The instant case was instituted on the basis of a petition under Section 12 filed by Ankur Saraf, Son of Jugal Kisore Saraf, resident of Asokpally, P.O. & P.S.- Raiganj, Dist.- Uttar Dinajpur which was registered as Consumer Case No. 07/18 in this Forum.

The fact of the case as revealed from the petition of complaint as well as from the evidence is that the complainant (Ankur Saraf) purchased a Happy Family Floater Policy for self and his dependants including his father (Jugal Kishore Saraf) vide policy no.- 313501/48/2017/678 which was valid up to 19/06/2017 from the opposite party for their medical treatments.

From the petition as well as evidence it is found that the father of the complainant aged about 76 years old and he was admitted to Bellevue Clinic, under Dr. U.N. Bramhachari Street, Kolkata- 17 on 10.02.2017 for his treatment and he was discharged on 11-02-2017 after treatment. The total cost of treatment was paid by the complainant to the hospital.

After discharged from the Bellevue Clinic the complainant/ petitioner claimed the entire amount from the O.P. along with all relevant documents but the O.P. denied to pay the amount which was paid by the complainant for the treatment of his father Jugal Kisore Saraf.

The further case of the complainant is that the complainant along with his father was under the coverage of valid mediclaim policy and the O.P. intentionally refused to pay the treatment amount just to harass the complainant and the claim was submitted on 23.02.2017 and the cause of action arose on 24.02.2017.

The complainant has prayed for reimbursement of amount for the medical treatment of the father of the complainant amounting to Rs.39,813/- along with compensation of Rs.5000/- and litigation cost of Rs.10,000/-.

The petition has been contested by the O.ps. by filling W.V. denying all the material allegations as leveled against the Insurance Company denying all the material allegations that the instant case is not maintainable.

The definite defence case is that the claim was repudiated on the ground that the father of the complainant Jugal Kisore Saraf was not admitted in Bellevue Clinic for a period of 24 hours for his treatment purpose. Naturally as per provision of clause 3.17 of Happy Family Floater policy, 2015 the complainant is not entitled to get any amount for the treatment purpose. As such the Company repudiated the claim legally. So, the instant case is liable to be dismissed with cost.

During trial the complainant (Ankur Saraf) was examined as PW1 and he was cross examined. No other witness was examined on behalf of the complainant. On the other hand Parimal Ch. Sarkar was examined as OPW 1 on behalf of the Insurance Company. During trial the O.P. filed some documents and also exhibited that is discharged certificate.

Now the point for determination as to whether the complainant is entitled to get any amount under the policy or not.

          D E C I S I O N W I T H R E A S O N S:

 It is not disputed that the Complainant purchased a Happy Family Floater Policy which was valid on the date of discharge of his father at Bellevue Clinic. Now the main point is to be considered whether the father of the complainant was treated at Bellevue Clinic for more than 24 hours or not. In this regard the Learned Lawyer of the O.P. submits that the father of the complainant was admitted on 10/02/2017 at 3.12pm and discharged on 11.02.2017 at 12.02pm. So, definitely the father of the complainant was treated at Bellevue Clinic for less than 24 hours. So the Insurance Company as per provision of clause 3.17 of the Happy Family Floater Policy, 2015 repudiated the claim.

On the other hand the Learned Lawyer of the complainant submitted that at the time of first issuing discharge certificate no time was mentioned. But later on, the time of discharge was mentioned.  He further argued that the total cost of treatment of his father was paid by the complainant to the Hospital authority and such procedure took place for a long time. According to the argument as advanced by the Ld. Lawyer of the complainant is that the total period from the date of admission and payment of cost for the treatment will be more than 24 hours.  But on perusal of the documents filed by the complainant as well as OP it is found that in the final bill the date of time was mentioned which is less than 24 hours from the date of admission. So, the argument raised by the Learned Lawyer of the complainant is not at all acceptable. Moreover, the document regarding purchase of medicine will not be treated as a discharge document. It is the liberty of the patient party to purchase the medicines either at the time of discharge of the patient or at any time which he likes.

 Moreover, in the Happy Family Floater Policy in a case of day care procedure, if a patient is admitted to a Nursing Home for a medical treatment less than 24 hours then the mediclaim is admissible. But it is found that the father of the complainant was treated at Bellevue Clinic for colonoscopy which is not mentioned in the Appendix 1 i.e. Day Care procedure. So, in such circumstances the complainant is not entitled to get any amount for reimbursement of the medical treatment or compensation or litigation cost. So, considering such facts and circumstances that the instant case is liable to be dismissed.   

C.F. paid is correct,

Hence, it is,

                                O R D E R E D:

 That the complainant case being No. CC-07-18 be and the same is dismissed on contest but without any cost.

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