In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, 4th Floor, Kolkata-700087.
CDF/Unit-I/Case No.200/2011.
1) Sri Girija Shankar Ghosh,
84, Ram Chand Dey Street, Kolkata-700151. ---------- Complainant
---Versus---
1) The Chairman, Reliance Industries Ltd.
Reliance Centre, 19, Walchand Hirachandm Marg,
Ballard Estate, Mumbai-400001.
2) The Zonal / Regional Manager,
Reliance General Insurance Co. Ltd.
Kolkata Zonal / Regional Office,
Himalaya House, 8th Floor, 38B, J.L. Nehru Road,
P.S. Shakespeare Sarani, Kolkata-71.
3) M/s. Paramount Health Service (TPA) Pvt. Ltd.
Icmard Building, 8th Floor, 14/2, CIT Road,
Scheme-VIII, Ultadanga, Kolkata-67. ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri, Member.
Order No. 22 Dated 30/08/2013.
The case of the complainant in short is that complainant after discovering the normalcy in his blood pressure after a thorough medical check-up by the authorized medical practitioner at the instance of agent of M/s Paramount Health Services Pvt. Ltd., the TPA of insurance company, one mediclaim policy being no.10000865058, duly proposed and declared on 21.1.08 by office code no.1503 for an insured sum of Rs.4 lakhs ata high premium of Rs.10,428/- due to his old age of 69 years for a period from 22.1.08 to mid night on 20.1.09, in detailing pre-existing disease as ‘diabetes mellitus’ only, was made from the end of the TPA, which has been certified also by its letter dt.11.12.07 regarding exemption of tax u/s 80D of Income Tax Act, 1961.
After a long 9 months of the said mediclaim policy, since he was felt uneasy, he was hospitalized at Ruby General Hospital Ltd. at Kasba Gole Park, E.M. Bye Pass, Kolkata-700107 on and from 13.11.08 to 26.11.08 in order to implantation of pacemaker. He was examined before Rabindra Nath Tagore International Institute of Cardiac Science of Mukundapur, Kolkata-99 in order to check up his heart whereby it would be revealed that his fasting sugar was on 22.8.08 within good LV systolic function with grade-I diastolic dysfunction and from the x-ray report of his chest it would be also crystal clear that both of his lung fields were well expanded and clear and that no active parenchyma lesion was seen and cardiac silhouette was normal in size and configuration and the mediastinum was central and risk factors of hypertension was nil. It would also be revealed from the report of his blood duly made by Welkin Medicare Pvt. Ltd. dt.27.8.08 that his blood sugar (PP) was 138 mg/dl as on 27.8.08 and the report dt.27.10.08 says that his blood sugar was 119 mg/dl which was within normal range. From the discharge certificate of said hospital dt.26.11.08 it would be also transpired that no medicine has been prescribed for the alleged ailment.
Since complainant’s blood pressure was quiet normal neither any prescription, before hospitalization and/or implantation or at the time of discharge has been prescribed for controlling high blood pressure which may cause hypertension nor has hypertension been incorporated in the previous history of the policy as pre-existing disease.
Against the said impugned claim status dt.21.2.09, as per note of the said TPA, complainant was constrained to make an appeal to the Ld. Insurance Ombudsmen on 6.4.09 wherefrom complainant has been advised by its letter dt.24.4.09 to submit a representation to the insurance company against the said decision.
Complainant being a bonafide claimant by its representation dt.23.9.09 requested the insurance company for rescinding, withdrawing and/or canceling the impugned repudiation of the said TPA dt.20.1.09 whereby his mediclaim in respect of the policy no.1000865058 has been defeated and/or rejected.
Hence the case was filed by the complainant with the prayer contained in the petition of complaint.
O.p. nos.1 and 2 had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them and prayed for dismissal of the case. Ld. lawyer of o.ps. in the course of argument submitted that the case has got no merit and the same is liable to be dismissed. O.p. no.3 did not contest the case by filing w/v. and matter was heard ex parte against o.p. no.3.
Decision with reasons:
We have gone through the pleadings of the parties, evidence and documents in particular and we find that complainant did not file reply by swearing affidavit as against the questionnaire filed by o.ps. and as such, o.ps. did not get any scope to contradict the statement of evidence on oath by complainant and as such, the evidence of complainant cannot be give credence to for want of reply by complainant. In short the petition of complaint has become without evidence. That being the position we are of the views that complainant fails to prove his case and complainant is not entitled to relief as prayed for.
Hence, ordered,
That the case is dismissed on contest without cost against o.p. nos.1 and 2 and dismissed ex parte without cost against o.p. no.3.
