West Bengal

Paschim Midnapore

CC/169/2012

Rahul Ranjan Maity - Complainant(s)

Versus

The Divisional Manager, United India Insurance Co. Ltd - Opp.Party(s)

04 Apr 2013

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

 

 Complaint case No.169/2012                                                        Date of disposal: 04/04/2013                               

 BEFORE : THE HON’BLE PRESIDENT :  Mr. K. S. Samajder.

                                                      MEMBER : 

                                                      MEMBER :  Mr. Kapot Chattopadhyay.

    For the Complainant/Petitioner/Plaintiff : Mr. S. Chakraborty. Advocate.

    For the Defendant/O.P.S.                           : Mr. M. K. Choudhury.  Advocate.

          

                 Rahul Ranjan Maity, S/O-Sunil Kumar Maity at Natunbazar, P.O. & P.S.-Midnapore

                 Town, Dist-Paschim Medinipur ……………………………Complainant.

                                                              Vs.

1. The Divisional Manager, United India Insurance Co. Ltd., Medinipur Divisional Office at Library Road, Battalachak, P.O. & P.S.-Midnapore Town, Dist-Paschim Medinipur
2. Heritage Health T.P.A. Pvt. Ltd., Nicco House, 5^th floor, 2-Here Street, Kolkata-700071……………………………Ops.

The complainant in this case claimed Rs.6,079/-(Six thousand seventy nine) towards cost of his treatment.

It is the case of the complainant that after sustaining an injury in a motor accident on 13/02/2012, the complainant was admitted in Midnapore Medical College and Hospital and discharged there from on 14/02/2012. For better treatment he was again admitted at Midnapore Nursing Home on 06/03/2012 and discharged therefrom on 07/03/2012. On 03/05/2012 the complainant preferred his claim to the Op. no.1 by filing up a claim form but claim was ultimately repudiated on the ground of delay.

Hence this case :-

The Op. no.1 contested this case by filing a written objection contending specifically that a sum of Rs.4,745/-(Four thousand seven hundred forty five) was found as admissible expenses as against the claim of Rs.6,079/-(Six thousand seventy nine) but the amount of admissible expenses was also not payable due to violation of terms and conditions of the policy. So the Op. no.1 prayed for dismissal of this case.

The Op. no.2 died not contest the case.

Contd…………..P/2

 

- ( 2 ) -

The only point for consideration is that whether the complainant is entitled to get the amount claimed.

Decisions with reasons

  Everything in this case is admitted save and except the amount and validity of the claim.

The claim of the complainant of Rs.6,079/-(Six thousand seventy nine). As against that the Op. no.1 found an amount of Rs.4,745/-(Four thousand seven hundred forty five)to be admissible expenses. During hearing Ld. Lawyer to the complainant fairly submitted that he did not stick to his claim of Rs.6,079/-(Six thousand seventy nine). He submitted that the complainant is willing to accept the amount of Rs.4,745/-(Four thousand seven hundred forty five)which has been found to be admissible  expenses by the Op. no.1.

Now, the Op. no.1 took the plea of delay. Accordingly to the Op. no.1 as per the terms and condition of the policy, the complainant was to intimate about the hospitalization within 24 hours from the date of admission and to submit the claim written the 15 days from the date of discharge.

In this case, if we strictly look at the terms and conditions then we may see that there was no intimation and claim on the part of the complainant within the stipulated time. But from the record we find that on two occasions the complainant had to be admitted in the hospital as well as nursing home. We should not be unmindful of the fact that after sustaining an injury in a accident one makes arrangement for treatment at first, not looks at complying with the terms and condition of the policy. Even after being released from the hospital it may not be possible for a person to make claim as per policy within the prescribed period because of concentrating on follow up treatment and other allied matters for the purpose of recovery. The Op. should have considered those aspects. The complainant being a consumer under Op. no.1 the latter should not have acted in a hyper technical manner and repudiated the claim. Possibly every action of the Op. no.1 is not unblemished keeping that view in mind the Op. no.1 should have consider the claim of the complainant with compassion.

Having regard to the aforesaid facts and circumstances of the case we find that complainant is entitled to get Rs.4,745/-(Four thousand seven hundred forty five)from the Op. no.1.

                 Hence it is,

                                     Ordered,

                                               that the case succeeds in part on contest against the Op. no.1 and exparte against the rest.

                 The Op. no.1 is hereby directed to pay Rs.4,745/-(Four thousand seven hundred forty five)

Contd…………..P/3

 

- ( 3) -

to the complainant. The Op. no.1 shall also pay Rs.500/- (Five hundred) to the complainant towards litigation cost. Both these amounts shall be paid by the Op. no.1 within 30 days from this date, otherwise, the total amount shall carry interest at the rate of 9% p.a. from the date of filing of this case till recovery of the entire amount.

Contesting parties be supplied with copy of this judgment free of cost.

 

Dic. & Corrected by me

              

         President                                             Member                                               President

                                                                                                                              District Forum

                                                                                                                         Paschim Medinipur.