THE PRESIDENT

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA :  AGARTALA

 

 

CASE No.  CC-  95 of  2019

 

 

Shri Biswajit Paul,

S/O_ Late Manik Paul,

Vill: Bankumari, P.O. Jogendranagar,

(Near Kalimandir), P.S. East Agartala, 

District- West Tripura, Pin-799004,

Contact- Mobile No- 9436125441. .............Complainant.

 

-VERSUS-

 

The Chief Manager,

Life Insurance Corporation of India,

Agartala Branch No.1, Paradise Chowmuhani,

Hospital Road Extension, Agartala,

District- West Tripura. ..................Opposite Party.

 

 

 

     __________PRESENT__________

 

 SRI RUHIDAS PAL

PRESIDENT,

  DISTRICT CONSUMER  

DISPUTES REDRESSAL COMMISSION

      WEST TRIPURA, AGARTALA. 

 

 

Dr (SMT) BINDU PAL

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL COMMISSION

  WEST TRIPURA,  AGARTALA.

 

C O U N S E L

 

For the Complainant : In Person.   

  

For the O.Ps.  : Sri P. K.Debnath,

  Learned Advocate.  

 

 

 

JUDGMENT  DELIVERED  ON :  17.02.2021

 

 

J U D G M E N T

The Complainant's case in short is that the complainant is a citizen of India and at present fully self employed. He is authorized agent of LICI and have a LICI Policy in Branch no.1 being no-997635693(Health Insurance Jeevan Arogya Table N- 904). He claimed for sanction of health benefits to the said Branch no.1 due to his minor operation  case  dated 25.01.2019 and submitted the claim for compensation amounting to Rs.18000/- but the O.P. sanctioned only Rs.2200/- . Hence, the complainant claimed for the benefit of Rs.18000/- along with Rs.10,000/- as compensation total Rs.28,000/-. Hence this complaint. 

 

2. On the other hand O.P. contested the case by filing written objection. It is stated by the O.P. that there is no cause of action and jurisdiction in the instant complaint. They also stated that the complaint is bad for non-joinder of necessary and proper party. The complaint petition is barred by waiver, estoppels, acquiescence and law of limitation and it is liable to be rejected. The O.P. further stated that the claim of the complainant is not entertainable in law as claimed in the petition. It is misconceived, arbitrary, waiver and out of all proportion. The complainant is not entitled to get any amount beyond the policy terms. Thus the O.P. prayed for dismissal of the complaint with cost. 

 

EVIDENCE  ADDUCED  BY  THE  PARTIES:-

3. The Complainant submitted his examination in chief by way of affidavit. He submitted 12 documents by firisti dated 13.11.2019 and 03.02.2020. On identification the documents were marked as Exhibit– 1 Series. The complainant was also cross examined by the O.P. side.

 

4. On the other hand, the O.P. submitted examination in chief by way of affidavit. The O.P. is cross examined by the complainant side. They did not produce any documentary evidence. 

 

5. POINTS TO BE DETERMINED:- 

  (i) Whether there is any deficiency of service on the part of the O.P. towards the Complainant?

  (ii) Whether the complainant is entitled to get compensation/  relief as prayed for?

 

6. ARGUMENTS:-

On the date of arguments the complainant remained absent. On the other hand Learned Advocate Mr. P.K. Debnath appearing on behalf of the O.P. submitted that as per terms and conditions of the policy complainant was given the benefits amounting to Rs.2,200/- and complainant is not entitled to get any further amount. Being authorized agent of the LICI complainant is very much aware about the terms and conditions and knowing fully well he filed this complaint without any basis and this complaint is liable to be dismissed with cost. 

Though complainant was absent at the time of arguments but we will decide the case on merit.    

 

 

7. FINDINGS  AND  REASONS  FOR  DECISIONS:- 

      We have perused the pleadings as well as the evidences  adduced from both sides. On perusal of the pleadings and the evidences we find that there is no dispute about the factum of minor operation of the complainant dated 25.01.2019. The question is whether the complainant is entitled to get his total claim as per terms and conditions of the policy. O.P.W. 1 namely Madhav Kalai, Branch Manager(IC)/Manager, Administrative, Agartala Branch No-I, LICI in his examination in chief on affidavit stated that the insurance company is liable to make any payment under policy as per terms and conditions. The policy was taken under Jeevan Aroygya Plan(T-904). The daily benefits opted under the plan was Rs.1000/- only. The policy was taken on 28.10.2016 and the date of admission in the hospital was 25.01.2019. As per the policy Bond conditions and privileges the complainant is entitled to get benefit increased by addition of 5% of the initial daily benefit each year. At para-7 it is also stated that the complainant, the policy holder who stayed in the hospital for 25 hours is eligible for other surgical benefits as per policy Bond is Rs.2200/- only and it was reightly paid. In cross examination the O.P.W. Stated that the complainant is not entitled to get other benefits and he is not deprived of his benefits. 

It is the duty of the complainant to justify his claim by way of adducing sufficient proof. Though the complainant submitted original policy and other documents regarding the treatment and expenditure but he failed to rebut the argument advanced from the side of the O.P. 

 

8. Considering the evidences of both sides as well as the terms and conditions of the policy we are of the opinion that the complainant has failed to prove his claim and we also do not find any deficiency in service on the part of the O.P. Accordingly the complaint is liable to be dismissed. Hence, complaint is dismissed. No costs.  Supply copy of the judgment to both the parties free of cost.

 

Announced.

 

SRI R. PAL

PRESIDENT, 

DISTRICT CONSUMER  

DISPUTES REDRESSAL COMMISSION,

WEST TRIPURA, AGARTALA. 

 

 

Dr (SMT) B. PAL

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL COMMISSION, 

  WEST TRIPURA,  AGARTALA.