In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, 4th Floor, Kolkata-700087.
CDF/Unit-I/Case No. 244/2011.
1) Abira Thakkar,
2) Jigar Thakkar,
3) Aakansha Thakkar,
All residing at 15, Bechulal Road,
Block-C, Flat-5, Kolkata-14. ---------- Complainants
---Versus---
1) The Manger,
Bajaj Allianz General Insurance Co. Ltd.
57, Chowringhee Road, 2nd Floor,
Horizon Building A,
P.S. Shakespeare Sarani, Kolkata-71.
2) The Manager,
Bazaz Allianz General Insurance Co. Ltd.
GE Plaza, Airport Road, Yerwada, Pune-411006. ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri, Member.
Smt. Samiksha Bhattacharya, Member
Order No. 18 Dated 22-07-2013.
The case of the complainant in short is that husband of complainant no.1 Lae Manish Thakkar got Health Insurance Policy being policy no.OG-10-2401-6004-0000 2303 on 12.11.09 valid for one year for Rs.2 lacs from the o.p. no.1 and it was expired on 12.11.10, thereafter o.p. no.1 issued another health insurance policy to the said Manish Thakkar by receiving a sum of Rs.5746/- as premium being policy no.OG-11-2401-6004-0000 1998 on 12.11.10 valid for one year for Rs.2 lacs on the terms and conditions that during the validity period of aforesaid policy the o.ps. shall indemnify /pay the medical expenses upto Rs.2 lacs incurred in the medical treatment of the said Manish Thakkar.
O.ps. further agreed to pay Rs.10,000/- as bonus for not claiming in the previous year and Rs.1000/- per day as hospital cash benefit for a maximum period of 30 days.
On 21.4.11 complainant no.1 claimed the whole amount of health insurance policy i.e. Rs.2,25,000/- (Rs.2 lacs policy amount + Rs.10,000/- bonus + Rs.16,000/- as hospital cash benefit for 16 days) and submitted all the relevant documents, papers and receipts of medical expenses in original to o.p. no.1 and still lying with him.
O.ps. repudiated the claim by letter dt.2.5.11.
On 13.5.11 complainant no.1 gave legal notice to o.ps. through her ld. advocate asking them to pay Rs.2,26,000/- the medical expenses as per the terms and conditions of the health insurance policy, within a week from the receipt of the notice.
O.ps. failed and neglected to comply the said legal notice. Hence the case was filed by the complainant with the prayer contained in the petition of complaint.
O.ps. 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. Ld. lawyer of o.ps. 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 that On 21.4.11 complainant no.1 claimed the whole amount of health insurance policy i.e. Rs.2,25,000/- (Rs.2 lacs policy amount + Rs.10,000/- bonus + Rs.16,000/- as hospital cash benefit for 16 days) and submitted all the relevant documents, papers and receipts of medical expenses in original to o.p. no.1 and still lying with him. But We further find that the claim was repudiated on 2.5.11. It is an admitted position that complainants were not defaulter at the relevant point of time and one is not supposed to know what sort of disease one is carrying and Hon’ble Apex Court observed in CTJ May 2010 Vol-18 No.5 Page 66 that insurance company is bound to pay some portion of the claim whilst insured claims were not found defaulter at the relevant point of time.
In view of the findings above and having due regards to the decision of the Hon’ble Apex Court we are of the views that o.ps. had sufficient deficiency being service provider to their consumers / complainants and complainants are entitled to relief in part.
Hence, ordered,
That the case is allowed on contest with cost against the o.ps. O.ps. are jointly and/or severally directed to pay to the complainants a sum of Rs.1,50,000/- (Rupees one lac fifty thousand) only (non standard basis) towards medical expenses and are further directed to pay compensation of Rs.40,000/- (Rupees forty thousand) only for harassment and mental agony and litigation cost of Rs.10,000/- (Rupees ten thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 10% p.a. 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.
