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 was rejected. The evidence adduced consisted of Ext. A1 to A3 and Ext. B1 to B4.;