In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, Kolkata-700087.
CDF/Unit-I/Case No. 341 / 2010.
1) Smt. Rasula Begum Chowdhury,
Subarnarekha Apartment, 4th Floor,
C1, Baghajatin, P.S. Jadavpur, Kolkata-700092. ---------- Complainant
---Versus---
1) NOVARTIS INDIA LTD.,
24A, Shakespeare Sarani, Kolkata-700017.
2) The Oriental Insurance Co. Ltd.,
Regional Office-4, Lyons Rance Kolkata-700001. ---------- Opposite Party
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri, Member
Smt. Sharmi Basu, Member
Order No. 24 Dated 28/09/2012
The petition of complaint has been filed by the complainant against the o.p1 namely Novartis India Ltd., Medicine Supplier and op2 namely The oriental Insurance Co.Ltd., Insurance Company ,with an allegation of deficiency in rendering service.
In a nut shell the case of the complainant is that the complainant has been suffering from neovascular (wet) age rated to muscular degeneration (AMD), Visual Disorder and required Lucentis treatment a product of o.p.1 and the cost of such treatment was borne by the complainant and o.p.2 repudiated the claim through e-mail dated 10.11.09. due to non-follow-up with concerned Doctor. Further case of the complainant is that the o.p.1 purchased a mediclaim reimbursement policy from o.p.2 in the name of complainant since the cost of the medicine were costly, vide policy no.181200/48/2009/1253, certificate no.2 and period of insurance was from 25.09.08 to 24.09.09. and date of purchase is 16.09.08. and sum insured Rs.1,65,000/- as per terms and conditions . But, o.p.2 made reimbursed all expensed but declined to reimburse the amount of medicine of 4th dose i.e. the cost of Rs.71,412/- on the ground of failure of monthly follow up within a month. Hence the case.
O.p.2 had entered his appearance in this case by filing w/v and denied all the material allegations labeled against him and o.p.1 did not contest the case.
Decision with reasons:-
We have gone through the pleadings of the parties, evidence and documents in particular. It is an admitted position that the complainant had above mentioned insuran ce policy and she was not defaulter so far as policy is concerned. The plea taken by o.p.2 that follow up action was not taken by comoplainant in making payment of fourth dose medicine amount Rs.71,412/- is not satisfactory in view of the certificate of the Doctor vide Annex-B, annenxed with the petion of complaint and it is also further admitted position both the ops have their ties with each otherand they can not shirk off their responsibility in the matter of making payment of Rs.71,412/- as per terms and conditions of Mediclaim Reimbursement Policy and the cost of 4th dose of medicines as promised and such unfair trade practice is highly condemnable and should be nipped in the bud and such action on the part of the o.p.s throws the society in wilderness and stern action is highly warranted to put an end of it. And we find that ops had sufficient deficiencies being servlice provider to its consumer/complainant and we further hold that the ops have been running unfair trade practice as defined u/s.2(1)( r) of the Consumer Protection Act,1986 and complainant is entitled for relief.
Hence, Ordered
The instant case is allowed exparte with cost against o.p.1 and on contest against o.p.2 with cost. Both o.p.s are jointly and/or severally directed to reimburse a sum of Rs.71,412/- to the complainant for cost of fourth dose medicine with interest @9% p.a. from the date of repudiation till the date of realization and are further directed to pay compensation of Rs.65,000/- for the harassment and mental agony caused to the complainant and are further directed to pay litigation cost of Rs.10,000/- and both the o.p.s are directed to pay a sum of Rs.2,00,000/- to the complainant and Rs.5,00000/- in favour of Consumer Welfare Fund, Govt. Of West Bengal as punitive damages as per provision laid down u/s 2(1)(r ) of the Consumer Protection Act,1986 for carrying on unf air trade practice . O.P.s are jointly and/or severally directed to comply the aforesaid said award
Supply certified copy of this order to the parties free of cost.
