In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, Kolkata-700087.
CDF/Unit-I/Case No. 264 / 2008.
1) Shaboob Ali,
33/A, Garden Reach Road, Kolkata-700024. ---------- Complainant
---Versus---
1) The Divisional Manager, The New India Assurance Co. Ltd., Unit-501603,
18/2, Gariahat Road, Neelanjan, Kolkata-700019.
2) The Branch Manager, The New India Assurance Co. Ltd., Unit-501603,
39, Diamond Harbour Road, Kolkata-700008.
3) E-Meditek Solutions Ltd.
Santiniketean Building, Room-5, 1st Floor,
8, Camac Street, Kolkata-700019. ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. A. B. Chakraborty, Member
Order No. 2 8 Dated 1 0 / 0 1 / 2 0 1 2 .
The petition of complaint u/s 12 of the C.P. Act, 1986 has been filed by Shaboob Ali against the o.ps. New India Assurance Co. Ltd. and others. The case of the complainant in short is that he had a mediclaim policy bearing no.510403/34/07/20/0000/499 with o.p. no.2 and the sum was assured Rs.1 lakh w.e.f. 2.7.07. Further case of the complainant is that on 25.9.07 complainant met with a road accident and was seriously injured and on 27.9.07 he was admitted by the advice of the doctor at Bellona Nursing Home and Diagnostic Centre and further case of the complainant is that complainant tried to take cashless facility for his treatment but due to non availability of photo card complainant could not take his reasonable chance and complainant paid entire billing amount of nursing home for his treatment and was discharged on 29.9.07. Thereafter complainant preferred a claim as against the mediclaim of Rs.29,266/- and the claim was submitted on 10.12.07 with o.p. no.2 but till date o.ps. failed to take any steps, as a result complainant on 20.12.07 had been to the office of o.p. no.2 and enquired about and came to learn that o.p. no.2 has sent the claim form to o.p. no.3 being claim adjudication authority of adjudication of the claim and on 24.12.07 agent of the complainant went to the office of o.p. no.3 and on inquiry o.p. no.3 received the document in respect of claim of the applicant dt.17.12.08 and o.p. no.3 told the agent of the complainant that the claim of the applicant will be adjudicated within a short while but no step was taken and on 26.2.08 complainant made a representation to o.p. no.3 for releasing claim amount. But no step was taken by o.ps. and on 15.1.08 complainant submitted a letter showing the reason for delay submission and o.ps. did not meet up the claim of the complainant despite thorough correspondences and persuasion. Hence, the instant case.
O.p. nos.1 and 2 contested the case entering their appearance by filing w/v and denied all the material allegations labeled against them and prayed for dismissal of the case. O.p. no.3 did not enter its appearance and matter was fixed for ex parte as against o.p. no.3.
Decision with reasons:
We have gone through the evidence of the complainant and the o.p. nos.1 and 2 and the documents lying with the record meticulously and it is an admitted position as it appears from the record with that the policy in question was cashless facility as has been admitted by the complainant vide para 3 of the complainant. He made payment of Rs.29,266/- for his treatment in the aforesaid nursing home and for which he preferred claim as against the said mediclaim policy. We have gone through policy and the medical papers as well as claim report and the it is seen from the policy itself that the claim was within the period of the mediclaim policy in question. It is not understood as to what prompted the o.ps. to repudiated the claim of the complainant. we are of the view that the complainant had bona fide claim and o.ps. are duty bound on the strength of mediclaim policy to make payment of the claim policy amount. And we find that there is deficiency on the part of the o.ps. being service provider to his consumer / complainant and complainant is entitled to relief as prayed for.
Hence, ordered,
That the petition of complaint is allowed on contest with cost as against o.p. nos.1 and 2 and ex parte as against o.p. no.3. O.ps. are hereby directed to pay a sum of Rs.29,266/- together with interest @ 9% p.a. from the date of claim till the date of realization to the complainant. O.ps. are further directed to pay a sum of Rs.50,000/- (Rupees fifty thousand) only as compensation for harassment and mental and litigation cost of Rs.2000/- (Rupees two thousand) only to the complainant. O.ps. are jointly and severally directed to pay the aforesaid amount as ordered above within 45 days from the date of communication of this order, i.d. an interest @ 9% p.a. shall carry over the entire sum due to the credit of the complainant till the date of realization.
Supply certified copy of this order to the parties.
_____Sd-_______ ________Sd-_________
MEMBER PRESIDENT
