In the Court of the Consumer Disputes Redressal Forum, Unit -I, Kolkata, 8B, Nelie Sengupta Sarani, Kolkata-700087. CDF/Unit-I/Case No. 266 / 2008 1) Smt. Shyama Ghosh, N-255, Fathepur 2nd Lane, Garden Reach, Kolkata-24. ---------- Complainant ---Verses--- 1) The Divisional Manager, The New India Assurance Co. Ltd., 18/2, Gariahat Road, Kolkata-700024. 2) The Branch Manager, The New India Assurance Co. Ltd., 39, D.H. Road, Kolkata-700008. 3) E-Meditek Solutions Ltd., 8, Camac Street, Kolkata-19. ---------- Opposite Party Present : Sri S. K. Majumdar, President. Sri T.K. Bhattachatya, Member. Order No. 1 1 Dated 2 7 / 1 1 / 2 0 0 9 . Complainant Smt. Shyama Ghosh (Bhattacharjee), wife of Sri Prabhat Ghosh by filing a petition u/s 12 of the C.P. Act, 1986 on 8.8.08 has prayed for issuing direction upon the o.ps. to pay the cost of medical test amounting to Rs.1620/- along with interest @ 12% p.a. and compensation of Rs.500/- per month and litigation cost of Rs.5000/- payable by the o.p. nos.1 to 3. Fact of the case in short is that the complainant is an insured person bearing the claim policy no.51063/48/06/20/70001536 including her family members under the mediclaim insurance policy MIP under the New India Assurance Co. Ltd, Thakurpukur Branch for a sum assured of Rs.50,000/- from the date of inception of the policy dt.9.7.01. On 18.11.06 the daughter and the husband of the complainant attended to the Tribedi and Roy Diagnostic Laboratory at 93, Park Street, Kolkata-16 for medical test and on 20.11.06 and 3.1.07 the petitioner also attended the said diagnostic laboratory and they had to spend Rs.1620/- for such medical check up. On 19.2.08 complainant made application to pay the cost of such medical test as per the condition of policy, but even after repeated persuasion they did not pay such cost of medical test and since inception of the policy i.e. 9.7.01 the complainant has been renewing the policy till date without any break, but as the o.ps. have not paid the said sum of Rs.1620/- the complainant has filed this case with the aforesaid prayer. The o.p. no.3 did not file the w/v. The o.p. nos.1 and 2 had filed their w/v on 9.1.09 wherein they have admitted that the complainant is a mediclaim policy holder under them and they have challenged that the case is bad for non-joinder of necessary parties, that the complainant is not a consumer etc. and they have also claimed that there is no deficiency of service on their part but they have admitted the sum assured amounts to Rs.50,000/- and they have challenged that other than the applicant two other insured persons have not been made parties, so the case is bad for non-joinder of necessary parties. Their specific case is that in addition to cumulative bonus the insured shall be entitled to reimbursement of cost of medical check up whereas at the end of block of every four consecutive years provided there are no claim reported during that block period and as per their rules, the complainant is entitled to Rs.1000/- for medical check up for two persons each for Rs.500/- only. And in terms of Clause 10 of mediclaim policy the applicant’s husband and daughter are entitled to get reimbursement of Rs.500/- each towards health check up subject to production of their individual cash receipt. The o.ps. sent an account payee cheque bearing no.235432 dt.5.12.08 to the petitioner, but it was returned with the postal remark ‘refused’ by the applicant herself. So there is no deficiency of service on the part of the o.ps. and accordingly, the case is liable to be dismissed. Decision with reasons : The main point to be decided is that whether the complainant for medical check up is entitled to get Rs.1620/- or Rs.1000/- as claimed and sent by the o.p. through cheque. The complainant refused to accept it and it is the specific case of o.p. nos.1 and 2 that as per their rule the complainant in every four years block entitled to get Rs.5000/- each for medical check up. We have also perused the affidavit of examination in chief of the complainant wherein she has stated that the complainant has admitted that the o.ps. have admitted that she is an insured person for the mediclaim of herself and her daughter and husband. The o.p. nos.1 and 2 have also filed their affidavit of examination-in-chief wherein they have also stated that the complainant, her husband and her daughter are entitled to be reimbursed @ Rs.500/- each towards the medical check up subject to production of cash memo. The complainant according to the o.ps. is entitled to get Rs.1000/-only out of the claimed amount of Rs.1620/-. Both of them have submitted their B.N.A. We have also perused the insurance policy and the sum insured for each i.e. the complainant, her husband Prabhat Ghosh and daughter Samita Ghosh is Rs.50,000/- each. Test for total charges as it appears from the receipt dt.18.11.06 amounts Rs.1120/-. Annex-B is the test report. The petitioner has submitted a letter dt.19.2.08 addressed to the Manager, New India Assurance Co. Ltd. o.p. no.1 and o.p. no.3 E-Medicate Solution Ltd. wherein it has been stated that health check up benefit will be accrued after completion of four years continuous claim, that condition has been satisfied. And the amount claimed there is Rs.1120/-. We have also perused the cheque bearing no.235432 dt.5.12.08 sent by the o.p. to the petitioner. But it has been refused by the petitioner. Therefore, considering the facts, circumstances and evidence on record, we are of the opinion that the petitioner is entitled to get the benefit as ordered hereunder. Hence, Ordered, That the petition of compliant is allowed in part on contest against o.p. nos.1 and 2 and ex parte without cost against o.p. no.3. The petitioner is entitled to get Rs.1000/- (Rupees one thousand) only as medical check up reimbursement payable by the o.ps. and to pay litigation cost of Rs.500/- (Rupees five hundred) only. So, the grand total of Rs.1500/- (Rupees one thousand five hundred) only is to be paid by the o.ps. positively within thirty days from the date of communication of this order, failing which it will carry interest @ 10% p.a. till full realization. Fees paid are correct. Supply certified copy of this order to the parties on payment of prescribed fees. ____Sd-______ ______Sd-______ MEMBER PRESIDENT | 
