Tripura

StateCommission

A/57/2017

The General Manager, Cholamandalam MS General Insurance Co. Ltd. - Complainant(s)

Versus

Sri. Sidhartha Sekhar Banik - Opp.Party(s)

Mr. Prabal Kumar Ghosh, Mr. Rakesh Ch. Deb

04 Jun 2018

ORDER

Tripura State Consumer Disputes Redressal Commission, Agartala.

 

Case No.A.57.2017

 

 

 

1. The General Manager,

Cholamandalam MS General Insurance Company Ltd.,   

2^nd Floor, 2, N.S.C. Bose Road,

Chennai-600001.

 

2. The Manager,

Cholamandalam MS General Insurance Company Ltd.

Akhaura Road, Near Raymond Showroom,

P.S. West Agartala,

District - West Tripura, Pin: 799001.

… … … … … Appellant/Opposite Parties.

Vs

 

1. Sri Sidhartha Sekhar Banik,

S/o Late Srinibash Banik,

9, Thakurpalli Road,

Bidurkarta Chowmuhani,

Agartala, P.O. Agartala, P.S. West Agartala,

District - West Tripura, Pin: 799001.

… … … … … Respondent/Complainant.

 

 

Present

Mr. Justice U.B. Saha,

President,

State Commission, Tripura.

 

Mrs. Sobhana Datta,

Member,

State Commission, Tripura.

 

Mr. Narayan Chandra Sharma,

Member,

State Commission, Tripura.

 

 

For the Appellants:                                         Mr. Prabal Kumar Ghosh, Adv.

For the Respondent:                                      Mr. Anjan Kanti Pal, Adv.

Date of Hearing & Delivery of Judgment:     04.06.2018.

 

J U D G M E N T [O R A L]

 

U.B. Saha, J,

The instant appeal is filed by the appellants, the General Manager, Cholamandalam MS General Insurance Company Ltd. and another, challenging the judgment and order dated 30.05.2017 passed by the learned District Consumer Disputes Redressal Forum Agartala (hereinafter referred to as District Forum), West Tripura in Case No.C.C.37 of 2017 whereby and whereunder the learned District Forum allowed the complaint petition filed by the respondent (hereinafter referred to as petitioner) directing the appellant (hereinafter referred to as opposite parties/Insurance Company) to pay Rs.2,20,000/- to the petitioner for deficiency of service and sum insured fixed for treatment cost as well as cost of litigation. Payment is to be made within two months, if not paid; it will carry interest @9% per annum. An application for condoning the delay of 130 days in preferring the appeal has also been filed.  

2. Heard Mr. Prabal Kumar Ghosh, Ld. Counsel appearing on behalf of the appellant-opposite parties as well as Mr. Anjan Kanti Pal, Ld. Counsel appearing on behalf of the respondent-petitioner.
3. On 11.01.2018, after hearing the Ld. Counsel appearing for the parties, the delay of 130 days was condoned subject to payment of Rs.30,000/- as cost to the respondent-petitioner. Accordingly, the said amount was paid to the petitioner and the appeal was admitted to be heard. Today the appeal is taken up for hearing.     
4. Brief facts needed to be discussed are as follows:-

The respondent-petitioner purchased one Health Master Policy vide Policy No. 2842/00101187/000/00 dated 23.07.2013 from the opposite parties, Insurance Company, type of policy – Family Floater (Self + Spouse + Two Children). The policy was valid from 19.07.2013 to 18.07.2014 and the value of Policy is Rs.2,00,000/- (Rupees two lacs only). During the life of Policy Certificate, the petitioner met with an accident on 10.06.2014 on Kumarghat-Pecharthal road at about noon time during riding a motor cycle at the place of Sidhongcherra. As a result, the petitioner sustained grievous injuries on his person and local people shifted him to the local hospital at Dharmanagar and thereafter he took treatment at Valley Hospital and Research Centre (Pvt.) Ltd., Silchar from 11.06.2014 to 28.06.2014, where he went for surgery on his knee and other parts of body. After completion of his treatment on 14.06.2016, he has submitted his claim petition to the Claim Manager of the opposite parties-Insurance Company at Agartala Branch along with the medical bills and other necessary papers and the same was received by the opposite parties-Insurance Company at Agartala on 14.06.2016. As the claim was not settled, the petitioner sent a lawyer notice to the opposite parties on 09.01.2017, but the opposite parties did not take any action even after receipt of the lawyer notice. Being aggrieved by the action of the opposite parties, the petitioner has filed an application under Section 12 of the Consumer Protection Act, 1986 before the learned District Forum claiming the benefit of the insurance policy as well as compensation etc. amounting to Rs.18,73,000/- along with 12% interest.

