PER SHRI. S.B.DHUMAL - HON’BLE PRESIDENT :
1) In brief consumer dispute is as under –
In the year 1992, the Complainant had taken ‘Club Solace Policy’ for his entire family from Opposite Party No.2 through Opposite Party No.1. The Complainant has been regularly paying premium of the aforesaid policy to Opposite Party No.2 through Opposite Party No.1 vide his Credit Card No.36559019495004. Alongwith complaint the Complainant has annexed copy of Club Solace Policy, dtd.11/01/2002 at Exh.‘A’.
2) It is the case of the Complainant that on 08/12/01, his wife was admitted to the I.C.U. of Jaslok Hospital for heart ailment and breathing problems. This fact was immediately informed to the Opposite Party No.1 being the agent of Opposite Party No.2. According to the Complainant, Opposite Party No.1 had inquired whether the Complainant had mediclaim policy of any other Insurance Company. The Complainant disclosed that he was also insured with the United India Insurance Co. Ltd., to the tune of Rs.2,50,000/- vide Policy No.120400/48/01/00788. Thereafter, Opposite Party No.1 advised Complainant to call on United India Insurance Co. Ltd. and first file his claim through them. Accordingly, the Complainant wrote letter dtd.21/12/01 to United India Insurance Co. Ltd., and called for the claim form.
3) According to the Complainant, his wife expired on 09/01/02. Then he called upon Opposite Party No.1 to inform about the procedure to be followed to file the claim with Opposite Party No.2. That time total claim of medical expenses was Rs.5 Lacs. As per advice of Opposite Party No.1, Complainant firstly approached United India Insurance Co. Ltd. on 05/03/2002 and submitted all its original papers as demanded. Then submitted claim of balance amount of Rs.2,50,000/- to Opposite Party No.2 through Opposite Party No.1. In the month of May, 2003, United India Insurance Co. Ltd., sanctioned claim of Rs.2,09,362/-. Then Complainant immediately approached Opposite Party No.1 for the balance amount as the total claim of Rs.5 Lacs. The Complainant submitted claim form duly filled alongwith original document to Opposite Party No.2 on 23/05/03 to clear the balance amount.
4) However, Opposite Party No.2 vide their letter dtd.05/09/2003 rejected Complainant’s genuine claim stating that ‘since there was delay in submitting of claim papers, we regret to inform you that we are unable to entertain your claim and are returning the papers herewith.’ The Complainant has produced copy of aforesaid rejection letter dtd.05/09/03 alongwith complaint at Exh.‘C’.
5) It is submitted by the Complainant that there was no delay on his part in submitting the claim to Opposite Party No.2. He acted only as per the advice of Opposite Party No.1 being the agent of Opposite Party No.2. As per advice of Opposite Party No.1, firstly he submitted claim to United India Insurance Co. Ltd. The Complainant on 15/10/03 wrote a letter to Opposite Party No.1 detailing the sequence of events right from 08/12/01 and all the advice given by Opposite Party No.1 to the Complainant in this regard. Copy of said letter is produced alongwith complaint at Exh.‘D’. Opposite Party No.1 send their reply duly on 20/10/03 to the Complainant in which Opposite Party No.1 did not deny a single contention of the Complainant and remained silent thereby accepting and admitting the same. It is the grievance of the Complainant, even though he acted as per advice of Opposite Party No.1 who is agent of Opposite Party No.2 and firstly submitted his claim to United India Insurance Co. Ltd. his claim was wrongly rejected by Opposite Party No.2. Therefore, he had sent legal notice on 16/01/04 to Opposite Party No.1 & 2. Copy of said legal notice dtd.16/01/04 is produced at Exh.‘F’.
