IN THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI PRESIDENT BEFORE : Hon’ble Thiru Justice R. SUBBIAH F.A.NO.847/2025 (Against order in CC.NO.7/2025 on the file of the DCDRC, Krishnagiri)

DATED THIS THE 27^th DAY OF OCTOBER 2025 The Divisional Manager United India Insurance Company M/s. R. Kannadasan

5^th Floor, IV Block, 6 PLA Rathna Towers Counsel for

12 Anna Salai, Chennai-600 006 Appellant /Opposite party Vs.

1. Mrs. Suguna W/o. Late Anandappa 2. Miss A.Archana D/o. Late Anandappa

3. A. Abishek D/o. Late Anandappa No.2/3-6A, SRO Street, 1^st Cross M/s. V. Balaji Denkanikottai Town & Taluk Counsel for Krishnagiri District- 635 118 Respondents/ Complainants The Respondents as complainants filed a complaint before the District Commission against the opposite party praying for certain direction. The District Commission has partly allowed the complaint. Against the said exparte order, this appeal is preferred by the opposite party praying to set aside the order of the District Commission dt.16.4.2025 in CC.No.7/2025.

This appeal is coming before me for hearing finally today. Upon hearing the arguments of the counsel appearing for bothsides, and upon perusing the documents, lower court records, and the order passed by the District Commission, this commission made the following order in the open court:

ORDER

JUSTICE R. SUBBIAH , PRESIDENT (Open court

1. The opposite party before the District Commission is the appellant herein.

2. The case of the complainant before the District Commission is that Mr.Anandappa, husband of the 1^st complainant and father of the 2^nd & 3^rd complainants was working as B.T.Teacher in the Government Middle School, Pennangur, Krishnagiri District. Being a government employee, the Mr. Anandappa was covered under the NHIS scheme, with the opposite party / insurance company. When he was alive he was paying the premium regularly. Whileso, Mr.Anandappa was admitted in P.M.Santhosa Hospital, Bangalore on 14.10.2020, for the complaint of severe breathlessness, cough, and Bilateral Pneumonia. Inspite of treatment he died due to Cardiac Respiratory Arrest and Bilateral Viral Pneumonia on 29.10.2020. The complainants have spent totally Rs.7,65,000/- towards the treatment. Since the deceased was covered under the NHIS scheme, complainants had submitted the claim form to the opposite party, through proper channel viz. Block Educational Officer, Thally, alongwith medical bills, NHIS Form, Medical Bills (Original), Death certificate of the deceased, and legal heir certificate and other relevant documents on 2.12.2022. The Block Educational Officer, Thally has forwarded the letter with claim form to the opposite party, Chennai on 12.12.2022. Subsequently, the opposite party sent a letter dt.30.8.2023, asking the complainant to send all original documents. Since the complainants have sent all originals through Block Educational Officer, Thally, the complainant has forwarded the copy of relevant documents to the opposite party on 1.9.2023. After receipt of the claim application, the opposite party has to take decision, within a period of 30 days. But till date, inspite of reminders the opposite party had not taken any steps to settle the claim of the complainants. Therefore, alleging deficiency in service on the part of the opposite party, the complainant has filed a complaint before the District Commission, praying for a direction to the opposite party to pay a sum of Rs.5,73,750/- towards the medical expenses, alongwith compensation of Rs.4 lakhs and cost of Rs.30000/-

3. The Appellant/ opposite party, inspite of service of notice, had failed to appear before the District Commission, hence an exparte order was passed in favour of the Respondent/ complainant, by holding that there is deficiency in service on the part of the opposite party and has directed the opposite party to pay a sum of Rs.5,73,750/- towards medical expenses, alongwith compensation of Rs.50000/- and cost of Rs.10000/-. Aggrieved over the order impugned