IN THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, MURSHIDABAD AT BERHAMPORE.

                CASE No.  CC/57/2019.

 Date of Filing:                    Date of Admission:            Date of Disposal:

   10.04.19                                    24.04.19                                    30.03.23

Complainant: 1. Mukti Chakraborty

W/O- Late Gopal Chakraborty,

7/3/7/1, Kantanagar Road,

                        PO- Cossimbazar, PS- Berhampore,

Pin- 742102

  2. Sujoy Chakraborty

S/O- Late Gopal Chakraborty,

 7/3/7/1, Kantanagar Road,

 PO- Cossimbazar, PS- Berhampore,

Pin- 742102

-Vs-

Opposite Party:  1. Divisional Manager,

National Insurance Company Limited,

Berhampore Division

5/5, S.S.Sen Road, PO & PS- Berhampore,

Pin- 742101

    2. Manager, MDINDIA HEALTHCARE SERVICES(TPA) PVT, LTD

169, Sarat Bose Road,

2nd Floor, Kolkata- 700026

Agent/Advocate for the Complainants                       : Rajdip Goswami.

Agent/Advocate for the Opposite Party No.1 : Gopen Prasad Sinha

Agent/Advocate for the Opposite Party No.2 : None.

   Present:    Sri Ajay Kumar Das………………………….......President.     

         Sri. Nityananda Roy……………………………….Member.

FINAL ORDER

Sri.ajay kumar das, presiding member.

This is a complaint under section 12 of the CP Act, 1986.

            One Mukti Chakraborty and Anr.  (here in after referred to as the Complainants) filed the case against Divisional Manager, National Insurance Company limited and Anr.  (here in after referred to as the OPs) praying for compensation alleging deficiency in service.

    The material facts giving rise to file the complaint are that:-

                 The Complainants are the customers of the OP No. 1, National Insurance Co. Ltd. The Complainants took mediclaim policy in their names being policy No. 154000/48/12/8500001269 and for long time the Complainants continued mediclaim Policy with the OP No. 1.

                 The Complainant Mukti Chakraborty due to her serious illness was admitted to Bangur Institute of neurosciences on 08.11.12 and discharged from the said Hospital on 03.12.12. The said matter was intimated to the OPs on 17.12.12. Thereafter the Complainants submitted claim form, all medical documents, KYC documents along with other papers on 17.09.15, but after receiving all the documents the OPs did not settle the said matter nor inform the Complainant regarding their claim.

                 The Complainant requested the OPs several times by letter, email and phone to settled the mediclaim matter but all attempts on the part of the Complainant were turned in vain.

            The OP No. 2 by phone and by letter dated 12.03.16 requested the Complainants to submit their KYC documents and cancelled cheque regarding mediclaim of the Complainant in respect of claim No. MD12498147. The Complainant accordingly went to the Office of the OP No. 2 and submitted KYC documents and cancelled cheque on 21.03.16 and they also by email sent the scan copy of cancelled cheque to the office of the OP No. 1. But in spite of receiving the said documents the OPs kept silent and did not pay the claim amount of Rs. 71,403/- to the Complainants.

                 Thereafter, on several times the Complainants went to the Office of the OPs regarding the settlement of mediclaim. They assured to the Complainant that they would see the matter but till now neither they paid the claim amount nor they rejected the mediclaim submitted by the Complainant.

                 On 22.11.18 the Complainant No. 1 went to the Office of the OP No. 1 and submitted a claim letter regarding the status of the mediclaim under claim No. MD12498147 for Rs. 71,403/-. The OP No. 2 received the said letter but failed to pay the mediclaim amount.

                 Due to negligence and male practice of the OPs the Complainants incurred losses and mentally upset and it is the completely deficiency of service on the part of the OPs.

                 Thereafter, the Complainants submitted complaint regarding the above matters to the office of the Assistant Director Consumer Affairs & Fair Business Practices, Murshidabad Regional Office, Berhampore, Murshidabad but the OPs did not attend before mediation meeting arranged by the said office on 07.01.19 and 18.01.19.

                 Till now the OPs had not settled the mediclaim matter of the Complainant by payment of Rs. 71,403/-. Hence the Complainant filed this complaint before the Ld. Forum for seeking relief as mentioned under.

                 The Complainants prays for directing the OPs to pay Rs. 71,403/- along with interest @ 10% P.a. upto the date of payment from the date of discharge from Bangur Institute of Neurosciences on 03.12.12 and also pass an order directing the OPs to pay compensation of Rs. 50,000/- for harassment, mental agony and Rs. 30,000/- for litigation cost.

                 The OP No. 1 is contesting the case by filing Written Version stating that the case is hopelessly barred by limitation and as such the complaint is liable to be rejected with costs.

                 The point to be noted is that notice was served upon the OP No. 2 but the OP No. 2 had not filed Written Version.  

