PHENOMENAL HEALTH CARE SERVICES LTD. Vs. THRESIAMMA KUNJAVARA
KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Phenomenal Health Care Services Ltd.
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VALSALA SARANGADHARAN, MEMBER -
(1.) THE appellants were the
opposite parties 1st and 2nd and the 1st respondent was the complainant
in C.C. 117/2006. The complaint therein was filed alleging deficiency in
service on the part of the opposite parties in not settling the insurance
claim made by the complainant.
(2.) THE case of the complainant is that she is a member of Phenomenal Health Care Limited and as per the terms and conditions of the
membership, she is entitled to get Rs. 25,000/ - towards medi claim. The
complainant was admitted in Lissy Hospital Ernakulam consequent to a fall
and was subjected to an operation and discharged on 20.10.2005 and
treatment is still continuing. She spent Rs. 24,000/ - towards treatment.
But the opposite parties did not settle the claim on the ground that the
claim was not submitted within one month from the date of discharge.
Hence alleging deficiency in service on the part of the opposite parties
she filed complaint before the Forum and claimed a sum of Rs. 24,000/ -
with 12% interest.
(3.) THE opposite party 1 and 2 filed version and admitted that the complainant is a member of Phenomenal Health Care Limited. They further
contended that the complainant had agreed to obey all the rules and
regulations of 1st and 2nd opposite parties and that of the Oriental
Insurance Company with whom the 1st and 2nd opposite parties had entered
into an agreement. As per the rules the claim should be made within 30
days from the date of discharge from the hospital. But the complainant
filed the claim after 30 days from the date of discharge, hence the claim
The evidence adduced consisted of Ext. A1 to A3 and Ext. B1 to B4.;
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