Order No. -12 Dt.-05/05/2014
The record is placed before us for passing final order.
The hearing arises out of an application filed by Banwar Lal Parakh against National Insurance Company Ltd.
Complainant’s case in a nut-shell is that the complainant is a mediclaim policy holder being no. 153900/48/11/8500002746 of the National Insurance Company Ltd., Thana More, Jalpaiguri. The complainant insured himself and his family members in the above mentioned mediclaim policy. The assured sum of the said mediclaim policy is Rs.3,00,000 in total. Complainant’s son Jayant Prakash was admitted with severe back pain in K.N.Chatterjee Memorial Nursing Home on Hill Cart Road Siliguri on 19/10/12 and he was released there from on 22/10/12. On 27/10/12 he was again admitted at Mitra’s Clinic and Nursing Home, Hakimpara, Siliguri and he was released on 29/10/12. It was detected that Jayant Prakash was a patient of Tubercolusis of Spine since 27/09/12 and he was also suffering from disc dissection at D8-D9 level. The complainant went to Apollo Hospital Delhi for better treatment of his son Jayant Prakash who is still under treatment. It is alleged by the complainant that he repeatedly knocked the door of Divisional Manager National Insurance Company Ltd., Jalpaiguri for mediclaim insured amount of his son but all his efforts are in vain and at present the total amount of claim of the complainant is Rs. 9000/- only and he has no other claim against the O.P. The complainant has prayed for settlement of his claim with the O.P. and for compensation for mental harassment. Although notice was served upon O.P.No.2, O.P. No.2 didn’t turn up to contest the case. Only O.P.No.1 has contested the case by filing a written statement wherein the O.P.No.1 has denied and disputed the claims and contentions of the complainant with prayer for dismissal of the case with cost.
POINTS FOR CONSIDERATION.
- Is the case/ application maintainable as claimed?
- Is the son of the complainant, Jayant Prakash, a consumer as per provision of Consumer Protection Act.1986?
- Is/Was there any deficiency of service on the part of the O.Ps. as alleged?
- Is the complainant entitled to get the reliefs as prayed for? If so to what extent?
DECISION WITH REASONS
All four points are taken up together for consideration and decision for the sake of convenience.
Although the O.P. has challenged the maintainability of the case on various technical grounds but the matter was not agitated at the time of final hearing of the case. On perusal of the materials on record we find nothing adverse against the maintainability of the case. Therefore we find and hold the case is well maintainable.
Admittedly the complainant’s son Jayant Prakash is a mediclaim policy holder of the O.P. Insurance Company. Therefore, Jayant Prakash be termed as consumer as per provision of C.P.Act 1986.
Now after due consideration of argument of Ld. Lawyers of both sides and the materials on record we find that the O.P. has already paid the major portion of the insured sum to the complainant and that Rs.9000/- has fallen due and the O.P. has not paid the entire insured amount to the complainant despite his repeated request. Admittedly Jayant Prakash, son of the complainant, a mediclaim policy holder of the O.P. National Insurance Company Ltd. and that was valid. Therefore it was the legal as well as moral obligation on the part of the O.P.( National Insurance Company Ltd.) to pay the insured amount to the insurer Jayant Prakash after complainant’s prayer for settlement of his claim for the medical expenditure of Jayant Prakash borne by his father, the complainant. However the O.P. has already paid a major portion of the sum assured of the Mediclaim Policy of Jayant Prakash so, we believe that the O.P. Insurance company shall pay the rest amount(Rs. 9000/-) to the complainant. As the O.P. has already paid the major portion of the insured sum to the complainant, so we think that there is no necessity to pay any compensation to the complainant.
In this view of the matter we find and hold that the complainant is entitled to get only Rs. 8000/- from the O.P. for O.P.s deficiency of service for not paying the entire Insured amount after complainant’s request to settle his claim and the litigation cost of Rs.1000/- only, and in our considered opinion that would be just an adequate litigation cost.
All four points are disposed off. In the result the case/application succeeds.
Hence, it is
ORDERED
that the case is allowed on contest in part with litigation cost of Rs.1000/- (One Thousand) only against O.P. No.1and ex-parte against O.P.No.2. The complainant do get an award of Rs.8000/-(Eight Thousand)only and the litigation cost of Rs.1000/- (One Thousand) only. The O.P.(National Insurance Company Ltd.) is hereby directed to pay to the complainant the aforesaid awarded amount of Rs.8000/-(Eight Thousand)only and the litigation cost of Rs.1000/- (One Thousand) only within one month from the date hereof failing which the O.P. shall have to pay to the complainant interest @ of 9% p.a. for the aforesaid awarded amount of Rs.8000/- and the litigation cost of Rs.1000/- till realization and the complainant shall be at liberty to realize the same through execution in accordance with law.
Let copy of this final order be supplied to the parties free of cost forthwith in terms of Sec.5(10) of West Bengal Consumer Protection Rules 1987.