6) It is submitted by the Complainant that after receipt of legal notice dtd.16/01/2004 the Opposite Party No.2 realized their mistake in not considering Complainant’s claim as there was no intention of any suppress or concealment of facts or deliberate delay on the part of Opposite Parties. Therefore, Opposite Party No.2 vide their letters dtd.27/01/2004 and 13/02/2004 assured of processing claim and requested the Complainant to give the policy number/certificate number. The Complainant replied through his advocates letter dtd.31/01/04 and 20/02/04 giving the required information. Copies of aforesaid letters are produced alongwith complaint at Exh.‘G’ colly. Opposite Party No.2 alongwith their letter had sent claim form to the Complainant. The Complainant collected all necessary documents and submitted the same alongwith claim form as requested by the Opposite Party vide their letter dtd.25/02/04.
7) Subsequently, the Complainant received letter dtd.06/04/04 from Opposite Party No.2 in which Opposite Party No.2 admitted the receipt of all the documents alongwith claim form through their agent Opposite Party No.1, but stated that they regret to entertain the claim due to inordinate delay. Copy of said letter is produced at Exh.‘I’. According to the Complainant, in view of aforesaid facts rejection of Complainant’s claim by the Opposite Party amounts to deficiency in service and also unfair trade practice.
8) It is submitted that present complaint is within period of limitation of the Opposite Party No.2 as even after agreeing to clear claim as a special case, refused to entertain vide their letter dtd.06/04/04 and thereby failed and neglected to pay an amount to the Complainant. The Complainant has requested to condone the delay if any caused in filing of this complaint and to hold both the Opposite Parties deficient in service. The Complainant has requested to direct Opposite Party to pay to the Complainant sum of Rs.2,90,638/- as claim due alongwith interest @ 18% p.a. from the date of filing of this claim i.e. from 23/05/2003 till realization. He has prayed Rs.25,000/- as cost of this proceeding and Rs.1 Lac as compensation for mental agony from the Opposite Parties.
9) Alongwith complaint the Complaint has produced copies of the documents at Exh. ‘A’ to ‘I’ and affidavit in support of the complaint.
10) Opposite Party No.1 has filed written statement and thereby resisted claim of the Complainant contenting that they are not concerned with the indemnity cover offered by the Insurance Policy. The complaint is devoid of substance. Opposite Party No.1 is unnecessarily joined as a party to this complaint and therefore, complaint against Opposite Party No.1 deserves to be dismissed. It is alleged that Complainant has not filed this complaint with clean hands and has deliberately suppressed material facts from this Forum. According to the Opposite Party No.1, application accepted by Diners Club/Citibank will not constitute deemed acceptance of applicant as eligible for the insurance cover by the Insurance Company. Diners Club/Citibank will not be responsible for any rejection request for Good Health Policy benefits by Insurance Company. Diners Club/Citibank is purely a facility to the members to avail of insurance cover. Citibank holds out no warranty or makes no representation about quality, deliver of the cover or claims processing whatsoever. Insurance Company is solely liable in case of death, disability, injury or hospitalization of the insured person and Diners Club/Citibank will not be responsible in any manner, for compensation or otherwise. If, the Insurance Company accepts a request for Good Health Policy, a cover note will be send by Insurance Company directly to the insured person. The insured person will be bound all the terms and conditions of Insurance Policy.
11) It is submitted that as per terms agreed between the parties, the insured person will get in touch with the Insurance Company, directly in case of claims and showing ignore Diners Club/Citibank in any manners whatsoever. The Insured person will undertake to intimate Insurance Company, fill up Claim Form and support claims with appropriate documents.
12) Opposite Party No.1 has admitted correctness of the contents of complaint para nos.1 & 2 and denied allegations made in the rest of the complaint against the Opposite Party No.1. It is contented that in the instant case Opposite Party No.1 acted as a post for reaching the offer form of Complainant to the Opposite Party No.2, who have their own discretion regarding accepted the offer and provided insurance cover to the Complainant. Thus “Club Solace Policy’ had taken by the Complainant’s for his entire family on 11/01/02. The Opposite Party No.1 as agent of the Complainant, in this regard acted like Post Box, to receive the form sent by the subscriber and handed over the same to the Opposite Party No.2. Opposite Party No1 has denied allegations that he is a agent of Opposite Party No.2. It is contended that on account of group insurance scheme, the benefits of discounts are passed on to the cardholders as a gesture of goodwill and to promote the benefit of use of credit card which is being widely encouraged by the Central Government. However, Opposite Party No.1 is not agent of the certificates provider. It is submitted that the Complainant has no cause of action against Opposite Party No.1 and therefore, Complainant is not entitled for any reliefs against Opposite Party No.1.
