At, Kerala State Consumer Disputes Redressal Commission Thiruvananthapuram
By, SRI. M.V. VISWANATHAN: JUDICIAL MEMBER & SRI. M.K. ABDULLA SONA: MEMBER
For the Appearing Parties: M/s. P.S.Usuph, Sri.George William, Advocates.
SRI.M.V.VISWANATHAN: JUDICIAL MEMBER
The appellants were the complainants and respondents were the opposite parties in OP:444/02 on the file of CDRF, Ernakulam. The aforesaid complaint was filed for getting the mediclaim with respect to policy issued by the 1st opposite party. The 2nd opposite party was the senior associate of the 1st opposite party. The 1st opposite party entered appearance and filed written version. The 1st opposite party took the contention that the documents called for were not produced by the complainant and so the mediclaim could not settled. Before the Forum below the 1st complainant, George Vattoly has been examined as PW1. He categorically admitted in his cross-examination that the 1st opposite party issued letter requesting for production of documents after performance of the operation. It is further deposed that all the documents were produced after completion of the treatment; but PW1 could not specifically mention the documents which he produced before the 1st opposite party. The 1st opposite party in its written version categorically contended that the following 3 documents are necessary for settlement of the claim and that the claim could not be settled because of the failure of the complainants to produce those documents. The 3 documents mentioned in the written version are:-
1. Doctor?s first prescription with detailed case history and commencement of ailment with registration number of doctor.
2. Nursing home bill and receipt in original, all test reports during hospitalization, details of medicine for Rs.19,213.19 during hospitalization.
3. Original discharge certificate.
2. Admittedly the first document namely the first prescription has not been produced by the complainants. Learned counsel for the appellants categorically admitted the fact that the first prescription could not be produced. He has also got a case that the complainants are not having the first prescription called for by the first opposite party.
3. It is to be noted that the first opposite party has got a case that the ailment for which the claim is made was a pre-existing disease and so the complainants are not entitled to get the amount claimed. It is the case of the 1st opposite party that the first prescription and the detailed case history are necessary to settle the claim and also to decide the issue as to whether the ailment was a pre-existing ailment or not. So, it was the duty of the complainants being the insured to produce the documents called for. The Forum has also directed the complainants to produce the documents called for. It is made clear that the complainants have to produce the documents which are mentioned in the written version filed by the 1st opposite party. We do not find anything wrong with the impugned order passed by the Forum below. No prejudice or inconvenience will be caused to the appellants by producing the documents called
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for. So, there is no ground to interfere with the impugned order dated:15th October 2003 passed by CDRF, Ernakulam in OP:444/02. In the result the appeal is dismissed. The impugned order dated:15..10..2003 passed by the Forum below in OP:444/02 is confirmed. The parties are directed to suffer their respective costs.