DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

WEST TRIPURA :  AGARTALA

 

 

CASE   NO:   CC-  37  of 2017

 

 

Sri Sidhartha Sekhar Banik,

S/O- Late Srinibash Banik,

9, Thakurpalli Road,

Bidurkarta Chowmuhani,

Agartala, West Tripura. .....…...Complainant.

 

 

                      VERSUS

 

 

       1. The General Manager,

Cholamandalam MS General Insurance Co. Ltd.,

2nd Floor, 2 NSC Bose Road,

Chennai- 600 001.

 

 

      2. The Manager,

Cholamandalam MS General Insurance Co. Ltd.,

Akhaura Road, Agartala,

West Tripura. .......... Opposite parties.

 

 

 

                      __________PRESENT__________

 

 SRI A. PAL,

PRESIDENT,

  DISTRICT CONSUMER  

DISPUTES REDRESSAL FORUM,

      WEST TRIPURA, AGARTALA. 

 

SMT. Dr. G. DEBNATH

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL FORUM, 

  WEST TRIPURA,  AGARTALA.

 

SRI U. DAS

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL FORUM, 

  WEST TRIPURA,  AGARTALA.

 

C O U N S E L

 

For the Complainant : Sri Anjan Kanti Pal,    Advocate.

 

For the Opposite Parties : None appeared.    

 

 

JUDGMENT  DELIVERED  ON:   01.06.2017

 

 

J U D G M E N T

 

This case arises on the petition filed by Sidhartha Sekhar Banik U/S 12 of the Consumer Protection Act. Petitioner's case in short is that he purchased one Health Master Policy from the O.P. Insurance Company on 23.07.13. The policy was valid from 19.07.13 to 18.07.14. It covers his illness and illness of his family members(wife and children). During the life of the policy certificate he met an accident and was under treatment in the nursing home at Silchar local hospital. He claimed the amount spent as medical expenses. But the expenditure incurred was not paid by the O.P. so this case filed for compensation for the deficiency of service. 

 

2. Notice served on O.P. No.1 and 2 General Manager, Cholamandalam, Chennai and Manager, Cholamandalam, Akhaura Road, Agartala but no step taken by the O.P. so case proceeded exparte.

 

3. Petitioner produced legal notice, medical expenses, G.D. Entry, letter, Driving license, prescription, Insurance certificate, cash memos, Service certificate, bank statement.

 

4. We have gone through all these documents and also gone through the statement on affidavit produced on behalf of the complainant. From the perusal of the policy certificate it is found that total sum insured was Rs.2 Lacs and also period was from 19.07.13 to 18.07.14. The name of the policy was 'Family Health Silver'. Petitioner met accident on 10.06.14. 

 

5. We have gone through the Certificate of the O/C regarding G.D. Entry dated 18.01.15. We have also gone through the prescription voucher as produced by the petitioner. From the prescription voucher it is found that huge amount was spent for the treatment. It is found that in total Rs.4,53,058/- was spent for treatment. But insurance coverage is not to that extent. It is up to Rs.2 lacs. Petitioner submitted the claim before the insurance company on 14.06.16. List of Medical expenditure with medical bills, F.I.R., G.D. Entry, Hospital Admission copy, Certificate of Cholamandalam General Insurance all produced but the claim is not settled till today. For such deficiency of service petitioner suffered. Cholamandalam Insurance Company did not assign any reason for such delay in settling the claim. Petitioner paid Rs.5100/- as premium for coverage of his health risk from 19.07.13 to 18.07.14. During the policy certificate period he suffered the illness and spent huge amount for treatment purpose. He claimed the amount. The coverage Rs.2 lacs could have been paid by the O.P. but it was not paid which is definitely deficiency of service by O.P. Insurance company. For this deficiency of service petitioner suffered and entitled to get compensation Rs.15,000/- petitioner is also entitled to get the sum insured Rs.2 lacs for treatment expenditure. Petitioner is also entitled to get Rs.5000/- for litigation cost.

 

6. We therefore direct the O.P. Insurance company to pay Rs.2,20,000/- to the petitioner for deficiency of service and sum insured fix for treatment cost also litigation cost. Payment is to be made within 2 months if not paid it will carry interest @ 9% P.A. 

 

 

Announced.

 

 

 

SRI A. PAL

PRESIDENT,

DISTRICT CONSUMER  DISPUTES 

REDRESSAL FORUM,

WEST TRIPURA,  AGARTALA.

 

 

 

SMT. DR. G. DEBNATH,

MEMBER,

 DISTRICT CONSUMER DISPUTES 

REDRESSAL FORUM, 

WEST TRIPURA, AGARTALA SRI U. DAS

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL FORUM, 

  WEST TRIPURA,  AGARTALA.