Date of Filing:-17.07.2018 :

 Order No. - 10                                                                                   Dated-  6.12.2018.             

                                  F I N A L   O R D E R /JUDGEMENT

Sri Lakshmi Kanta Das, Ld. President

1)        This is an application u/s. 12 of the Consumer Protection Act, 1986 of Dr. Mithun Roy for compensation and other reliefs from the National Insurance Company Limited with the following averments :-

    The Complainant took a Mediclaim Policy from  the Opposite Party(National Insurance Company) on 22.5.2015 and the said policy due to the subsequent renewal remained effective till 22.5.2018.  The complainant developed right lower ureteric  calculus  for which he was treated at Neotia Getwell Health Care Centre, Siliguri, from 18.8.2017 till 21.8.2017 during which period he was operated upon. But the Insurer continued to pay the cost of aforesaid treatment amounting to Rs.86,707/- for which the cause of action accrued.

2)     The opposite party National Insurance Company Ltd. has taken  the pleas in support of its refusal of the claimed amount(Rs.86,707/-) that the complaint had pre-existing calculus touching upon clause-4.1 of the Insurance agreement.            

3)       It is admitted position that in 2010 operation was conducted upon the complainant in M.S. Ramaih Hospital in Bangalore for uroteric calcula.

4)       A perusal of the Insurance agreement reveals that clause-4.1 is limited to certain diseases such as, diabetic and hypertension as well as diabetes mellitus.

5)      There is no evidence on record on the  basis of which we can connect the                     operation conducted by Neotia Getwell Health Care Centre, Siliguri with the treatment the complainant receive in Bangalore. A man can develop uroteric calculus more than once during his life-time. It cannot be said in the absence of evidence that the uroteric calculus of the complainant continued to exist even after that  for years together.  

        6)            The plea taken by the Insurer has hopelessly failed.  There is no room for the insurer to escape the liability for incurring the risk of treatment he received in Neotia Getwell Health Care Centre, Siliguri.

        7)  The complainant is entitled to get cost of treatment amounting to Rs.86,707/- in addition to the compensation for the mental pain and agony he suffered and also litigation cost. The compensation sought for by the complainant for pain and agony is Rs.50,000/- which appears to be quite reasonable one.  Obviously he is expected to get a sum of Rs.10,000/- for running the litigation.  Therefore,the complainant will get from the insurer Rs.86,707 + 50,000 +10,000/- = Rs. 1,46,707/-.

            Hence, it is

                                                                  O R D E R E D :

              that the Consumer Case No.33 of 2018 be and the same is allowed on contest against the O.P with a litigation cost of Rs.10,000/-. The complainant is also entitled to get Rs.86,707/- towards compensation. The complainant is further entitled to get Rs. 50,000/- towards pain and agony suffered by him. As such the O.P National Insurance Company Limited, Jalpaiguri is directed to pay Rs.1,46,707/- in total by A/C payee cheque in the name of the complainant Dr. Mithun Roy within thirty days  from this day, failing which the amount shall carry interest @ 9% per annum from the date of filing of this case i.e on and from 17.7.2018.

Let the original documents, if any, filed by the parties be returned on proper receipt. 

Let a plain copy of this order be supplied free of  cost forthwith to the parties on proper acknowledgement or be sent by registered post with A/D, in terms of Rule-5(10) of the West Bengal Consumer Protection Rules, 1987 and the extra sets be returned to the parties on proper receipt.