BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION:HYDERABAD (ADDITIONAL BENCH)

FA. No. 427/2021 AGAINST ORDERS IN CC. No. 106/2015 ON THE FILE OF DISTRICT CONSUMER COMMISSION-III, HYDERABAD Between :

The New India Insurance Co. Ltd., Rep. by its Manager, C/o. TTK Health Care, TPA Pvt. Ltd., Office at: 2, HB Complex, 100 Feet Ring Road, BTM First Stage, BTM Layout, Bangalore, Karnataka.

…..Appellant/Opp. Party No.4 AND:

1. Mr. Syed Ahmed Mohiuddin, S/o. Syed Mohiuddin Afzal, Aged about: 40 years, Occ: Advocate.

2. Mr. Syed Mohiuddin Afzal, S/o. Late. Syed Mohd. Abdur Rahman, Aged about: 70 years, Occ: Retd. Service.

R1 & R2 are R/o. 13-6-822/1/11, Mehdi Colony, Plot No.35, Langarhouse, Hyderabad.

(R2 died on 07.04.2021 and memo filed by R1, that he is the sole legal heir of R2).

…..Respondents/Complainants

3. Synergy Aditya Insurance Brokers, Rep. by its Mangar, Corp. Office at Plot No.401, Siri Estates, Ellareddyguda, Ameerpet, Hyderabad-500016.

4. Synergy Aditya Insurance Brokers, Rep. by its Mangar, Corp. Office at Plot No.301, Govinda Mansions, Plot No.18, CMB Compound, Visakhapatnam-3, Andhra Pradesh.

5. TTK Healthcare Pvt. Ltd., Rep. by its Manager at 47-14-30, 04th Floor, Vidisha Towers, Dwarakanagar Main Road, Visakhapatnam – 530016, Andhra Pradesh.

…..Respondents/Opp.Parties No.1 to 3 (Not necessary Parties)

Counsel for the Appellants/Opp. party No.4 : M/s. S.N. Padmini Counsel for the Respondent No. 1& 2/ Complainants : Mr. Shashank Goel QUORUM: Hon’ble Sri V.V.Seshubabu, Member (M-J), &

Hon’ble Smt.R.S.Rajeshree, Member (N-J)

WEDNESDAY, THE THIRTEENTH DAY OF DECEMBER, TWO THOUSAND TWENTY THREE *****

ORDER : (HON’BLE SRI V.V.SESHUBABU, MEMBER JUDICIAL)

1. The appeal is filed on U/s.15 of C.P. Act, 1986, aggrieved by the order of the District Consumer Disputes Redressal Commission-III Hyderabad, dt.21.02.2018, in CC. No. 106/2015, directing the Opposite Party No.1 to 5 to pay Rs.65,000/- with joint and several liability besides compensation of Rs.50,000/- and the costs of Rs.10,000/- payable within 30 days, else the complainants are entitled interest on the amounts @7% p.a., till realization.

2. The brief averments of the complaint are that complainant No.1 is an Advocate and son of complainant No.2 and they have obtained medi-claim policy from the opposite parties and issued with separate health care cards which are valid from 13.10.2011 to 12.10.2012; that on 27.08.2012 the complainant No.2 was admitted in safe health heart centre, Erramanzil Colony, Hyderabad with a complaint of chest pain and discharged on 28.08.2012 after treatment;

that the Complainants have incurred Rs.65,000/- towards cost of the treatment and the claim was submitted with the opposite parties; that on 05.09.2012 complainant NO.1 personally approached the opposite party No.1 with a request to settle the claim; that subsequently also complainant approached the opposite parties, but there was no response; that a legal notice dt.03.04.2013 was issued to the opposite parties demanding to settle the claim for which opposite party No.4 given a reply dt.25.04.2013 stating that the treatment undergone by the complainant NO.2 is excluded from the scope of policy; that it was repudiated after 8 months of the treatment which caused lot of mental agony; hence, the complaint.

3. The opposite parties No.1 to 4 were called absent and set-exparte. 4. Before the forum below complainant filed evidence affidavit as PW1 and got marked Ex.A1 to A16. The complainant filed written arguments and made oral submissions.

5. The forum below settled the following points for discussion, viz., (i) Whether there is deficiency of service on the part of the opposite parties?

(ii) Whether the complainants are entitled for the policy claim of Rs.65,000/-?

(iii) Whether the complainants are entitled for compensation and costs as prayed for?

(iv) To what relief?

6. Having heard the complainant counsel, the forum below passed the order as stated supra. Aggrieved by the same the Opposite part