Ld. Advocate(s)
For Complainant: Shantanu Datta
For OP/OPs : None
Date of filing of the case : 07.10.2021
Date of Disposal of the case : 07.08.2023
Final Order / Judgment dtd. 07.08.2023
Complainant above name filed the this case against the aforesaid OPs u/s 35 Consumer Protection Act 2019 praying for direction to OP no. 1 and 2 for disbursement of Medical expense of complainant amounting to Rs. 17,857/- interest @ 12 % per annum, compensation amounting to Rs. 50,000/- and cost of the case amounting to Rs. 20,000/-.
He alleged in the petition that complainant is a employee of OP no. 3. At the time of employment he got the Medical benefit facility provided by OP no. 1 and 2.
There was a tie up in between OP no. 1 and 2 with OP no. 3 to the effect that OP no. 1 and 2 shall provide Medical expenses to the employees of the OP no. 3.
Complainant felt some problem in his Eyes and he visited Doctor Anup Kumar Goswami on 04.01.2020 and he diagnosed that complainant has cataract in his eye and Doctor Anup Kumar Goswami advised complainant to have surgery of his eye within 11.01.2021. He also advised some necessary test before surgery. Complainant informed the OP no. 3 about his aforesaid surgery. Complainnat did all the tests and took admission at Central Nursing Home, Krishnagar, Nadia on 11.01.2020 and he was released on the same day from the said Nursing Home after a successful Cataract Surgery. Thereafter, complainant visited the chamber of aforesaid Doctor on 3 occasions and paid consultation fees amounting to Rs. 300/- for his every visit. Thereafter, complainant submitted his claim along with necessary documents before the OP no. 1 and 2 on 19.02.2020 and claimed Rs. 17,857/-. OP no. 1 and 2 did not disburse the same sum despite receiving claim application from the complainant. Thereafter complainant sent e-mail to the OP n. 1 and 2 requesting them to disburse the aforesaid amount. OP no. 1 and 2 gave reply giving assurance that Medical Claim will be paid shortly. Thearafter, OP no. 2 sent letter to the complainant on 22.02.2020 asking him to submits KYC, Claim intimation copy of bill, original Doctors advise and complainant submitted all these documents to the OP no.1 and 2 but OP no. 1 and 2 did not disburse the said amount in his favour. Complainant sent one advocate letter to the OP no. 1 and 2 on 12.03.2021 but did not get any fruitful result.
Hence, complainant filed this case.
TRIAL
During trial complainant filed affidavit-in-chief
DOCUMENTS
Complainant produced following documents:
- Prescription of Dr. Anup Kr. Goswami dtd. 04.01.2020.( Xerox copy).
- Bill of Central Nursing Home dtd. 21.01.2020.
- Prescription of Dr. Anup Kr. Goswami dtd. 19.01.2020.( Xerox copy).
- Prescription of Dr. Anup Kr. Goswami dtd. 16.02.2020.( Xerox copy).
- Report of E.C.G dtd. 14.12.2019 ( Xerox copy).
- Bill of DR. SKS DIAGNOSTIC CENTRE, KRISHNANAGAR dtd. 14.12.2019. ( Xerox copy).
- Bill of DR. SKS DIAGNOSTIC CENTRE, KRISHNANAGAR dtd. 01.12.2020. ( Xerox copy).
- Copy of GST INVICE dtd. 19.01.2020. ( Xerox copy).
- Bill of Dutta Drug House dtd. 11.01.2020. ( Xerox copy).
- Cash memo of M/S TARULATA PHARMACY dtd. 19.01.2020. ( Xerox copy).
BNA
Complainant filed BNA.
DECISION WITH REASONS
We have carefully gone through the petition of complaint filed by the complainant, documents filed by the complainant, affidavit-in-chief filed by the complainant and BNA filed by the complainant.
On perusal of the affidavit-in-chief, we find complainant corroborated the allegation which he mentioned in the petition of complaint.
Moreover, aforesaid affidavit-in-chief is nothing but unchallenged testimony.
On perusal of the said documents we find that complainant being employee of OP no. 3 is entitled to Medical reimbursement of OP no. 1 and 2.
As OP no. 1-3 is not contesting the case, in this situation we have no other alternative but to believe the affidavit-in-chief of the complainant.
Placing reliance of the said document we find that complainant is entitled to Medical Reimbursement from the OP no. 1 and 2.
On perusal of prescription issued By Dr. Anup Kumar Goswami we find that complainant visited before him on 14.01.2020 and he advised him some test and directed the complainant for operation on his right eye.
On perusal of bill issued by owner of Nursing Home we find that total amount of the bill for the aforesaid operation of complainant was Rs. 18,804/-.
On perusal of prescription of Dr. Anup Kumar Goswami dtd 19.01.2020 and 16.02.2020 we find that complainant visited before him on those days.
We also find that complainant paid Rs. 60/- and Rs. 770/- for investigation. We also find that complainant purchased medicine for amounting to Rs. 163/-, Rs. 205/-, Rs. 141 and Rs. 114/-.
We also find that complainant has spent Rs. 150/- for ECG test.
On perusal of prescribed claim form we find that complainant submitted claim before OP no. 1 and 2 on 19.02.2020.
On perusal of copy of e-mail dtd. 23.07.2020 we find that complainant sent all the necessary documents to the OP no. 1 and 2.
On perusal of the copy of e-mail dtd. 27.07.2020 we find taht OP no. 3 asked to complainant to produce same documents .
On perusal of the e-mail dtd. 19.09.2020 we find that Mr. Subrata Dutta gave his reply.
On perusal of the document dtd. 22.07.2020 we find that OP no. 1 and 2 gave some direction to the OP no. 3.
On perusal of advocate’s letter dtd. 12.03.2021 we find that notice was served upon the authorised person of OP no. 1 and 2 by the complainant with the request to pay the medical bill in favour of the complainant.
On perusal of the record we find complainant is a consumer and OP is the service provider.
Having regard to the aforesaid discussion it is clear before us that complainant is entitled to reimbursement of the aforesaid amount of Rs. 17,857/- from the OP no. 1 and 2 and we do not find any reason to reject the said amount.
In the result present case succeeds.
Hence,
It is
Ordered
that the present case be and the same is allowed ex-parte against OP no. 1-3 with cost of Rs. 5,000/- to be paid by OP no. 1 -2 in favour of the complainant.
OP no. 1-2 jointly or severally are directed to pay RS. 17,857/- ( seventeen thousand eight hundred fifty seven) along with interest @ 9 % per annum from the date of filing of the claim i.e 19.02.2020.
OP no. 1 and 2 jointly or severally are directed to pay Rs. 10,000/- as compensation in favour of the complainant within 45 days from this date for his harassment , metal pain and agony.
OP no. 1 and 2 are directed to pay aforesaid amount within 45 days from this date failing which complaint shall have liberty to put this order into execution.
Let a copy of this order be supplied to both the parties as free of cost.
Dictated & corrected by me
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PRESIDENT
(Shri DAMAN PROSAD BISWAS,) .................................................
PRESIDENT
(Shri DAMAN PROSAD BISWAS,)
I concur,
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MEMBER
(NIROD BARAN ROY CHOWDHURY)