5. The learned District Forum after taking cognizance of the complaint petition, issued notice upon the opposite party no.1, the General Manager, Cholamandalam MS General Insurance Company Ltd., 2nd Floor, 2, N.S.C. Bose Road, Chennai as well as the Manager, Cholamandalam MS General Insurance Company Ltd., Akhaura Road, Agartala, West Tripura, but no step was taken by the opposite parties even after receipt of the notice. Hence, the case was proceeded ex parte against the opposite parties.
6. Petitioner produced legal notice, medical bills regarding the expenses of treatment, G.D. Entry and other necessary documents, Insurance Certificate, cash memos. The petitioner has also examined himself as P.W.1.
7. The learned District Forum after going through the evidence on record and the documents submitted before it observed, inter alia, that “From the prescription voucher it is found that huge amount was spent for the treatment. It is found that in total Rs.4,53,058/- was spent for treatment. But insurance coverage is not to that extent. It is up to Rs.2 lacs. Petitioner submitted the claim before the insurance company on 14.06.16. List of Medical expenditure with medical bills, F.I.R., G.D. Entry, Hospital Admission copy, Certificate of Cholamandalam General Insurance all produced but the claim is not settled till today. For such deficiency of service petitioner suffered. Cholamandalam Insurance Company did not assign any reason for such delay in settling the claim. Petitioner paid Rs.5100/- as premium for coverage of his health risk from 19.07.13 to 18.07.14. During the policy certificate period he suffered the illness and spent huge amount for treatment purpose. He claimed the amount. The coverage Rs.2 lacs could have been paid by the O.P. but it was not paid which is definitely deficiency of service by O.P. Insurance Company. For this deficiency of service petitioner suffered and entitled to get compensation Rs.15,000/- petitioner is also entitled to get the sum insured Rs.2 lacs for treatment expenditure. Petitioner is also entitled to get Rs.5000/- for litigation cost.” In total Rs.2,20,000/-.
8. Aggrieved by and dissatisfied with the impugned judgment, the appellant-opposite parties preferred the instant appeal.
9. Mr. Ghosh, Ld. Counsel has urged for setting aside the impugned judgment and remand the matter to the learned District Forum to decide the matter afresh after hearing the appellant-opposite parties. He has also contended that though the notice was issued, but the said notice was not served upon the appellant-opposite parties in time and only on 30.05.2016, the appellants came to know about the said case bearing No.C.C.37 of 2017 which was fixed on 01.06.2017 for judgment. He finally submits that the learned District Forum most illegally came to a conclusion that the appellant is entitled to get Rs.2,20,000/- without considering that aspect that no specific defence could be filed by the appellant as to the maintainability of the appeal.
10. On the other hand, Mr. Pal, Ld. Counsel while supporting the impugned judgment has taken us to the documents submitted before the learned District Forum including the medical bills regarding the expenditure of treatment and contended that though the expenditure was near about Rs.4,53,058/-, but the learned District Forum allowed only the insured amount and compensation of Rs.15,000/- as well as cost of litigation of Rs.5,000/-, in total Rs.2,20,000/- which is just, proper and reasonable. He further submits that though the petitioner claimed the transportation cost as well as the hotel expenditure of his escort, but the learned District Forum did not give any amount for that purpose.
11. We have gone through the records of the learned District Forum from which it appears that the notice was served upon the opposite party no.2, Manager, Cholamandalam MS General Insurance Company Ltd., Agartala Branch, but even after receipt of the notice, the said opposite party did not appear before the learned District Forum. The opposite party no.2 though in the memo of appeal submitted that the opposite party did not receive the notice, but from the records it appears that such contention is not correct as the opposite party no.2 admittedly, received the notice. Not only that, even opposite party no.2 also received the claim petition on 14.06.2016. It was the duty of the opposite party no.2, Manager, Cholamandalam MS General Insurance Company Ltd., Agartala Branch to take up the matter with the opposite party no.1, but it is not clear as to whether he has taken up the matter as such or not. From the medical bills and other documents submitted by the insured-petitioner, it appears that the treatment cost including the cost of medicine is near about Rs.2 lacs excluding the transportation and food and lodging charge claimed by the petitioner. Insured-petitioner being the resident of Tripura was initially taken to the local hospital by the local people. Subsequently, he was shifted to a hospital at Silchar in the State of Assam where he was treated from 11.06.2014 to 28.06.2014. Thereafter also, he went to the said hospital for post operative treatment. Therefore, it cannot be said that the learned District Forum committed any error while assessing the claim of the petitioner. The opposite parties-Insurance Company when did not settle the claim of the petitioner within a reasonable time even after receipt of notices from the learned District Forum, then obviously the action of the opposite parties-Insurance Company come within the purview of deficiency of service. More so, it is the opposite parties-Insurance Company who did not appear before the learned District Forum and file their respective written statement even after receipt of the notices. Thus, the learned District Forum did not commit any wrong in deciding the case proceeding ex parte against them. We have gone through the records of the learned District Forum including the documents regarding the treatment of the petitioner in the Valley Hospital and Research Centre. We are of the view that it would not be proper to remand the matter before the learned District Forum setting aside the impugned judgment as contended by the Ld. Counsel for the opposite parties-Insurance Company at this belated stage. The petitioner-insured met with an accident and he was treated in the year 2014. Thereafter, he approached the Insurance Company in 2016, but the Insurance Company admittedly, did not settle the claim of the insured-petitioner and also did not appear before the learned District Forum to contest the claim of the petitioner. According to us, the learned District Forum did not commit any wrong while passing the impugned judgment considering the evidence on record.         

In the result, the appeal is dismissed being devoid of merit. No order as to costs.

Send down the records to the learned District Forum, West Tripura, Agartala.

 

 

MEMBER State Commission Tripura

MEMBER State Commission Tripura

PRESIDENT State Commission Tripura