In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, 4th Floor, Kolkata-700087.
CDF/Unit-I/Case No.99/2011.
1) Parimal Kumar Saha,
Asha Deep, 83-A, Sagar Manna Road, Kolkata-60. ---------- Complainant
---Versus---
1) Medicare TPA Services (I) Pvt. Ltd.
6, Bishop Lefroy Road,
Kolkata-20, P.S. Bhowanipore.
2) The New India Assurance Co. Ltd.,
1-D, Malayala, WoodburnPark, Kolkata-20. ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri, Member.
Order No. 24 Dated 27-09-2013.
We have gone through the pleadings of the parties, evidence and documents in particular and we find that complainant has been owing a mediclaim policy covering self and his family members since long back with M/s The New India Assurance Co. of above address (policy no.511605/34/07/11/00004202). Said mediclaim policy is renewed / revalidated every year with the same company.
Complainant had been suffering from some ailment, in the gum since Oct.2008 and therefore had consulted a doctor at VivekanandaHospital and Research Institute on 24.11.08 (ticket regn. no.231). Attending surgeon had prescribed anti-biotics and other medicines which complainant had duly purchased and consumed.
Ailment had still persisted and complainant was compelled to consult another doctor on 11.12.08 who had again advised for x-ray and prescribed anti-biotics with other allied medicines. Since the ailment still continued and pus was getting discharged from the roots of teeth with swelling gum and infusion in the oral region, the complainant was compelled to consult Dr. Saibal Sen, an eminent Consultant Dental Surgeon on 3.1.09.
Complainant had submitted a claim for Rs.16,497/- to o.p. no.1 through o.p. no.2. O.p. no.1 had sent a claim repudiation letter dt.25.3.09 on some pretext or other completely denying an refuting the long lasting ailment of gums with discharging fluids and pus motivatedly branding the entire process of treatment as ‘Cosmetic Surgery’.
Hence the case was filed by the complainant with the prayer contained in the petition of complaint.
O.p. no.2 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 has got no merit and the same is liable to be dismissed. O.p. no.1 did not contest the case by filing w/v and matter was heard ex parte against o.p. no.1.
Decision with reasons:-
Complainant has claimed Rs. 16,497/- but the document filed by him shows that expenditure was Rs. 14315/- (Annexed with complaint as Serial no. 2). O.ps. plea for repudiation is not at all acceptable as the treatment shows that it is not any type of cosmetic surgery. In view of the above findings and on care full scrutiny of the entire materials on record we find that the repudiation dt.25.3.09 has got no basis at all and this act on the part of o.ps. amounts to deficiency in service being service providers to their consumer and/or complainant and complainant is entitled to relief.
Hence, ordered,
That the case is allowed on contest with cost against o.p. no.2 and ex parte without cost against o.p. no.1. O.p. no.2 is directed to refund the amount of Rs.14,315/- (Rupees fortheen thousand three hundred fifteen) only and is further directed to pay to the complainant compensation of Rs.7,000/- (Rupees seven thousand) only for harassment and mental agony and litigation cost of Rs.2000/- (Rupees two thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 10% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.