     On the basis of the complaint and the written version the following points are framed for proper  adjudication of the case :

Points for decision

1. Isthe Complainant a consumer under the provision of the CP Act, 1986?

3. Has the OP any deficiency in service, as alleged?

4. Is the Complainant entitled to get any relief, as prayed for?

Decision with Reasons:

Point no.1

Ld. Adv. for the Complainant submits before this District Commission that the Complainants have mediclaim policy with OP Insurance Company and as such the Complainants are consumer under the OP. Ld. Advocate for the OP No. 1 raises no objection. Moreover, the facts and circumstances of the case as per materials on record suggest that the Complainants are consumer to the OPs. The point No. 1 is thus decided in favour of the Complainant.

Point No.2,3 & 4

            All the points are taken up together for the sake of convenience and brevity of discussion.

                 It is the case of the Complainant that the Complainant Mukti Chakraborty due to her serious illness was admitted to Bangur Institute of neurosciences on 08.11.12 and discharged from the said Hospital on 03.12.12. The said matter was intimated to the OPs on 17.12.12. Thereafter the Complainants submitted claim form, all medical documents, KYC documents along with other papers on 17.09.15, but after receiving all the documents the OPs did not settle the said matter nor inform the Complainant regarding their claim.

                 The OP No. 2 by phone and by letter dated 12.03.16 requested the Complainants to submit their KYC documents and cancelled cheque regarding mediclaim of the Complainant in respect of claim No. MD12498147. The Complainant accordingly went to the Office of the OP No. 2 and submitted KYC documents and cancelled cheque on 21.03.16 and they also by email sent the scan copy of cancelled cheque to the office of the OP No. 1. But in spite of receiving the said documents the OPs kept silent and did not pay the claim amount of Rs. 71,403/- to the Complainants.

                 Thereafter, on several times the Complainants went to the Office of the OPs regarding the settlement of mediclaim. They assured to the Complainant that they would see the matter but till now neither they paid the claim amount nor they rejected the mediclaim submitted by the Complainant.

                 This fact is supported by the evidence of the Complainant. This fact is also supported by the relevant documents such as mediclaim policy, medical treatment paper, copy of claim form and the cost of treatment amounting to Rs. 71,403/-.

                 On this point, Ld. Advocate for the OP submits that they are not denying the claim of the Complainant. They have only objection is that the claim of the Complainant is barred by limitation.

                 Ld. Advocate for the OP drew my attention to section 69 (1) of the consumer Protection Act, 2019 where in it is stated, ‘’The District Commission, the State Commission or the National Commission shall not admit a complaint unless it is filed within two years from the date on which the cause of action has arisen.’’

                 In the instant case we find that the Complainant Mukti Chakraborty was admitted to Bangur Hospital of Neuroscience on 08.11.12 and discharged from the said hospital on 03.12.12. The Complainant Sujoy Chakraborty informed the matter to the OP National Insurance Co. Ltd. vide letter dated 17.12.12. The Complainant also submitted claim form before MDIndia Healthcare Pvt. Ltd. on 17.09.15.

                 Here we find that the Complainant informed the matter to the Insurance Company vide letter dated 17.12.12 and submitted the claim form on 17.09.15 and thereafter the Complainant, Mukti Chakraborty submitted cancelled cheque on 21.03.16 as asked for by the OP Insurance Company.

                 It would not be out of place to mention here that the OP vide E-mail dated 02.05.16 informed the Complainant, ‘’ This is to acknowledge you that we are in receipt of the E-mail along with the attachment we are coordinating with our due concern. We shall update you upon the same at the earliest.’’

                 But till today the claim of the Complainant has not been settled. It is still pending by the OPs. Here we find that the delay in settling the claim of the Complainant is the case of action. The facts and circumstances suggest that it is a continuing cause of action. So the case is not barred by limitation as per provisions of section 69 (1) of the Consumer Protection Act, 2019.

                 In view of the matters discussed above we are of the view that the Complainant is entitled to get the relief as claimed for.

Reasons for delay

The Case was filed on 10.04.19 and admitted on 24.04.19. This Commission tried its level best to dispose of the case as expeditiously as possible in terms of the provision under section 13(3A) of the CP Act,1986. Delay in disposal of the case has also been explained in the day to day orders.

In the result, the Consumer case is allowed.

     Fees paid are correct. Hence, it is

Ordered

that the complaint Case No. CC/57/2019 be and the same is allowed on contest against the OP No.1 and ex-parte against OP No.2.

Both the OPs are jointly and severally liable to pay the mediclaim amount of the Complainants. The Complainants are entitled to get the mediclaim amount of Rs. 71,403/-. The Complainants are also entitled to get Rs. 26,597/- as compensation for mental pain and agony and Rs. 2,000/- as litigation cost.

Both the OPs are directed to pay the total amount of Rs. 1,00,000/- ( One Lakh only) to the Complainant by 29.05.23 i.d. the said amount of Rs. 1,00,000/- will carry interest @ 10% p.a. on and from 30.05.23.

        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.