West Bengal

Kolkata-I(North)

CC/401/2007

Sri Gora Chand Roy - Complainant(s)

Versus

National Insurance Co. Ltd. and 2 others - Opp.Party(s)

17 Jul 2008

ORDER

Consumer Disputes Redressal Commission, Kolkata - I (North)
8B, Nelie Sengupta Sarani, 4th Floor, Kolkata-700087.
Web-site - confonet.nic.in
 
Complaint Case No. CC/401/2007
( Date of Filing : 14 Dec 2007 )
 
1. Sri Gora Chand Roy
Vill. Gopalpur, P.O. Howakhana, P.S. Jangipara, Dist. Hooghly
...........Complainant(s)
Versus
1. National Insurance Co. Ltd. and 2 others
Division III, 1, Shakespeare Sarani, P.S. - Park Street, Kolkata - 71.
2. The Divisional Manager, National Insurance Co. Ltd.
Division-III, 1, Shakespeare Sarani, P.S. - Park Street, Kolkata - 71.
3. The Golden Trust Financial Services
16, R. N. Mukheree Road, Kolkata - 700001.
............Opp.Party(s)
 
BEFORE: 
 
PRESENT:
 
Dated : 17 Jul 2008
Final Order / Judgement

            None appears on behalf of complainant. O.p. no.3 is present. Matter is otherwise ready for hearing. Accordingly, the consumer complaint is taken up for hearing. Heard ld. Counsel for the o.p. no.3.

            Petitioner in this consumer complaint has claimed Rs.14,131.92 from o.p. no.1 towards medical expenses with reference to Group Mediclaim Coverage Policy no.100300/46/01/8500107/03/85/30046 covering period from 1.11.03 to 31.10.04 for an amount Rs.15,000/-. Petitioner met an accident on 13.12.03 and he underwent treatment at United Nursing Home (P) Ltd., 10/B, Acharya K.C. Bhattacharyya Street, Serampore, Hooghly from 13.12.03 to 20.12.03, annex-A2. He incurred an expenditure to the extent of Rs.14131.92 for his treatment.

            Petitioner was a beneficiary certificate holder of the above policy obtained by o.p. no.3. Petitioner submitted his claim to o.p. nos.1 and 2 through o.p. no.3 since petitioner was a member of the club. But o.p. nos.1 and 2 repudiated the claim for the violation of the condition no.5.3 and 5.4. Hence petitioner moved this forum for realization of the medical expenses.

            O.p. no.3 filed a written statement admitting the contention of the petitioner. Notices of the consumer complaint have been duly served to o.p. nos.1 and 2, but they did not turn up to contest the claim of the petitioner. The consumer complaint is heard in absence of o.p. nos.1 and 2. O.p. nos.1 and 2 did not file any w/v challenging the allegation of the petitioner.

            It is evident from the record and the annexures petitioner incurred medical expenses to the extent of Rs.14,131.92 during subsistence of the Group Mediclaim Policy issued in favour of the o.p. no.3 of which petitioner is a beneficiary and certificate holder. The violation of the conditions as recorded in annex-A5 in repudiating the claim of he petitioner is not a fundamental laches. Moreover, o.p. nos. 1 and 2 even after service of notice did not come to contest the claim of the petitioner. Therefore, the  entire contention of the petitioner is unchallenged. There is no evidence contrary to the statement made in the petition of complaint. In view of the fact, petitioner is entitled to relief in this consumer complaint. The consumer complaint accordingly succeeds and it is awarded in the following terms. 

            O.p. nos.1 and 2 are directed to pay Rs.14,131.92 (Rupees fourteen thousand one hundred thirty one and paise ninety two) only and compensation Rs.1000/- (Rupees one thousand) only and litigation cost Rs.500/- (Rupees five hundred) only within two months from date, failing which it will carry an interest @ 8% p.a. till realization.

            Let copy of this order be supplied to the parties free of cost.

 

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