13) Opposite Party No.1 has denied allegation that advice was given to the Complainant as alleged in the complaint. It is submitted that complaint against Opposite Party No.1 be dismissed with cost.
14) Opposite Party No.2 has filed separate written statement and thereby resisted claim of the Complainant contending interalia that allegations made in the complaint are false and complaint deserves to be dismissed. It is admitted by the Opposite Party No.2 that Complainant had taken ‘Club Solace Policy’ for his entire family in the year 1992. Opposite Party No.2 has no knowledge whether the Complainant wife is having heart and breathing problems or hospitalization of his wife. Further, Opposite Party No.2 is not aware about the correspondence between the Complainant and United India Insurance Co. Ltd. Further, Opposite Party No.2 has no knowledge as to whether United India Insurance Co. Ltd. has settled Complainant’s claim of Rs.2,09,362/-.
15) It is admitted by the Opposite Party No.2 that they have rejected claim of the Complainant on the ground that there was delay in submitting claim papers by the complainant. According to Opposite Party No.2, card member has to forward the preliminary notice of claim within 7 days form the date of hospitalization. The Complainant has delayed submission of his claim for more than 19 months, which is contrary to the clause 5(i) and 5(ii) of the policy. Due to the inordinate delay, the Complainant’s claim was rightly rejected by the Opposite Party. Opposite Party No.2 has denied allegation that Opposite Party No.1 is agent of Opposite Party No.2. It is denied that Complainant acted as per advice of Opposite Party No.1. It is submitted that even assuming that Opposite Party No.1 had advised Complainant to first approach the United India Insurance Co. Ltd., for his claim and thereafter Opposite Party No.2, the said advice is not binding on Opposite Party No.2. Terms and conditions prescribed under the policy are binding upon the insured and he is not entitled to claim any exemption there from even on any bonafide grounds. In the instant case, inordinate delay of 19 months caused in submitting claim to the Opposite Party No.2 which cannot be condoned.
16) Opposite Party No.2 has admitted receipt of Complainant’s legal notice dtd.16/01/04. By the said notice Complainant had called upon Opposite Party No.1 to claim Rs.2,50,000/- alongwith interest and not to the Opposite Party No.2. It is admitted that letters dtd.27/01/04 and 13/02/04 issued to the Complainant requesting certain details, interalia regarding Policy No., Certificate Number, etc. Hence, the said letters should never be misinterpreted in the contest. It cannot be assumed that Opposite Party No.2 condoned/waived the delay caused in submitting the claim. Opposite Party No.2 has denied allegation that they adopted unfair trade practice. Further they have denied allegation of deficiency in service. According to the Opposite Party No.2 there are not liable to pay Complainant sum of Rs.2,90,638/-, compensation of Rs.1 Lac and Rs.25,000/- as cost of this proceeding and therefore, complaint be dismissed with cost.
17) On 03/02/05 Opposite Party No.2 had filed application for amendment in the written version/written statement. The Complainant has filed reply and thereby opposed Opposite Party No.2’s request for amendment of the written statement. After hearing Ld.Advocates for both the parties by order dtd.27/06/06 application for amendment of written statement filed by Opposite Party No.2 is rejected. The Complainant has filed affidavit in rejoinder. Opposite Party No.2 has filed affidavit of evidence. The Complainant and Opposite Party No.1 & 2 have filed their respective written statements. Opposite Party No.1 has filed pursis that written argument of Opposite Party No.1 be treated as oral argument. Heard Jahangir Gai, Representative of the Complainant, Ld.Advocate Mrs. Minal Kaul for Opposite Party No.1 and Ld.Advocate Mrs. Rathina Maravarman for Opposite Party No.2 and the complaint was closed for order.
