Smt. Sharmi Basu ,Member

Order No.   10    Dated  18-02-2013.

            The case of the complainant in short is that complainant took a Individual Mediclaim Insurance Policy from o.p. no.2 in the year 2001 i.e. 10.4.01 and renewed the same after one year and the present policy further renewed on 19.4.10 to midnight of 18.4.11 and complainant’s policy number is 030800/48/10/20/00000254, premium of insured amount is Rs.3930/- and the total insured amount is Rs.1,00,000/-.

            Complainant states that due to Chymoral Torte and  other problem due to old age, complainant was admitted in the Micro Lab Nursing Home on 6.11.10 as per advice of Doctor Sougata Dev, M.S. FRCS and discharged on 7.11.10.

            Complainant states that then the complainant submitted his bill amount of Rs.14,804/- to o.p. but till the date they did not take any action for the complainant’s mediclaim insurance claim amount.

            Complainant sent several letters to o.p. and requested for payment the legitimate claim amount but no action taken by o.ps. till the date. Hence the case was filed by complainant with the prayer contained in the petition of complaint.

            O.p. no.1 had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them and prayed for dismissal of the case. O.p. no.2 did not contest the case by filing w/v and matter was heard ex parte against o.p. no.2. Ld. lawyer of o.p. no.1 in the course of argument submitted that the case has got no merit and the same is liable to be dismissed.

Decision with reasons:-

            We have gone through the pleadings of the parties, evidence and documents in particular and we find complainant took a Individual Mediclaim Insurance Policy from o.p. no.2 in the year 2001 i.e. 10.4.01 and renewed the same after one year and the present policy further renewed on 19.4.10 to midnight of 18.4.11 and complainant’s policy number is 030800/48/10/20/00000254, premium of insured amount is Rs.3930/- and the total insured amount is Rs.1,00,000/- and complainant was admitted in the nursing home on 6.11.10 for some ailment and was discharged on 7.11.10. Further we find from the record that complainant submitted claim of Rs.14,804/- and o.ps. neither repudiated nor allowed the claim.

            It is seen from the record that complainant was not defaulter at the relevant point of time i.e. at the time of submission of claim to o.ps. and repudiation of claim by o.ps. also amounts to deficiency of service and we do not find any justification for such action of o.ps. We are of the views that o.p. no.1 had sufficient deficiency in service being service provider to its consumer / complainant and complainant is entitled to relief.

            Hence, ordered,

            That the case is allowed on contest with cost against o.p. no.1 and ex parte without cost against o.p. no.2. O.p. no.1 is directed to pay to the complainant the claim amount of Rs.14,804/- (Rupees fourteen thousand eight hundred four) only and 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 @ 10% shall accrue over the entire sum due to the credit of the complainant till full realization.

            Complainant is at liberty to file execution case before this Forum in case of non execution of the aforesaid order in its entirety within the stipulated period under the provision of the COPRA, 1986.

            Supply certified copy of this order to the parties free of cost.