance.
Case – Reliance Insurance Co Ltd & Anr Versus Shaju V D & Ors.
Citation - First Appeal No. A/268/2020
Date – 22 November