18) Following points arises for our consideration and our findings thereon are as under -
Point No.1 : Whether the Complainant has proved deficiency in service on the part of Opposite Party No.1 & 2 ?
Findings : The Complainant has proved deficiency in service on the part of Opposite Party No.2 only.
Point No.2 : Whether the Complainant is entitled for reliefs from Opposite Party as prayed for ?
Findings : As per final order.
Reasons :-
Point No.1 :- Following facts are admitted facts that Opposite Party No.1 has given Credit Card No.36559019495004 to the Complainant. The Complainant had obtained ‘Club Solace Policy’ from Opposite Party No.2 through Opposite Party No.1 for the entire family in the year 1992. It is not in dispute that the Complainant regularly paid premium of the said policy through his aforesaid credit card. The Complainant has produced copy of Club Solace Policy alongwith list of document at Exh.‘A’. According to the Complainant, Club Solace Policy was regularly renewed from time to time. The Complainant’s aforesaid version is not disputed by the Opposite Parties. It is undisputed fact that on 08/12/2001, the Complainant’s wife was admitted to the I.C.U. of Jaslok Hospital for heart ailment and breathing problems. According to the Complainant, he informed Opposite Party No.1 about admission of his wife in Jaslok Hospital. Opposite Party No.1 in their written statement have not specifically denied aforesaid averments made in complaint paragraph No.4b that the Complainant had informed Opposite Party No.1 about admission of his wife in Jaslok Hospital. According to the Complainant, after receipt of information Opposite Party No.1 inquired with the Complainant whether Complainant has mediclaim policy of any other Insurance Company and Complainant disclosed that he has another insurance policy of United India Insurance Co. Ltd., to the tune of Rs.2,50,000/-. As per the Complainant, Opposite Party No.1 advised the Complainant firstly filed his claim to United India Insurance Co. Ltd. The Complainant in a letter dtd.15/10/03 sent to the Opposite Party No.1 has raised same contentions. Opposite Party No.1 has not denied the contents in a reply sent to the Complainant.
According to the Complainant, as per the advice, Complainant firstly submitted his claim to the United India Insurance Co. Ltd., to the tune of Rs.2,50,000/- vide Policy No.120400/48/01/00788. United India Insurance Co. Ltd. in May, 2003, sanctioned Complainant’s claim of Rs.2,09,363/-. This fact is also not disputed by the Opposite Parties.
It is submitted on behalf of Complainant, after death of wife the Complainant again called upon Opposite Party No.1 to inform about the procedure to be followed to file the claim with Opposite Party No.2. According to the Complainant, at that point of time total claim was for Rs.5 Lacs. Complainant had firstly filed claim for Rs.2,50,000/- to United India Insurance Co. Ltd., and in the month of May, 2003, United India Insurance Company sanctioned only Rs.2,09,362/- the Complainant. Then Complainant immediately approached Opposite Party No.1 for balance amount as the total claim was for Rs.5 Lacs. As per the advice of Opposite Party No.1 the Complainant send all original documents alongwith claim form duly filled to Opposite Party No.2. However, Opposite Party No.2 by letter dtd.05/09/03 rejected Complainant’s claim on the ground that there was delay in submitting claim papers. According to the Complainant, thereafter, he immediately on 15/12/03 wrote a letter to Opposite Party No.1. Opposite Party No.1 sent reply letter dtd.20/12/03 in which Opposite Party No.1 did not deny delay any single contention of the Complainant and remained silent. Therefore, Complainant sent legal notice dtd.16/01/04 to Opposite Party No.1 & 2. Copy of legal notice is produced alongwith at Exh.‘F’. According to the Complainant, after receipt of legal notice dtd.16/01/04, Opposite Party No.2 realized their mistake and vide letter dtd.27/01/04 called upon Complainant to sent policy number/certificate number to enable them to proceed further in this regard. By subsequent letter dtd.13/02/04, Opposite Party No.2 called upon Complainant to furnish correct policy number and certificate number for doing the needful. The Complainant through his advocate’s letter dtd.20/02/04 furnished necessary information to the Opposite Party No.2. It appears from the record that Opposite Party No.1 after receipt of Complainant’s legal notice, sent letter to the Complainant. Copy of which is at Exh.