The instant case was started on the basis of a petition under Section 12 of the Consumer protection act, 1986 filed by the complainant which was registered as Consumer Case No. 27/17 in this Forum.

The fact of the case as revealed from the petition of complaint as well as the evidence is that the complainant/petitioner is the holder of Medi-claim policy being no-313501/48/16/02156.

That during the continuance of the said policy the complainant became ill and admitted on 20.06.2016 to Marwari Relief Society Hospital, Kolkata and was treated there for Viral Fever with Acute Febrile illness and discharged there from on 25.06.2016.

The matter of treatment of the complainant was duly communicated to the office of the OP/Ins. Co. and the father of the complainant claimed medical re-imbursement of Rs.17,519/- but the O.P/Insurance Co. settled the claim to Rs.10,184/- by  deducting of Rs.7,418/- as non medical expenses.  The complainant in support of his claim submitted all the bills and medical papers to the O.P/Ins. Co. to substantiate his claim. But the O.P/Ins. Co did not pay any heed to his claim of Rs.7,418/-. Finding no other alternative the complainant sent a legal notice dt.27.01.17 through his Ld. Advocate by registered post.

From the petition of complaint it is found that the complainant already submitted all documents but the OP did not paid the amount. As such the complainant was compelled to file the petition before this Forum for reimbursement of Rs.7,418/- (rupees seven thousand four hundred eighteen only) for medical treatment with a prayer for compensation of Rs. 10000/- for harassment and mental pain and agony and Rs.5000/- as litigation cost.

The petition has been contested by the OP by filling the written version denying all the material allegations as leveled against the OP contending inter alia that the case is not maintainable in its present form, the case is bad for estoppels and defect non joinder of necessary parties. The claim case is barred by law of limitation. There is no cause of action to file this case.

The definite defence case is that the O.P/ Insurance Company paid Rs.10,184/- to the complainant due to medical re-imbursement and Rs.7,418/- was deducted from his total claim as per terms and conditions of the policy as it is a non medical expenses. There is no deficiency or negligence or latches on the part of the OP Insurance Company. Considering such facts and circumstances the case is liable to be dismissed with cost.

During trial Dipak Kr. Saha the father of the complainant was examined as P.W.1 and he was cross examined. Some documents were filed on behalf of the complainant. On the other hand the O.P did not adduce any evidence to his defence.

Now the point for determination whether the complainant/petitioner is entitled to get any relief as prayed for.

DECISION WITH REASONS:

At the time of argument the Ld. Lawyer of the O.P argued that Rs.7,418/-was deducted as non medical expenses. Besides that the Insurance Co. has paid the rest amount. But no document has been filed by the Ins. Co. to show that Rs.7,418/-has been deducted from the total claim due to non medical expenses. But no document has been filed by the Ins. Co. to show that the expenses are related to non medical expenses. Why the Forum will come to a conclusion unless and until such document is filed to show that Rs.7,418/- was meant for non medical expenses. In this regard the Forum has no other alternative but to accept the total demand of Rs.17,519/- on the basis of the final bill granted by Marwari Relief Society, Kolkata. Mere statement in the W.V is not sufficient to prove that it is a non medical expenses which violated the terms and conditions of the policy. The O.P should have produced such bills and document to show that it is related to non medical expenses. So, in such circumstances the claimant is entitled to get Rs.7,418/- for medical expenses as and when the Forum finds the total bill of Rs.17,519/- on the basis of final bill granted by Marwary Relief Society, Kolkata. So, the complainant gets Rs.7,418/- for medical treatment and Rs.2,500 as compensation for mental pain and agony and Rs.2,500/- for litigation cost.

C.F paid is correct,

Hence, it is

                                           ORDERED

That the instant case being no. CC-27/17 is allowed on contest with litigation cost of Rs.2,500/-.

The complainant is entitled to get sum of Rs.7,418/- as compensation for medical treatment. Besides that he is entitled to get Rs.2,500/- for mental pain and agony and Rs.2,500/- as

Litigation cost. Total amount comes to Rs Rs.12,418/- (Rupees twelve thousands four hundred eighteen) only..  

The O.P. is directed to make the payment by A/C Payee cheque in the name of claimant or cash within one month from the date of passing of this order failing which it will carry interest at the rate of 5% per annum over the awarded amount from the date of default till the recovery. In the case of failure of payment, the petitioner/ complainant will have the liberty to execute the order for recovery of the amount as per provision of law.

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