BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION.

                                                KAMRUP

                              C.C.No.117 /2016

Present:       

I)   Shri A.F.A.Bora, M.Sc.,L.L.B.,A.J.S(Rtd.)                           -President

II)  Smti Archana Deka Lahkar,B.Sc.,L.L.B.                               -Member

III) Sri Jamatul Islam,B.Sc Former Dy   Director, FCS & CA   - Member

           Dr. Mridul Dutta                                              -Complainant

           S/O Sri Dharmeswar Dutta

R/0 House No. 100, Srimantapur

JEC Road , Garmur, Jorhat,Assam

Pin-785001

Communication address

Dr. Mridul Dutta

Department of Business Administration,

Tezpur University,

Sonitpur Assam, Pin-784024.                                                   

                                    -vs-

            I)          The Branch Manager                                            - Opposite party

                        Star Health & Allied Insurance Company Ltd.

                        Branch office ,Guwahati

                        4^th floor, Ganapati Enclave,

                        Ulubari, G.S.Road, Guwahati-6

                        District : Kamrup, (Metro), Assam

Appearance              

Learned advocate Md.H.Bhuyan, T.H.Choudhury,MRZ Chudhury, D.Parbin, J.Borah  for the complainant  .

Learned advocate   Sri Palash Chutia, Smti Sanchaita Barman for the opp. parties

            Date of filing written argument:-   7.9.18      

            Date of oral argument:-                    9.3.21                  

Date of judgment: -                          20.3.21     

JUDGMENT

1)        This is a complaint filed u/s 11& 12 of the consumer Protection Act ,1986  by one Shri Mridul Dutta against opp.party branch Manager Star Health and allied Health Insurance Co.Ltd.  and complainant made an insurance policy from the respondent company bearing policy No. T/191311/01/2015/001742 for Rs.10,00,000/- along with bonus of Rs.3,50,000/- It is mentioned in the insurance policy that policy holder will get facility like room rent , nursing charged and professional charges and other difficulties when policy holder is under treatment in the hospital. It  is  submitted that the complainant was under treatment in the Baptist Christian Mission Hospital ,Tezpur from 25^th Jan.2014 to 29^th Jan.2014 and thereafter he was under treatment in GNRC Hospital , Guwahati from 6^th Sep. 2014 to 7^th Sep, 2014 and it is alleged that facilities were not provided according to the assurance given in policies. The complainant submitted the MRI plates and X-ray plates to the insurance company  when he was at Baptist Christian Mission Hospital the reimbursement was not done nor X-ray plates were returned to him.  It is alleged that the complainant again submitted MRI plates and X ray plate when he was in GNRC hospital , but no reimbursement was made  and X-ray plates and MRI plates were not returned. Therefore it is alleged that op.party have violated the policy condition and complainant have suffered loss and need to be compensated to the tune of Rs.15,00,000/- . Subsequently the plaint was amended and fact has been added stating that the complainant was under treatment in the Fortis Memorial Research Institute , Gurgaon from 16.9.2014 to 28.9.2014 and during the treatment in that hospital he incurred expenditure of total amount of Rs.4,54,378/- out of which Rs.4,00,000/- was reimbursed by the  insurance company and balance Rs.54,378/- was paid by the complainant himself. The complainant submitted 2 no.of bill s for payment by the insurance company for the  amount Rs.9,378/- and Rs.45,000/- for the expenditure incurred at Forties Memorial Research Institute , Gurgaon, Thereafter , complainant again continued his treatment in the said hospital at Gurgaon and paid another 3 bills for Rs.15,00, Rs.17,595/- and Rs.675/- which was not re-imbursed by the insurance company. According to the complainant there were total unpaid bill by the opp.party for 3 hospitals is amounting to Rs.1,55,091/-. According to the complainant on 27,.8,2014 , 11.9.2014, 16.9.2014  and 7.5.2014 he sent e.mail s to the respondents seeking return of MRI plate and X-ray plate and those were ignored but opp.party sent an e.mail on 7.5.15 and 9.6.15 ,22.8.20 ask him for original hospitalisation bill of hospital dtd. 6.9.14 and 7.9.14.

2)                    The complainant not getting any appropriate reply of his notices on 1.11.2016 filed this present complaint petition claiming compensation for loss and damages Rs. 10,00,000/- and for mental and physical harassment for Rs. 5,00,000/-

3)                    The opp.party after receipt of notice appeared and filed vakalatanama and thereafter took time to file written statement on 20.7.2017. Thereafter case was pending for filing w.s.by opp.party , but by order dtd. 21.12.17 the case was fixed for exparte hearing . Accordingly, the proceeding was continued uncontested and complainant have filed evidence in affidavit and placed his argument before this commission .

4)        We have gone through the evidence of the complainant and submitted in the form of affidavit where he annexed the hospital bill vide  Ext.3 and Ext.4(a), 4(b) which were paid by him as those were not paid by the insurance company. The complainant in his evidence on affidavit testified Ext.5(a), 5(b) and 5(c) 3 no. of bill  for treatment of Forties Memorial Hospital . Ex6(a) to 6(n) submitted by the complainant for Rs.15,5,65/- which was incurred in the Baptist Christian Mission Hospital , Tezpur  which was not paid by the insurance company . There is another bill  for Rs.11,000/- paid by the complainant at GNRC Hospital , Guwahati which were not reimbursed by the insurance company . In this way the complainant made a claim of unpaid bills for Rs.1,55,091/- along with compensation etc.

5)                    We have gone through Ext.1 and Ext.2,  two different no. of policy copy submitted by the complainant  which were in the name of the complainant and were duly renewed. The op.party have not contradicted the above policies by filing w.s. or by adducing any evidence. The claim made by the complainant in respect of unpaid bills supported by the documents as stated above are found sufficient for holding a view that there is a outstanding payment for Rs.1,55,091/- and complainant is entitled for the same. So far the question of compensation in respect of mental agony  is concerned  we have considered the fact that opp.party have paid a major amount of Rs. 4.00,000/- against  hospital bill of Forties Memorial Research Hospital for which the complainant have not suffered much harassment , but however there is a little deficiency in service for non payment of remaining  subsequent bills for which an amount of compensation to the tune of Rs.50,000/-(Rupees fifty thousand)only .

6)                    In the result , claim is decreed  in favour of the complainant directing the opp.party to pay the total unpaid bill amount of Rs.1,55,091/- (Rupees one lakh fifty five thousand and ninty one )only against unpaid bill and an amount of Rs. 50,000/-(Rupees fifty thousand )only for causing harassment  to the complainant  along with cost of proceeding of Rs.10,000/- (Rupees ten thousand)only.

7)                     The awarded amount to be paid  within 45 days from the date of judgment  failing which an interest @12% per annum to be paid to the complainant  on the entire decretal amount   till realisation . 

 Given under our hand and seal of the District Commission, Kamrup, this the 20^th   day of March,2021.

Md J.Islam                         Smt A.D.Lahkar                   Shri A.F.A . Bora

Member                                Member                                President

Dictated and corrected by me

Shri A.F.A. Bora

President,

District Consumer Commission, Kamrup.

Typed by me

Smt Juna Borah

Stenographer, District Consumer Commission, Kamrup.