‘H’. By referring to the aforesaid letter it is submitted on behalf of Complainant that Opposite Party No.1 also realized their mistake and informed the Complainant that as a very special case they have taken a matter with M/s. United India Insurance Co. Ltd. and requested the Complainant to send original set of documents to Opposite Party No.2 M/s. United India Insurance Co. Ltd. It is submitted that thereafter Opposite Party has wrongly rejected Complainant’s claim vide letter dtd.06/04/04. Mr. Jahangir Gai has referred to handwritten letter dtd.06/04/04 of Opposite Party No.2 and submitted that Opposite Party No.2 has again wrongly rejected Complainant’s claim on the ground that claim form on and related documents were not submitted within 30 days. It is submitted that the Opposite Party No.1 & 2 after receipt of Complainant’s legal notice on their own accord called upon the Complainant to submit policy number and certificate number for consideration of Complainant’s claim. From the contents of letters of the Opposite Party No.2 dtd.27/01/04 & 13/02/04 it is clear that Opposite Party No.2 had waived earlier objection of delay in submitting claim and called upon the Complainant to furnish the documents for consideration of his claim. It is to be noted that subsequent rejection was also on the ground of delay. According to the Complainant, in fact there was no delay in giving information of admission of Complainant’s wife in the Jaslok Hospital to the Opposite Party No.2 as said information was immediately given to Opposite Party No.1 who is a agent of Opposite Party No.2. Further, as per advice of Opposite Party No.2, the Complainant firstly submitted claim to United India Insurance Co. Ltd. and after settlement of claim by the United India Insurance Co. Ltd. the Complainant submitted claim for balance amount to the Opposite Party. However, Opposite Party has wrongly rejected claim of the Complainant which amount to deficiency in service on the part of Opposite Party No.2. In support of his aforesaid submissions Mr. Jahangir Gai has relied upon decision of the Hon’ble Maharashtra State Commission, reported in 2005(2) C.P.R. 24 in which it is held that “Clause regarding intimation of claim within one month is directory, insurance claim intimated late cannot be rejected on its violation alone.”
Mr. Gai has further relied upon decision of the Hon’ble National Consumer Dispute Redressal Commission, New Delhi, in Consumer Complaint No.27/2008 decided on 20/08/08. It appears from the reported judgment that in the said mater only dispute raised was not filing of claims within stipulated time. The Hon’ble National Commission has held that “In our view, the contention raised by Insurance Company cannot be justified because this Commission has repeatedly taken a view that in such cases the Insurance Company ought to have settled the claim of the Complainants without taking such technical pleas.”
Ld.Advocate for Opposite Party No.2 has submitted that as per terms and conditions of the Club Solace Policy, it was necessary on the part of Complainant to give information of admission of his wife within 7 days and ought to have submitted claim form alongwith necessary papers within 30 days. However, in this case the Complainant caused delay of 19 months in submitting claim form and therefore, as per terms and conditions of policy the Opposite Party has rightly rejected his claim. In such circumstances, rejection of claim cannot be treated as deficiency in service on the part of Opposite Party No.2. Terms and conditions group mediclaim policy are produced on record. Ld.Advocate for Opposite Party No.2 has pointed out procedure of submission of claim stated in the policy. As per the terms, information of illness should be sent to the Insurance Company within 7 days from the date of hospitalization. Further, it is pointed out that in case of delay Company shall not be liable for further payment. Ld.Advocate Maravarman has alternatively submitted that from the contents of letters of dtd.27/01/04 & 13/02/04, Opposite Party No.2 for the sake of argument if it is assumed that earlier ground of rejection of claim i.e. delay in submitting was waived by Opposite Party No.2, even then Complainant’s claim was liable to be rejected. According to Ld.Advocate for the Opposite Party No.2, in this case during relevant period of hospitalization of Complainant’s wife, family of the Complainant was not covered under Club Solace Policy. Alongwith complaint the Complainant has not produced relevant Club Solace Policy. It is submitted that the Complainant had taken Club Solace Policy form Opposite Party No.2 in the year 1992, but there was break in the policy. The Complainant’s wife Smt. Rohini M. Patel obtained cover under Good Health Policy for Mediclaim Insurance Policy for sum of Rs.5 Lacs under Certificate No.712500/02473/GS January, 2002 and for Rs.3 Lacs under Certificate No.712500/02482/GH for the same period i.e. form 01/01/02 to 31/02/02. It is submitted that aforesaid policy provided insurance covers w.e.f.01/01/02. However, Complainant’s wife had contacted ailment on 09/12/01 i.e. prior to taking over up policy. As per exclusion clause 4.1 in the said policy the insured was not entitled for reimbursement of mediclaim expenses incurred for pre-existing disease.
