Ld. Advocate(s)
For Complainant: Makbul Rahaman
For OP/OPs : Avijit Gope
Date of filing of the case :07.07.2021
Date of Disposal of the case : 07.08.2023
Final Order / Judgment dtd. 07.08.2023
Complainant above name filed the present complaint u/s 35 Consumer Protection Act 1986 against the aforesaid OPs praying for direction to pay Rs. 41,194/-, interest @ 10 % per annum over the said amount, compensation amounting to Rs. 20,000/- cost of the case and other reliefs.
He alleged in the petition of complaint the he purchased one medi claim policy form OP no.1 with the premium of Rs. 25,735/- for the period from 28.03.2019 to 27.03.2020. During continuance of aforesaid policy complainant was admitted at Narayana Hrudayalaya Pvt, Ltd. on 21.12.2019 and he was discharged on 23.12.2019. Aforesaid hospital authority claimed bill of Rs. 67,000/- but OP no. 1 approved Rs. 66,400/-. As train ticket was purchased earlier complainant compelled to start return journey in the night of 23.12.2019 and he failed to take benefit of cashless facilities. He paid entire amount before aforesaid Nursing Home.
After returning to his house he submitted entire bill before the OP no. 1 but he allowed Rs. 25,206 and transferred the said amount in his Bank Account through NEET.
Complainant prays for remaining amount of Rs. 41,195/- .
OP no. 1 contests the case by filing a W/V. He denied the entire allegation of the petition of complaint and further stated that OP no. 1 after maintaining the norms and exclusion cause already paid the justified claim amount. He further contended that there is no deficiency in service on the part of the OP no. 1.
TRIAL
During trial complainant filed affidavit-in-chief. OP no. 1 filed questionnaire. Complainant filed answer. OP no.1 filed affidavit-in-chief. Complainant filed questionnaire. OP no. 1 filed answer.
DOCUMENTS
Complainant produced the following documents:
1 .Copy of policy of The New India Assurance Co. Ltd ( original 4 sheet) annexure :1)
2. Copy of discharge summary dtd. 23.12.2019.( annexure : 2)
3.Copy of report of Central Nervous System dtd. 21.12.2019 ( 13 sheet Xerox annexure: 3)
4.copy of report of NH Mazumdar Shaw Medical Centre dtd. 19.12.2019 ( 13 sheet Xerox annexure : 4)
5. Copy of receipt of NH Mazumdar Shaw Medical Centre dtd. 21.12.2019 ( 2 sheet annexure:5)
6. Copy of Claim form part B ( one sheet Xerox annexure :6).
7. Copy of query detain ( two sheet Xerox annexure: 7).
BNA
Complainant filed BNA. OP no.1 filed BNA.
DECISION WITH REASONS
We have carefully gone through the petition of complaint filed by the complainant, W/V filed by OP no. 1, evidence of complainant, evidence filed by the OP no. 1, documents filed by the complainant, BNA filed by the complainant BNA filed by the OP no. 1.
We have carefully gone through the aforesaid documents we find that the complainant corroborated the allegation of petition of complainant. We also find that complainant stated that he purchased one mediclaim policy issued by OP no. 1 and said policy was validated for the period from 28.03.2019 to 27.03.2020.
On perusal of the aforesaid policy we find that OP no. 1 issued the said policy on 15.03.2019 and said policy was validated for the period from 28.03.2019 to 27.03.2020.
Complainant Further stated in the affidavit-in-chief that he got admission before the Narayana Hrudayalaya Pvt, Ltd on 21.12.2019 .
On perusal of the documents issued by the Narayana Hrudayalaya Pvt, Ltd we find that complainant was admitted before the said hospital and he continued treatment there as indoor patience. We find that OP no. 1 approved the cost of treatment as cashless facility amounting to Rs. 66,400/-.
On perusal of the Medi Claim policy filed by the complainant we find that the complainant paid Rs. 50,000/- before the said hospital on 21.12.2019 and he also paid Rs. 17,000/- on 21.12.2019 and he also paid Rs. 500/- on 19.12.2019 complainant also filed consolidated bill amounting to Rs. 55,403/-.
As OP no. 1 approved the amount of Rs. 67,000/- relating to cost of treatment of the complainant during his stay at aforesaid hospital , so OP no. 1 cannot go against the aforesaid approved amount by any means.
Ld. Adv for the OP no. 1 cited a decision reported in 2013 (3)CPJ 559.
On perusal of the said decision we find that the fact of the said case is totally different.
Accordingly, we find that said decision is not applicable in the present case.
He also cited another decision reported in 2009 (3) CPJ 158.
On perusal of the said decision we find that fact of the said case is also different.
Accordingly, we find that said decision is not applicable in the present case.
On perusal of the record we find the complainant is the consumer and OP no. 1 is service provider.
Having regard to the aforesaid discussion it is clear before us that complainant has able to establish his grievance by sufficient evidence beyond reasonable doubts.
Accordingly, we find that complainant is entitled to relief as per prayer.
In view of the aforesaid discussion complainant entitled to Rs. 55,403/-( fifty thousand four hundred three) from the OP no. 1 and 2 which he paid to the said Hospital. We also find from the record that OP no. 1 and 2 already paid Rs. 25,200/- in favour of the complainant. So as per prayer of the complainant he is entitled to Rs. 55,403/- - Rs25,200/- = Rs,30,203/-.
In the result present case succeeds.
Hence,
It is
Ordered
that the present case be and the same is allowed against OP no. 1 and allowed ex-parte against OP no. 2 with cost of Rs. 5,000/- to be paid by OP no. 1 in favour of the complainant.
OP no. 1 and 2 jointly or severally are directed to pay Rs. 30,203/-( thirty thousand two hundred three) in favour of the complainant within 45 days from this date failing which aforesaid amount shall carry interest @ 9 % per annum from this date to till the date of actual payment and complainant shall have liberty to put this order into execution.
Considering the facts and circumstance of this case no order is passed as compensation in favour of the complainant.
Let a copy of this order be supplied to both the parties as free of cost.
Dictated & corrected by me
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PRESIDENT
(Shri DAMAN PROSAD BISWAS,) .................................................
PRESIDENT
(Shri DAMAN PROSAD BISWAS,)
I concur,
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MEMBER
(NIROD BARAN ROY CHOWDHURY)
