Per Hon’ble Mr.Justice S.B.Mhase, President

Opponent’s advocate is absent.  No one is authorized to represent the opponent.

We heard Mr.M.G.Nadkarni-Advocate for the appellant.  This appeal is directed as against the order passed by District Forum, Central Mumbai in consumer complaint no.1/2010 decided on 17/08/2010.  Complainant has approached the District Forum claiming insurance claim of eye surgery for `22,665.78 ps.  Said claim was not given by the opponent/respondent and, therefore, above referred consumer complaint was filed.  However, said consumer complaint was dismissed by the District Forum on the above referred date.  Therefore, being aggrieved and dissatisfied with the order of District Forum, Central Mumbai in consumer complaint no.1/2010, original complainant has preferred this appeal.

The facts which are eloquently crystal clear are as follows:-

Opponent is a company having Central Government incorporation Registration no.11/105363.  In order to avail the membership of the opponent, complainant appellant has paid an amount of `25,925/- as subscription for getting membership and other benefits.  Accordingly, luxury membership was given to the appellant/ complainant.  Under this luxury membership, appellant/ complainant was entitled to have 61 Room Nights Purchased.  Surrender value of non utilization of the room rent facility is quoted to be `51,850/-.  Thus, as per this membership, appellant/ complainant was entitled for stay in the various hotels, restaurants of the respondent company.  Apart from the hospitality benefits conferred upon the said membership, there was further benefit of insurance.  Under this appellant was entitled to have Personal Accidental /Death Insurance to the extent of `5,00,000/- being the sum insured and the validity of the said accident policy was 18/11/2005.  There was also Mediclaim insurance benefit of `25,000/- and the commencement date of the said Mediclaim benefit was 23/11/2005.  Total period of membership was/is six years and therefore, from 31/10/2005 to 31/10/2011, appellant/complainant being a member was entitled to have above referred facilities.  It is also a fact that in the year 2007 the claim was made in respect of right eye cataract operation of the complainant and the claim was made for `19,656/- and it was accepted by the opponents.  However, thereafter in April 2008 another cataract operation of left eye was carried out and expenses incurred by the complainant for the same were/are `22,665.78 ps.  Therefore, complainant lodged the said claim.  However, it was not paid and, therefore, consumer complaint has been filed.

It appears from the written version and the documents produced before the District Forum that initially opponent had taken group insurance policy known as ‘Standard Group Insurance policy’ covering the liability of `25,000/- and, therefore, when the first claim was made it was satisfied by the Insurance Company.  Earlier policy which was taken by the opponent was for a period of one year and, thereafter, they had taken another Group insurance policy.  Said Insurance policy is known as ‘Janata Mediclaim policy’ and while taking the said Janata Mediclaim policy opponent ought to have insured the complainant for an amount of `25,000/- as per the membership, but instead of that, to save the prem