DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA :  AGARTALA

 

CASE   NO:   CC- 74 of 2020.

 

1. Sri Apurba Kr. Roy,

S/O. Lt. Amar Chandra Roy,

R/O. Palace Compound, Near Kar Bhavan, 

Old Sales Tax Office, 

P.O.-Agartala, P.S.-West Agartala,

Pin-799001, Dist.- West Tripura …....…....................Complainant.

 

-VERSUS-

 

1. The Cigna TTK,

Health Insurance Company Limited,

C/O. 401/402 Raheja Titanium, 

Western Express Highway,

Gurgaon East, Mumbai-400063.

 

2. Sri Suman Saha,

Of Peerless Finance Production,

Distribution Limited,

Near Shibbari, Central Road, P.O.-Agartala,

Dist.-West Tripura, Pin-799001.......….................Opposite parties.

 

    __________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.

 

SRI SAMIR  GUPTA

MEMBER,

  DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA. 

 

C O U N S E L

 

For the Complainant : Sri Suman Bhattacharya,

  Advocate. 

For the O.P. No.1 : Sri Prabal Kumar Ghosh,

  Advocate. 

For the O.P. No.2 : Sri Nanda Dulal Paul,

  Sri Nirnoy Paul,

  Advocates.

 

JUDGMENT  DELIVERED  ON: 31/10/2022.

 

J U D G M E N T

The complainant Sri Apurba Kr. Roy,  set the law in motion by presenting the petition U/S 12 of the Consumer Protection Act, 1986 complaining deficiency of service committed by the O.Ps.  

  The complainants' case, in brief, is that the Complainant is a Policy holder under the O.P. No.1 through O.P. No.2 bearing policy No.PRAHLRO10624075 valid from 20.03.2018 to 19.03.2019 and the sum insured was Rs.4,50,000/-. The said policy was a continuation of his earlier policy bearing No.52759680. The Complainant was suffering from some physical problems and for that reasons he went to the ILS Hospital, Agartala and admitted therein from 28.09.2018 to 29.09.2018. He was under the treatment of one Dr. Dimbeswar Das and in the said hospital he was treated by other Doctors relating to Cardiac problem. At the time of releasing the Complainant from the said hospital a bill of Rs.27,267/- was raised as said amount was required for his treatment. The Complainant raised his bill with the O.P. No.1 through the said hospital as the O.P. No.1 was providing him cashless facility for the same but the claim of the Complainant was not settled by the O.P. No.1 and the Complainant had to pay the said amount to the said hospital from his own sources. Thereafter, on 29.06.2020 the Complainant sent a demand notice to the O.Ps. wherein he requested them to pay him the said amount of Rs.27,267/- within a period of 15 days of from the date of receipt of that notice and he also informed that if they do not settle his claim in that case he would approach the Competent Court of law and at that time he would claim an amount of Rs.50,000/- for deficiency in service, Rs.10,000/- for harassment and Rs.20,000/- for cost of litigation. 

Hence this case. 

The O.P. No.1 Health Insurance Company Ltd. has contested the claim raised by the Complainant by filing written statement refuting the allegations of the Complainant. The O.P. No.1 has denied negligence and deficiency on his part in dealing with the claim of the Complainant. O.P. No.1 in the written objection stated that the original documents pertaining to the treatment of the Complainant was not received by the answering O.P. No.1, hence, it is not known whether the Complainant had undergone treatment at ILS Hospital at Agartala from 28/09/2018 to 29/09/2018 neither it is known to the answering O.P. No.1 whether an amount of Rs.27,267/- was spent by the Complainant for his treatment at ILS Hospital, Agartala as the same was not intimated to the answering O.P. No.1 by the Complainant. But O.P. No.1 never received any notice of demand from the Complainant for making payment of Rs.27,267/-.  O.P. No.1 also stated that in a prescribed format giving the full details of medical treatment and the expenses incurred out of the said treatment, but in this case , the Complainant never ever approached the O.P. No.1 claiming his benefits out of the policy and straightway approached this Ld. Commission without giving any opportunity or bringing the said fact under the notice of the O.P. No.1.  It is further stated that there was no deficiency of service or negligence by the O.P. No.1 Hence, the claim is not tenable in law as such liable to be dismissed. 

           O.P. No.2, M/s. Peerless Financial Products Distribution has contested the claim raised by the Complainant by filing written statement refuting the allegations of the Complainant. The O.P. No.2 has denied negligence and deficiency on his part in dealing with the claim of the Complainant. O.P. No.2 in the written objection is stated that the present complaint is not at all maintainable either in law or on fact and in its present form. O.P. No.2 stated that pursuant to the Provisions of Insurance Act, 1938 read with IRDAI(Registration of Corporate Agent) Regulations 2015 being the Insurance Intermediary/Corporate Agent we neither have any authority nor control over the settlement of any claims. O.P. No.2 further stated that the Complainant has purchased a policy bearing No.PROHLRO 10624075 2018, but the same is always subject to certain terms and conditions, provisions, exceptions, coverage & non-coverage clauses as set forth in the policy. O.P. No.2 also stated that it is reiterated that the question of providing service comes only after the policy terms & conditions precedent are satisfied by the Complainant. So,the Corporate Agent the O.P. No.2 shall have no liability to settle any claim.  

 3. EVIDENCE ADDUCED BY THE PARTIES:

The Complainant examined himself as PW-I and submitted his examination in chief by way of affidavit. He has produced 5 documents comprising 9 sheets under a Firisti dated 28/09/2020 but documents are not exhibited.  

The O.P. did not adduce any evidence.  

 POINTS TO BE DETERMINED:- 

4.  Based on the contentions raised by both the parties the following issues were framed for determination:  

   (I). Whether  there was/is  any deficiency of service committed by the O.P. towards the Complainant?

    (ii). Whether the Complainant is entitled to get any  compensation/relief ?

5. At the time of argument no one appeared and it is decided to deliver the judgment on merit. Accordingly, judgment is delivered. 

6. DECISION AND REASONS FOR DECISION:

Both points are taken-up together for convenience for decisions. 

We have gone through the pleadings as well as the oral evidence adduced by Complainant. On perusal of the pleadings we found that the O.Ps. have taken a stand that the Complainant never approached the O.P. for making reimbursement and O.P. had no information about under going treatment of Complainant at ILS Hospital, Agartala from 28/09/2018 to 29/09/2018. O.Ps. also contended that the complaint is not tenable in law as such it is liable to be dismissed.  

7. In the instant case Complainant failed to adduce any documentary evidence and also marking the documents Exhibited. From the record it appears that Complainant was absent for long on the date fixed at the stage of filing of evidence by the O.Ps. Complainant simply submitted his oral evidence and it is not sufficient to prove the complaint. Since O.Ps. did not admit the complaint or the facts of the complaint the burden lies upon the Complainant to prove his complaint. Here Complainant did not adduce any documentary evidence as such we must hold that Complainant has failed to prove his complaint.

In the result, the complaint is dismissed.

      Supply a certified copy of the judgment to both the parties free of cost.    

 Announced.

 

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

 

 

 

SRI SAMIR  GUPTA

MEMBER,

 DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA.