IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,                                     MURSHIDABAD AT BERHAMPORE.
CASE No.CC/144/2013
 Date of Filing:  13/12/2013                                     Date of Final Order:  31/03/2015    
 Complainant:    Aniruddha Upadhyay
                            18/5, S.N.Bagchi Road, P.O.& P.S.- Berhampore
                               Dist- Murshidabad.
                                               V/s
Opposite Party:     1) Branch Manager
                               National Insurance Co. Ltd.
                               3, Middleton Street, P.O. Box-9229.Kol.-700001.  
            2) Branch Manager,
                               M.D. India Health Care Services (TPA) Pvt. Ltd.
                               169, Sarat Bose Road, ( 3rd floor).Kol.700026.
                               3) Branch Manager
                               National Insurance Co. Ltd.
                               26/23/1, S.S.Sen Road, P.O.& P.S.- Berhampore
                               Dist- Murshidabad.          
    
 Sampa Roy. Ld. Advocate……………………………….for the Complainant
     Gopen Prasad Sinha. Ld. Advocate…………………for the OPs.

 
                                    Present: Hon'ble Member, Samaresh Kumar Mitra.
                                                    Hon'ble Member,Pranati Ali.
FINAL ORDER
Samaresh Kumar Mitra, Presiding Member.
           The simple version of complainant is that he made an Individual Medi-claim i.e. Hospitalization benefit Policy before National Insurance Co. Ltd through M.D. India Pvt. Ltd. being Policy No. 154000/48/12/8500001261. During the policy period he felt ill and was admitted on 01.2.2013 to E-24 Hospital Dolomandop Sahi, Puri, where he treated and discharged on 05.2.2013. Thereafter, he made his treatment at Apollo Gleneagles Heart Centre, Kolkata and Institute of Neuro Sciences, Kolkata. Then he submitted the bill for treatment before Divisional Manager, National Insurance co. Ltd at S.S. Sen Road, P.O.- Berhampore, Dist. Murshidabad. Thereafter, he sent a letter to OP No.3 on 30.5.2015 for getting payment of his bill. After that OP No.2 made a letter on 10.7.2015 for getting payment of his bill. Later on, the OP No.2 made a letter on 10.7.15 to this complainant for supplying relevant documents like ECG, X-Ray, Echo, Pathology report of Kolkata, USG, C.T. Cardiac dated 9.2.2015 and MRI of brain dated 18.2.2015 and EEG. The complainant went to the office of OP No.3 and showed all papers and documents. Then by a letter dated 18.7.2015 the complainant informed M.D. India Health Service (TPA) Pvt. Ltd ( OP No.2) through Divisional Manager, National Insurance Co. Ltd, Berhampore as to why the chest X-ray, EEG, Echo, C.T. Cardiac ,MRI of Brains and others cannot be furnished before the Insurance Co. Ltd. The complainant went to the office of OP No.3, where his relevant document are verified and assured the complainant regarding the settlement of claim as early as possible. But after a long time the complainant getting no money from the OPs, compelled to file this complaint before this Forum for getting medical expenses and compensation for harassment and mental agony from the OPs.  
                  Getting notice from the Forum the OP No.-3 put its appearance on 24.01.2014 empowering Ld. Advocate Mr. Gopen Prasad Sinha by executing Vokalatnama and filed Written Version on 21.7.2014 in which he denied the allegation as leveled against him and averred that complainant did not supply the documents as enquired for verification by the answering OP on repeated requests. He further stated that he has no deficiency for providing service to this complainant as such the complaint petition is not maintainable in its form.
               OP No.2 appeared on 21.07.2014 by its signatory authority Mr. Md. Samiyoddin Patel, who executed an Vokalatnama empowering Ld. Advocate Mr. Gopen Prasad Sinha to conduct the complaint case. The agent of the OP No.3 filed a petition on 18.08.2014 stating that he is not filing separate W/V prayed to accept the W/V filled by the OP No.1.
            The complainant by filing the statement of account in the form of Firisti informed this Forum that the OP No.2 deposited a sum of Rs.35,302/- on 04.03.2015 in the bank account of the complainant.
            But till date the complainant did not file any evidence on affidavit although a few adjournments have taken for filing the same and this Forum imposed no cost in that respect.
            That on 13.03.2015 agent of the parties advanced argument and the arguments heard in full.
             From the discussion herein above, we find the following Issues/Points for consideration.

ISSUES/POINTS   FOR   CONSIDERATION
1.    Whether the Complainant Aniruddha Upadhyay is a 'Consumer' of the opposite party?
2.    Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?
3.    Whether the O.Ps carried on unfair trade practice/rendered any deficiency in service towards the Complainant?
4.    Whether the complainant proved his case against the opposite party, as alleged and whether the opposite party is liable for compensation to him?
5.    Whether the complainant is entitled to relief(s) prayed for?      

