Concerns Of Common Man To Be Rightly Attended To: Consumer Court While Directing Expeditious Indemnification For Failed Sterilization Surgery

A Consumer Court in Kerala allowed a petition for compensation, filed by a woman who underwent a failed sterilization surgery. It directed the ICICI Lombard General Insurance Company to pay the insurance premium.

While directing indemnification within one month, the Court observed as follows:

"The concern of a common man is to be rightly attended to maintain a proper system in the society."

The Thrissur Consumer Disputes Redressal Commission comprising President CT Sabu and members Dr. K Radhakrishnan Nair and Sreeja S ordered the opposite parties to pay Rs 30,000 as compensation and Rs 2,000 as court costs.

Advocate AD Benny appeared for the petitioner and argued that his client had undergone sterilisation surgery in 2011. Since the procedure failed, being the beneficiary of the Insurance Company, she was entitled to indemnity, and sent a claim to this effect to the District Medical Officer of Health. 

Accordingly, the Medical Officer forwarded this claim to the Insurance Company along with all the required documents. However, no action was allegedly taken by the company.

Aggrieved by this inaction, the complainant filed a representation before the Consumer Court. 

The opposite parties attacked the very maintainability of the complaint on the ground that there was a delay in preferring the claim and that the required documents were not attached with the claim. 

The Insurance company further claimed that there was a deficiency of service on the part of the District Health Officer since the notice of the said claim was issued to them after 90 days from the date of failure of sterilization. 

On these grounds, both the opposite parties prayed that the complaint be dismissed. 

However, the Consumer Court noted that the claim, as well as all the requisite documents, had reached the insurance company on time. 

Upon perusal of all the records submitted and the arguments raised, the Court observed that the complaint was filed by a valid insurance policyholder against the denial of an insurance claim.

"The complainant is a lady who bonfidely approached the Government health Institution to get valued support. The government considered her as a beneficiary to such an insurance policy after fulfilling certain criteria," it noted.

For this reason, it was found that the company was invested with a heavy burden to prove that the denial of the benefit was for a specific reason. However, since the respondent failed to prove the same, the Court was inclined to allow the complaint. 

Accordingly, ICICI Lombard General Insurance Company was directed to pay an amount of Rs.30,000 and an additional Rs. 2000 as costs within one month.  

 Case Title: X v. District Medical Officer & Anr.

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