Consumer Disputes Redressal Forum, Unit -I, Kolkata,

8B, Nelie Sengupta Sarani, Kolkata-700087.

CDF/Unit-I/Case No. 340 / 2009

1)           Sri Sankar Dutta,

Vill. Durganagar West, Kolkata-65.                         ---------- Complainant

1)           The General Manager,

National Insurance Co. Ltd.,

3, Middleton Street, Kolkata-71.

2)           The Divisional Manager,

National Insurance Co. Ltd.,

9, Shakespeare Sarani, Kolkata-71.

3)           The Manager, The Family Health Plan Ltd.,

16/2, Lake View Road, Kolkata-700029.                ---------- Opposite Party

Present :        Sri S. K. Majumdar, President.

                        Smt. Jhumki Saha, Member.

                        Sri T.K. Bhattacharya, Member

Order No.    6     Dated 1 7 / 0 3 / 2 0 1 0 .

Complainant, Sri Sankar Dutta by filing a petition u/s 12 of C.P. Act, 1986 (amended) on 1.9.09 has prayed for issuing direction upon the o.p. nos.1, 2, and 3 to make payment of his claim to the tune of Rs.14,809/- with interest @ 12% p.a. till final payment and to pay compensation of Rs.25,000/- for deficiency of service and for Rs.25000/- as compensation for harassment and mental agony.

          Main grievance of the complainant is that he is a policy holder under policy no.100701/46/06/8500045 under UHID no. FHKN-0000476931 with the o.ps. who denied and disallowed the operation fee of Rs.12000/- which was incurred by the complainant for the surgical operation of his wife, Smt. Doly Dutta who was admitted to Popular Nursing Home Pvt. Ltd. on 16.12.06 and was released therefrom on 23.12.06 His total expenditure was Rs.24,816.80 and he has all the relevant documents for the medical treatment of his wife including the expenses for operation.

          The o.ps. after much persuasion issued him a cheque of Rs.10,007/- disallowing his actual claim of Rs.24,816.80 including the operation charge on the ground of non-availability of money receipt.

          The complainant submitted a duplicate money receipt along with the copy of the bill for Rs.12,000/- and the bill was signed by the physician dt.21.6.08. The complainant on several times requested the o.ps. to pay for his entire claim of Rs.24,816.80, byt as his claim was denied to the extent of Rs.14,809/-, the complainant finding no other alternative has filed this case against the o.ps. with the aforesaid prayers.

Decision with reasons :-

          It appears on perusal of the record that even in spite of receipt of notice vide order no.4 dt.9.12.09, the o.ps. have not come to contest this case and accordingly, the case is heard ex parte.

          Main points need be decided in this case are that (i) whether the claim of the complainant is justified and (ii) whether there is deficiency of service and / or unfair trade practice committed by the o.ps.

          U/s 58 of the Indian Evidence Act, admitted fact need not be proved. By giving a cheque of Rs.10,007/- the o.ps. have admitted that Smt. Doly Dutta , the wife of the complainant was admitted to Popular Nursing Home and by disallowing the claim of operation charge of Rs.12,000/-, they have interalia and ifsofacto, admitted that he claim of the complainant is not unjustified. So they admitted surgical operation of the wife of the complainant.

          Their main grievance is that for non-availability of money receipts the complainant is not entitled to operation charge of Rs.12000/- for his wife, Doly Dutta. We have perused the duplicate money receipt dt.21.6.08 with item wise fees/charges comprising of anesthetist fees Rs.1500/-, surgeon’s fee Rs.5000/- etc.

          The case was filed on 1.9.09. We should not loose sight of the fact that it is an age of computer; so duplicate of any document is always and readily available only by the device of ‘click’ of the bottom of the computer and the print out of the same is also easily available. Further, we have already mentioned that the complainant had supplied the copy of the same on 21.6.08. In that event, the repudiation and disallowing of his claim of Rs.1200/- is nothing better than a lame excuse only motivated to avoid claim of the complainant involving the question of not only deficiency of service but also unfair trade practice on the part of the o.ps. Accordingly, we like to conclude that the claim of the complainant is quite justified.

          that the case is allowed ex parte against the o.ps. The o.ps. are directed to make payment of Rs.14809/- (Rupees fourteen thousand eight hundred nine) only to the complainant along with compensation of Rs.10,000/- (Rupees ten thousand) only and litigation cost of Rs.1000/- (Rupees one thousand) only positively within forty five days from the date of communication of this order, failing which, grand total of Rs.25809/- (Rupees twenty five thousand eight hundred nine) only will carry interest @ 10% p.a. till full realization. Fees paid are correct.

          Supply certified copy of this order to the parties on payment of prescribed fees.