DECISION WITH  REASONS
   In the light of discussions here in above we find that the issues/points should be decided based on the above perspectives.
1.    Whether the Complainant Aniruddha Upadhyay is a 'Consumer' of the opposite party?
         From the materials on record it is transparent that the Complainant is a "Consumer" as provided by the spirit of section 2(1)(d)(ii) of the Consumer Protection Act,1986. As the complainant herein being the customer of OP is entitled to get service from the OP.
     (2).Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?
               The complainant & OPs are resident and carrying on business within the district of Murshidabad and cause of action took place at Berhampore, Murshidabad. The complaint valued at Rs.38,677/-+ Rs.4,00,000/- ad valorem which is within Rs.20,00,000/-limit of this Forum. So, this Forum has territorial/pecuniary jurisdiction to entertain and try the case.     
    (3).Whether the opposite party carried on Unfair Trade Practice/rendered any deficiency in service towards the Complainant?    
             The complainant, being Individual Mediclaim i.e. Hospitalization benefit policyholder of National Insurance Co. Ltd. through the MD India Pvt. Ltd. filed his treatment details before the OP for getting the expenses that incurred during the period of treatment, as he was treated during the policy period. But according to the complaint petition it was not possible to deposit all original documents like X- Ray plates with a presumption that if the originals are misplaced then the complainant will not get any alternative documents as a consequence his treatment may affect. But he informed the OP Insurance Company by a letter dated 18.7.2013 stating all the facts as to why the chest X-Ray, EEG,ECG, C.T. Cardiac, M.R.I of Brain did not submit.   
The complainant by a letter dated 18.07.2013 informed MD India Health Care Services Pvt. Ltd. through Div. Manager, National Insurance Co. Ltd., Berhampore regarding the inability to furnish the chest of X-Ray, EEG, ECG, C.T. Cardiac & MRI of Brain and others. But he rushed to the office of OP No.3 and verified all documents. Then the OP No.3 assured to settle the claim of this complainant shortly. The complainant waited for a long time then he took the recourse of this Forum for Redressal. The policy of the individual Mediclaim (Annexure-A) of the OP Company clearly speaks that policy issue date 27.08.2012, policy expiring date 26.08.13 and the name of the insured persons and others. It transpires that complainant being policy holder of OP Company paying premium to get his treatment insured and during the policy period he felt ill and treated before the E-24 Hospital, Dolamandap Sahi, Puri, Apollo Gleneagles Heart Centre and Kolkata & Institute of Neuro Sciences Kolkata (Annexure-C). His treatment & investigation is not questionable to the Ops. But OP in his W/V assailed that the complainant did not submit relevant papers to them. It appears from the letter of complainant dated 18.07.13 of OP No.2, the complainant furnished all the relevant documents to OP No.3 for his kind perusal and examination but the X-Ray Plates, MRI Plates are not feasible as the same will be damaged if it be send to good office of OP, which are essential for his treatment in future. At the relevant point of time the complainant produced everything before the expert of OP No.2 at the intervention of this Forum. Getting those papers the OP No.2 showed good gesture and sanctioned Rs.35,302/- which is transferred in the account of the complainant. The acceptance of such money in the account is admitted by the complainant and he also produced the Xerox copy of said bank account. The complainant further claimed for compensation.
    It is the general principles that the insurance policy is based on uberrimae fidei i.e. utmost on good faith in between the parties. The OPs being the largest Insurance Company running his business on good faith throughout the nation. So, the OP may be kind enough to settle the claim of the complainant as early as possible. But he tried to linger the claim of the complainant with lame excuse for which the complainant compelled to take the recourse of this Forum.
    Delay in sanctioning claim tantamount to deficiency of service for which the complainant is entitled to get compensation and litigation cost from the OPs jointly and or severally.
4. Whether the complainant proved his case against the opposite party, as alleged and whether the opposite party is liable for compensation to him?
               The discussion made herein before, we have no hesitation to come in a conclusion that the Complainant is able to prove his case beyond any reasonable doubt. So, the Opposite Party is liable to compensate the Complainant as we deem fit and proper.
5. Whether the complainant is entitled to relief(s) prayed for?
           As it is already proved in the discussion at point No. 3, the deficiency in service and unfair trade practice adopted by the Opposite Party cannot be ousted and as such the complainant is entitled to get relief(s).
ORDER
               Hence it is ordered that the complaint be and the same is allowed in party against the Opposite party with litigation cost of Rs.3000/-.
             So, we direct the Opposite Party to pay jointly and or severally to this complainant a sum of Rs.9000/- as compensation for mental pain, suffering and harassment within a period of 60 days from the receipt of this order. We also impose litigation cost of Rs.3000/- which be paid by the Opposite Party jointly and or severally within 60 days from the receipt of this order else it will carry interest at the rate of 10% p.a. till its realization. No other relief(s) is awarded to the complainant.
              At the event of failure to comply with the order the Opposite Party shall pay cost @Rs.50/-for each day's delay, if caused, on expiry of the aforesaid 60 days by depositing the accrued amount, if any, in the State Consumer Welfare Fund.
          Let plain copy of this order be made available and be supplied, free of cost, to the parties on contest in person, Ld. Advocate/Agent on record, by hand under proper acknowledgement/ be sent forthwith under registered post with A/D to the concerned parties as per rules, for information and necessary action.
 Dictated and corrected by me.
 

      Member,                                               
   District Consumer Disputes
  Redressal Forum, Murshidabad.

 
      Member,                                                                Member,
   District Consumer Disputes                                                                District Consumer Disputes                       
 Redressal Forum, Murshidabad.                                                      Redressal Forum, Murshidabad.