In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, Kolkata-700087.
CDF/Unit-I/Case No. 261 / 2010.
1) Ms. Sukhdev Kaur,
91, Haraprasad Sastri Sarani, Block0E, Alipore, Kol-53. ---------- Complainant
---Versus---
1) Reliance General Insurance Co. Ltd.
38B Chowringee Road, Kolkata-700071.
2) Medi-Assist India Pvt. Ltd.,
3rd Floor, 49, First Main Road, Sarakki Industrial Layout,
J.P. Nagar Third State, Bangalore-560078. ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. A. B. Chakraborty, Member
Order No. 1 3 Dated 1 8 / 0 1 / 2 0 1 2 .
The petition of complaint u/s 12 of the C.P. act, 1986 has been filed by Mr. Sukhdev Kaur against the Reliance General Insurance Co. Ltd. and another. The case of the complainant in short is that complainant had two mediclaim insurance policy on receipt of requisite premium bering no.282540001519 and 282530021203 and the period of policies 25.1.07 to 24.1.09 and 25.1.09 to 24.1.10 respectively and the complainant underwent for replacement of his right knee during last insurance policy period i.e. on 9.9.08 and no claim was preferred for that and he renewal policy o.p. no.1 agreed to reimburse the entire claim expenditure on account of pre-existing disease and thereafter complainant was admitted on 8.9.08 in Peerless Hospital and B.K. Roy Research Centre and underwent total knee replacement surgery on the right leg side on 9.9.08 and was discharged on 13.9.08 and complainant further states that during the renewal policy being no.282530021203 risk was covered from 25.1.09 to mid night 24.1.10 and the complainant fell sick and was admitted on 1.2.09 in Peerless Hospital and B.K. Roy Research Centre during the risk period of renewal policy and the complainant underwent total knee replacement on left knee on 2.2.09 and incurred medical expenditure of Rs.2,60,000/- as it was a cashless hospitalization claim form for medical insurance policy and thereafter complainant lodged claim upon o.p. and o.p. no.2 by letter dt.16.6.09 requested the compliant to clarify regarding delay in submission of the documents papers and o.p. no.2 n behalf of o.p. no.1 confirmed receipt of the claim for medical expenditure. Complainant received letters dt.17.8.09 and 1.10.09 from o.p. no.2 although insurance premium was paid by the complainant to o.p. no.1 and accordingly policy / mediclaim dt.25.1.09 and 23.2.07 were issued by o.p. no.1 and the first mediclaim policy and renewal policy were issued by o.p. no.1 at no point of time. O.p. no.1 asked for any papers and the complainant through letter addressed to o.p. no.2 clarifying the information required by o.p. no.2 vide letter dt.1.10.09 but the claim was not settled and o.p. declined to settle the claim of the complainant and refused to pay the medical expenditure to the Peerless Hospital and B.K. Roy Research Centre by its letter dt.2.2.09 ad flimsy ground. Hence the instant case filed by the complainant on being aggrieved for redressal.
O.ps. did not enter their appearance in this case by filing w/v and as such, matter was heard ex parte.
Decision with reasons:
We have gone through the complaint as well as evidence together with document in particular and we find that the evidence of the complainant remains unchallenged testimony and as such, we are of the view that the complainant is entitled to relief as prayed for.
Hence, ordered,
That the petition of complaint is allowed ex parte as against the o.ps. with cost. O.ps. are jointly and severally directed to pay a sum of Rs.2,60,000/- (Rupees two lakhs sixty thousand) only with interest @ 9% p.a. from the date of claim till realization and are further directed to pay compensation of Rs.15,000/- (Rupees fifteen 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 @ 9% p.a. shall accrue over the entire sum due to the credit of the complainant till the date of realization.
Supply certified copy of this order to the parties.
_____Sd-____ ______Sd-_______
MEMBER PRESIDENT
