In  the  Court  of  the

Consumer Disputes Redressal Forum, Unit -I, Kolkata,

8B, Nelie Sengupta Sarani, Kolkata-700087.

CDF/Unit-I/Case No. 99 / 2012

1)                   Dr. J.R. Banik,

AD-163, Sector-I, Salt Lake City, Kolkata-64.                                           ---------- Complainant

---Versus---

1)                   Managing Director,

National Insurance Co. Ltd.

3, Middleton Street, Kolkata-71.

2)       Divisional Manager,

      National Insurance Co. Ltd.

      189/1, Bidhannagar Road, Kolkata-67.                                                ---------- Opposite Parties

Present :           Sri Sankar Nath Das, President.

                        Dr. Subir Kumar Chaudhuri, Member

                        Smt. Sharmi Basu, Member

Order No.   30    Dated  14/11/2012.

The petition of complaint has been filed by the complainant Dr. J.R. Banik against the o.ps. National Insurance Co. Ltd. The case of the complainant in short is that complainant entered into an agreement for mediclaim policy being no.104200/48/08 – 85000878 with o.ps. in the year 2007 and o.ps. gave insurance certificate to complainant with a coverage of medical expenses upto Rs.1 lakh. Thereafter, complainant became seriously ill with brain hemorrhage and complainant was treated in th e R.N. Tagore International Centre (American Church Trauma Centre) and complainant had to pay sum of Rs.87,773/- to the said hospital. On 9.6.08 complainant lodged claim on the strength of mediclaim policy for reimbursement from o.ps. O.ps. unofficially proposed to pay Rs.64,360/- on 8.9.09, but denying to make payment of Rs.23,373/- with an alibi as referred to in the letter of o.ps. dt.8.9.09. It is pertinent to note here that o.ps. intentionally and deliberately deducted Rs.23,373/- without assigning any valid and cogent reason. Hence the case was filed by complainant with the prayer contained in the petition of complaint.

            O.ps. had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them and prayed for dismissal of the case. ld. lawyer of o.ps. in the course of argument submitted that the case is not maintainable since there is no basis to file the instant case by complainant.

Decision with reasons:-

            We have gone through the pleadings of the parties, evidence and documents in particular and we find that there is a gross deficiency on the part of o.ps. being service provider to its consumer / complainant and complainant is entitled to relief.

             Hence, ordered,

            That the cased is allowed on contest against the o.ps. with cost. O.ps. are jointly and/or severally directed to make payment of money of Rs.23,373/- (Rupees twenty three thousand three hundred seventy three) only together with interest @ 9% p.a. from the date of repudiation till realization and are further directed to pay compensation of Rs.50,000/- (Rupees fifty thousand) only for harassment and mental agony and litigation cost of Rs.5000/- (Rupees five thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 9% shall accrue over the entire sum due to the credit of the complainant till full realization.

            Supply certified copy of this order to the parties free of cost.