LAWS(NCD)-2015-8-92

MAHENDRA KUMAR ORS. Vs. NATIONAL INSURANCE CO. LTD.

Decided On August 28, 2015
Mahendra Kumar Ors. Appellant
V/S
NATIONAL INSURANCE CO. LTD. Respondents

JUDGEMENT

(1.) This revision is directed against the order of the State Commission Mumbai dated 05.07.2013 in first appeal No.A/09/338 arising out of the order of the District Forum Akola dated 31.01.2008 in case No. CC /08/191 whereby the State Commission allowed the appeal preferred by the opposite party insurance company and dismissed the complaint of the petitioner complainants.

(2.) Briefly stated, facts relevant for the disposal of the revision petition are that complainants filed a consumer complaint in District Forum Akola alleging that they purchased a family mediclaim policy from the opposite party on payment of premium of Rs.7681/-. The mediclaim policy was valid for the period w.e.f.29.09.2007 to 28.09.2008 and it extended cover to both the complainants. Complainant no.2 Sou usha developed problem in her eyes on 01.01.2008. She was treated at Bombay City Eye Institute and Research Centre Mumbai for two months. The complainants incurred expense of Rs.1,81,952/- for the said treatment. They also incurred other expenses and the total expenses incurred by the complainants were Rs.2,75,000/-. The complainant submitted the insurance claim alongwith relevant treatment documents. The Opposite Party instead of sending the complete claim of Rs.1,81,952/- sent a cheque of Rs.96,000/- with a forwarding letter and the discharge voucher for full and final settlement required to be signed by the complainants. The complainants accepted the cheque under protest as they were in need of money. Thereafter, they served notice dated 11.07.2008 upon opposite party claiming the balance amount of Rs.85952/- towards remaining insured sum besides legal expenses. The opposite parties failed to pay the balance claim despite of notice. Feeling aggrieved, the complainant raised the consumer dispute.

(3.) The respondent opposite party resisted the complaint. The opposite party contested the complaint mainly on the ground that subject matter of the complaint has already been settled as sum of Rs.96,000/- has been accepted by the complainants in full and final settlement of their claim and the complainants have signed the settlement voucher in this regard. Thus, the opposite party pleaded that there is no deficiency in service on its part.