IN THE DISTRICT CONSUMER DISPUTES REDRESSAL
FORUM, MURSHIDABAD AT BERHAMPORE.
CASE No.CC/120/2017
Date of Filing: 25/07/17 Date of Final Order: 05/12/18
Complainant:
Haridas Roy , S/o Ananta roy
Vill & Post Office : Rasulpur(Uttar Bazar),
P.S. Memary,Dist. Burdwan, PIN – 713151.
-Vs-
Opposite Party:
1) Branch Manager,
LICI, Kandi Branch, P.O. & P.S. – Kandi,
PIN – 742137.
2) Divisional Manager,
LICI, Jeevan Prabha,
DD- 5,Sector- 1, Salt lake City,
Kolkata – 700064.
Agent/Advocate for the Complainant : In Person
Agent/Advocate for the Opposite Party Nos 1&2:: Sri Saugata Biswas
Present: Asish Kumar Senapati…………………..........President.
Aloka Bandyopadhyay ………………….. .Member.
FINAL ORDER
ASISH KUMAR SENAPATI, PRESIDING MEMBER.
This is a complaint under section 12 of the CP Act, 1986.
One Haridas Roy (here in after referred to as the Complainant) has filed the case against ) Branch Manager, LICI, Kandi Branch and another (here in after referred to as the OPs) praying for compensation alleging deficiency in service.
The sum and substance of the complaint is as follows:
The Complainant has a Mediclaim Policy with the O.P. No. 1 being policy no. 997248385 w.e.f. 28.01.16. The Complainant was an indoor patient at Manipal hospital for his eye operation, namely “TIMPANOPLASTY” as per advice of the doctors of the said Hospital and paid Rs.52,449/- for his major surgery. The Complainant claimed the amount of Rs. 52,449/- from the LICI but the LICI paid only Rs.5,000/-.The Complainant wrote letters to the Authorities of the LICI for redressal of his grievance but in vain. Hence, the case is filed praying for compensation of Rs. 1,52,449/- against the O.Ps for their deficiency of service.
The OP No 1 contested the case by filing written version on 19.01.18 inter alia denying the material allegations made out in the complaint, contending that the Complainant had taken the Health Plus Policy from the O.P.No. 1 on 28.01.16 as Principal Insurer with his wife Madhabi Roy as other Insurer and the Complainant submitted claim of Rs.52,449/-before the O.P.No.1 on 25.10.16 for his TYM PANOPLASTY at Manipal Hospital. The OP No. 1 paid a sum of Rs.5,000/- to the Complainant as TYM PANOPLASTY is under day care procedure benefit not in major surgical benefit as per condition laid down in the Health Plus Policy (Table No. 904). The O.Ps have no deficiency in service and the Complainant is not entitled to get relief
against the O.Ps.
On the basis of the above versions following points are framed for proper adjudication of the case.
Points for decision
- Is the Complainant a Consumer ?
- Has this Forum jurisdiction to entertain the Complaint ?
- Is there any deficiency in service, as alleged by the Complainant ?
- Is the Complainant entitled to get any relief, as prayed for?
Point Nos.1 &2.
The Complainant has not taken part in hearing of argument.
The Ld. Advocate for the O.P.No.1 submits that the Complainant is not a consumer and this Forum has no jurisdiction to entertain the Complaint.
On perusal of the materials on record we find that the Complainant hired the services of the OPs on payment of consideration . We also find that the cause of action arose within territorial jurisdiction of this Forum and the claimed amount is also within pecuniary limit of District Forum. Hence, both the points are decided in favour of the Complainant.
Point Nos.3 & 4.
The Ld Advocate for the O.P. No. 1 submits that the Complainant had taken Health Plus (Table No.904) policy being No. 997248385 w.e.f. 28.01.16 and he submitted a claim of Rs. 52,449/- on 25.10.16for his TIMPANOPLASTY which is a day care procedure benefit as per table 904 and accordingly a sum of Rs. 5,000/- was paid to the Complainant as per TPA guideline. It is urged that there is no deficiency in service on the part of the O.Ps. He prays for dismissal of the Complaint with cost.
The Complainant has not filed any Policy details but the O.P. No. 1 has filed policy details from which it transpires that Policy No. 997248385 was a Health Plus Policy . It also appears from record that the O.P. No. 1 paid Rs. 5,000/- to the Complainant against his claim of Rs. 52,449/- for cost of TIMPANOPLASTY. It appears from the documents filed by the O.P. No. 1 that TIMPANOPLASTY is a day care Surgery and there is no wrong in settlement of the claim of the Complainant. We find that the O.P. No. 1 has paid Rs. 5000/- to the Complainant in terms of the policy and there is no deficiency in service on the part of the O.Ps. We hold that the Complainant is not entitled to get any relief in this Case.
Reasons for delay
The Case was filed on 25/07/17 and admitted on 07.08.17. The OP No. 1 contested the case by filing W.V. on 19.01.18. This Forum tried its level best to dispose of the case as expeditiously as possible in terms of the provision under section 13(3A) of the C.P. Act,1986. Delay in disposal of the case has also been explained in the day to day orders.
In the result, the complaint case fails.
Fees paid are correct. Hence, it is
Ordered
that the complaint case be and the same is hereby dismissed on contest against the OP Nos.1 without cost and dismissed exparte against the O.P. No.2 without any order as to cost.
Let plain copy of this order be supplied free of cost, to each of the parties / Ld. Advocate/Agent on record, by hand /by post under proper acknowledgment as per rules, for information and necessary action.
The Final Order will also be available in the following Website:
confonet.nic.in
Dictated & corrected by me.
President.
Member President.