It is submitted on behalf of Complainant that in the written statement the Opposite Party No.2 has not taken aforesaid defense and only at the time of argument Opposite Party No.2 has taken aforesaid defence of break in the policy and also about another policies and the exclusion clause of 4.1 in another policies taken by Smt. Rohini M. Patel. Therefore, aforesaid defense raised by Ld.Advocate for the Opposite Party No.2 cannot be taken into consideration. In the complaint, Complainant has specifically averred that from the date of inception of Club Solace Policy he regularly paid premium of the said policy through Opposite Party No.1 by his credit card. This fact is not denied by the Opposite Party. The Complainant has produced copies of number of Club Solace Policy issued by Opposite Party No.2. The policies issued were for period of one year. The Complainant has produced policy for the period 01/02/92 to 31/01/93 till 01/02/98 to 31/01/99 and policies of further period. It is true that policy of relevant period of hospitalization is not produced. According to the Complainant, relevant policy is missing. So Complainant had called upon Opposite Party to produce relevant policy and also called upon Opposite Party No.1 to produce statement of his credit card for the period November, 2002 to April, 2003. However, Opposite Party No.1 has not produced statement of credit card. Opposite Party No.2 has also not produced relevant record of insurance of Club Solace Policy to the Complainant. It appears that subsequent policy was issued to the Complainant. The Complainant’s claim was rejected on the ground of delay. Defence of break in the policy was raised for the first time at the time of argument. It is after thought they defence and considered facts of the case. We do not find any substance in the foresaid defence of breaking policy raised by the Opposite Party No.2.
We have to consider whether repudiation of claim by the Opposite Party No.2 on the ground of delay in submission of claim is justified or not ? As the Opposite Party No.2 has not rejected Complainant’s claim on the ground of taking policy or under exclusion clause 4.1 the defense raised at the time of argument by the Ld.Advocate of Opposite Party No.2 cannot be taken into consideration.
As discussed above, after first rejection of Complainant’s claim vide letter dtd.05/09/03, the Complainant had sent legal notice to Opposite Party No.1 & 2. The Complainant had sent legal notice dtd.16/01/04 to Opposite Party No.1 & 2. Thereafter, Opposite Party No.2 called upon the Complainant to submit policy and another necessary document to consider his claim. It means that the Opposite Party No.2 had waived earlier ground of rejection of claim i.e. delay in submission of claim. Opposite Party No.1 had also in their letter requested Opposite Party No.2 to consider Complainant’s claim as special case. Considering facts of this case subsequent rejection of claim by Opposite Party No.2 on the same ground of delay vide their letter dtd.06/04/2004 is not justified and it amounts to deficiency in service on the part of Opposite Party No.2. Hence, we hold that Complainant has proved deficiency in service on the part of Opposite Party No.2. In the result we answer point no.1 accordingly.
