In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, Kolkata-700087.
CDF/Unit-I/Case No. 357/2009.
1) Sibani Dey ,
Daughter of Santi Ranjan Ghosh,
264, Dakshin Behele Road, Radha Krishna Pally,
P.S. Thakurpukur, Kolkata-61 --------- Complainant
---Versus---
1) The Divisional Manager,
The New India Assurance Co. Ltd. Unit-510603,
18/2, Gariahat Road, P.S. Gariahat,
Neelanjan, Kolkata-19.
2) The Divisional Manager,
The New India Assurance Co. Ltd. Unit-510603,
39, Diamond Hurbour Road, Kolkata-08.
3) E-Meditek Solutions Ltd. service through its
Manager, Santinikaton Building, Room No.5, 1st Floor,
P.S. Shakespeare Sarani, 8, Camac Street, Kolkata-19 ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri, Member
Smt. Sharmi Basu, Member
Order No. 31 Dated 24/09/2012.
The petition of complaint has been filed by the complainant Sibani Dey against the o.ps. New India Assurance Co. Ltd. and others. The case of the complainant in short is that complainant has got herself insured under Universal Health Insurance Policy under o.p. no.1 and the policy was dated 27.3.07 and the claim policy no.510603/34/06/66/00001435 from 27.3.07 to 26.3.08 and complainant was not defaulter. Further case of the complainant is that she was admitted in the Bangur Medicare Research Institute (P) Ltd. on 23.3.08 for her treatment of injury sustained dueto road accident and incurred Rs.35,892.30 and was discharged on 30.3.08 and submitted claim before Medicare TPA Services on 21.7.08 but said company returned the said claim on 21.8.08 with a reply that they are TPA and thereafter the claim was placed before o.p. no.1 on 15.9.08 but no repudiation was there despite repeated persuasion by complainant. Hence the case.
O.p. nos.1 and 2 had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them. Ld. lawyer of o.ps. in the course of argument submitted that the instant case has got no merit and is liable to be dismissed. O.p. no.3 did not contest the case by filing w/v and matter was heard ex parte against o.p. no.3.
Decision with reasons:
We have gone through the pleadings of the parties, evidence and documents in particular and we find that complainant was not at all defaulter at the relevant point of time and it is surprising to take note as to what prompted o.ps. not to entertain her claim and this caused much harassment to the complainant. It is seen from the record that o.ps. neither repudiated the claim nor made any reference as regards the claim of the complainant.
In view of the above position and on perusal of the entire materials on record we are of the views that complainant was not at all defaulter and is entitled to relief and o.ps. had sufficient negligence on their part being service provider to their consumer / complainant.
Hence, ordered,
That the petition of complaint is allowed on contest with cost against o.p. nos.1 and 2 and ex parte without cost against o.p. no.3. O.p. nos.1 and 2 are jointly and/or severally directed to pay the medical expenses incurred by complainant for her treatment for Rs.35,892.30 (Rupees thirty five thousand eight hundred ninety two and paise thirty) only together with interest @ 9% p.a. from the date of claim till the date of realization and are further directed to pay compensation of Rs.10,000/- (Rupees ten thousand) only for harassment and mental agony and litigation cost of Rs.3000/- (Rupees three thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 9% shall accrue over the entire sum due to the credit of the complainant till full realization.
Supply certified copy of this order to the parties free of cost.
