1) Sri Sanjit Kumar Roy Choudhury,
3/95, Chittaranjan Colony, P.O. Jadavpur University,
P.S. Jadavpur, Kolkata-32. ________ Complainant
____Versus____
1) The Branch Manager,
United India Insurance Co. Ltd., D.O.-IV,
7th Floor, United India Towers,
Basheerbagh, Hyderabvad – 500029.
2) The Manager,
M/s. Good Health Plan Ltd.,
Flat No.49, Nagarjuna Hills, Panjaguita, Hyderabad – 500082.
3) The Branch Manager,
Andhra Bank, Jodhpur Park Branch,
1/392, Gariahat Road (South), P.S. Lake, Kolkata-68. ______ Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri, Member.
Smt. Samiksha Bhattacharya, Member
Order No. 9 Dated 15-01-2014.
We have gone through the pleadings of the parties, evidence and documents in particular and we find that complainant is a law abiding senior citizen and maintained a savings bank account being no.1186100112115 with Andhra Bank, Jodhpur Park Branch, Kolkata, o.p. no.3 herein.
During the year 2004 being allured with the request of the then Branch Manager of the said Branch of Andhra Bank and subsequent follow up, ultimately during June, 2004 the complainant obtained a mediclaim policy, known as ‘AB AROGYADAAN” to avail medical benefit for-self and his wife Smt. Surekha Roy Chowdhury, covering sum assured Rs.1 lakh upon payment of yearly premium.
The mediclaim policy was renewed subsequent years upon payment of yearly premium in time. Last renewal premium of Rs.2414/- was made by complainant to o.p. no.1 for the period 10.6.12 to 8.6.13 and intrun o.p. no.1 issued renewed mediclaim policy being no.050400/48/12/41/00000314 in the name of the complainant and his wife.
The policy was issued by the office of the United India Insurance Co. Ltd., o.p. no.2. The Good health Plan Ltd., Hyderabad, o.p. no.2 is appointed as TPA who delivered photo cards to the complainant and his wife for identification of policy holder.
On 8.9.12 at night time the complainant had high fever with severe chest pain and breathing problems etc. The family members of the complainant took the patient to several hospital / nursing home for necessary treatment but no bed was available due to epoch of “Dengue Fever” in and around in the city of Kolkata and ultimately at around 11-15 p.m. the complainant was admitted in Dr. Mira Majumder, Seva Mandir Pvt. Ltd. and the complainant treated at the said nursing home till morning hours on 11.9.12.
As per advice of the treating doctor on 11.9.12 at 11-30 a.m. the complainant was transferred to Red Plus Society Nursing Home for further management upon payment of bill for Rs.17,111.80. Thereafter the complainant was treated at Red Plus Society Nursing Home from 11.9.12 till 18.9.12 and was discharged on 19.9.12 with follow up advice, medicines and instruction to contract SOS and a total sum of Rs.23,581.17 had been incurred by the complainant for the treatment at Red Plus Society Nursing Home. Thereby, the complainant had to incur amount of Rs.17,118.80 plus Rs.23,581.75 i.e. Rs.40,563.55 towards his treatment during 8.9.12 to 19.9.12.
Subsequently, the complainant filed a claim with all documents in original with o.p. nos.1 and 2 through o.p. no.3 for reimbursement of total expenditure amounting to Rs.40,563.55 incurred by the complainant towards his treatment.
During the first week of January 2013 from the statement of accounts so issued by o.p. no.3 to the complainant it is observed that a sum of Rs.9715/- and Rs.6030/- totally to Rs.15,745/- were credited on 7.12.12 and 3.1.13 has been credited in the said S.B. A/C on scrutiny of records it is revealed the said amount has been remitted by o.p. no.2, no intimation and/or assigning any reason whatsoever for part payment of the claim that too in piecemeal basis.
Immediately on 16.1.13 the complainants lodged a complaint with o.p. no.2 through o.p. no.3 raise strong objection to their such above conduct and with the request to release the balance due amounting to Rs.24,818.55 without delay but it appears the o.ps. thought it proper to sit tight over the matter which speaks of repudiation of balance amount. But till date o.ps. have not paid the balance dues of Rs.24,818.55.,
O.ps. did not contest the case by filing w/v and matter was heard ex parte against all o.ps.
Decision with reasons:
In view of the finding above and on perusal of the entire materials on record we find that complainant has proved his case and is entitled to relief since o.ps. had sufficient deficiencies on their part being service providers to their consumer / complainant.
Hence, ordered,
That the case is allowed ex parte with cost against all o.ps. O.ps. are jointly and/or severally directed to refund Rs.24,818.55 (Rupees twenty four thousand eight hundred eighteen and paise fifty five) only towards the claim amount and are further directed to pay to the complainant compensation of Rs.20,000/- (Rupees twenty thousand) only for harassment and mental agony and litigation cost of Rs.5000/- (Rupees five thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 10% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.
