Order No. 11 Dt. 22.07.2015
This case has been filed by the Shri Monilal Ghosh on behalf of Smt. Susmita Ghosh as constituted Attorney u/s 12 of Consumer Protection Act, 1986 praying for an order for release of Rs.32800/- as insurance claim along with Rs.15000/- as harassment to him by O.P., Bazaz Allianz General Insurance Co. Ltd. (BAGICL)
The case of the complainant is that Susmita Ghosh made a policy with O.P. BAGICL for Rs. 2 lacs w.e.f. 27.01.2014 to be valid up to 24.01.2014 and she paid Rs.3283/- as premium. On 04.07.2014 she visited doctor of O.P.3 and had treatment for a cost of Rs.7600/- and thereafter she took treatment at O.P. 4 for a cost of Rs.25200/- with the total cost of Rs.32800/- and she submitted all documents to O.Ps.1 and 2 for claim amount of Rs.32800/- which was repudiated by O.P. Bazaz Allianz General Insurance Co. Ltd. Thereafter, she filed this case through his attorney.
On the basis of the same following issues are framed:-
- Whether the case is maintainable?
- Whether there is any cause of action to file this case?
- Whether there has been any deficiency in service on the part of the ops?
- Whether the complainant is entitled to get the reliefs as prayed for?
:DECISION WITH REASONS:
Issue Nos. 1,2,3 and 4
All the issues are taken up together for the sake of brevity and convenience of discussion.
From the evidence and facts it is crystal clear that the petitioner did not claim anything from O.P. No.3 and O.P. No. 4. O.P. 3 and O.P. 4 only treated the patient for the problem of her teeth and so they are unnecessary parties in this case though O.P. 3 filed W/V in this case. These O.P. 3 and O.P.4 are thus expunged from this case.
The claim of the petitioner is that she has a policy of insurance against O.P.1 and O.P.2. From the documents filed by the petitioner it is crystal clear, that the petitioner spent huge money for her treatment of teeth but she was not hospitalized and no documents filed that she was admitted in the hospital. On the other hand she filed outdoor tickets and prescriptions only. From the policy paper it is evident that the Insurance Company will not pay any expenditure unless the insurer is hospitalized and this clause debars the petitioner from claiming any compensation for her treatment.
The petitioner stated in her petition that the Insurance Company did not supply the policy document containing terms and conditions and the writings was so small that was not readable but she herself filed the document with her case and this statement is not acceptable when it is clearly written in column of cover description as “Hospitalization “ of the said document.
Therefore, the case of the petitioner miserably fails.
In the result the claim case fails.
Court fee paid on the petition, is correct.
Hence, it is ordered
that Malda D.F.C. Case No. 05/2015 be and the same is hereby dismissed without cost.
A copy of this order be given to the parties free of cost.