Point No.2 :- The Complainant has claimed recovery of Rs.2,09,638/- from the Opposite Parties as interest @ 18% p.a. on aforesaid amount from 23/05/03 till realization. Opposite Party No.1, in their written argument have submitted that Opposite Party No.1 is joined as formal party to the complaint because, Credit Card Holder of Opposite Party No.1 was entitled to the benefits of policy at a concession in the premium. In fact, insurance policy was issued by Opposite Party No.2. It is further submitted that as per the terms and conditions of the offer letter “The bank will not be liable in any manner whatsoever by virtue of any insurance cover provided, and that the Insurance Company will be solely liable in course of death of a Member and shall not hold the Bank responsible for any matter arising out of or in connection with such insurance cover, recovery or payment compensation, processing or settlement of claims or otherwise however and all such matters shall be addressed to and sorted out directly with the Insurance Company.” In support of aforesaid contention, Opposite Party No.1 has relied upon decision of Hon’ble National Commission, reported in 2004 NCJ 429 (NC), 2002 CTJ 741 (CP) (NCDRC). At the time of argument the Complainant has fairly submitted that he is not claiming any relief against Opposite Party No.1 Bank.
In the complaint it is averred that as total claim is Rs.5 Lacs. Initially he had submitted claim of Rs.2,50,000/- to United India Insurance Co. Ltd. and said United India Insurance Co. Ltd. in May, 2003 sanctioned claim of Rs.2,09,362/-and therefore, he has submitted his claim for balance amount of Rs.2,90,638/- against Opposite Party No.2. The Complainant has produced final bill of Jaslok Hospital dtd.12/01/02, it is for Rs.4,14,412.95 paise. It bears rubber stamp as paid. The Complainant has produced another bill dtd.12/01/02 for Rs.3,48,792.90 paise but there is no rubber stamp as paid. It appears that final bill of Jaslok Hospital was of Rs.4,14,412.95 paise and out of that bill the Complainant has received Rs.2,09,362/- from the United India Insurance Co. Ltd. After deducting amount of Rs.2,00,362/- from final bill of Jaslok Hospital of Rs.4,14,412.95 paise balance amount comes to Rs.2,05,050.95 paise. Therefore, the Complainant is entitled to recover Rs.2,05,050.95 paise from Opposite Party No.2.
The Complainant has claimed interest on aforesaid amount @ 18% p.a. from 23/05/03 till realization of entire amount. The Complainant has claimed interest at excessive rate. The Opposite Party has finally rejected claim of the Complainant vide their letter dtd.06/04/04. Therefore, we think it just to direct Opposite Party No.1 to pay to the Complainant interest @ 9% p.a. on Rs.2,05,050.95 paise from 06/04/04 till realization of entire amount to the Complainant.
The Complainant has claimed Rs.1 Lac toward a compensation for mental agony and torture and Rs.25,000/- as cost of this proceeding. The Complainant has claimed exorbitant amount as compensation for mental agony and also for cost of proceeding. The Complainants claim for balance amount his allowed with interest @ 9% p.a. Therefore, we think it just to direct Opposite Party No.2 to pay to the Complainant Rs.10,000/- as a compensation for mental harassment and torture and Rs.5,000/- towards cost of this proceeding. Therefore, we answer point no.2 accordingly.
For the reasons discussed above, compliant is partly allowed against Opposite Party No.2 and complaint is dismissed against Opposite Party No.1 with no order as to cost. Hence we pass the following order -
O R D E R
i. Complaint No.176/2004 is partly allowed.
ii.Opposite Party No.2 shall pay an amount of Rs.2,05,050.95 paise (Rs. Two Lacs Five Thousand Fifty and
Ninety Five Paise Only) with interest @ 9% p.a. on aforesaid amount from 06/04/2004 till realization of
entire amount to the Complainant.
iii.Opposite Party No.2 shall pay an amount of Rs.10,000/- (Rs. Ten Thousand Only) towards compensation
for mental harassment and torture & Rs.5,000/- (Rs. Five Thousand Only) towards cost of this proceeding
to the Complainant.
iv.Complaint against Opposite Party No.1 is dismissed with not order as to costs.
v.Opposite Party No.2 shall comply with the aforesaid order within one month from the date of receipt of this
order.
vi. Certified copies of this order be furnished to the parties.
