This case has been filed U/s.12 of the Consumer Protection Act, 1986 by the complainant that in the year 2002 and 2003 the complainant had taken medical policy vide no. 153602501710000047, from opposite parties company for himself and his wife and his father and the complainant is the sole proposal of said policy and since 2002-03 has been paid regular premium in respect of said policy to opposite party and at the time of renewal of he said policy the complainant each and every year has submitted all relevant documents like voter card, PAN card, Aadhaar card each insured person to opposite party concern and after perusing all documents submitted by the complainant to opposite party issued the policy certificate in favour of the complainant and collected premium money against the said policy and in the year 2015-16 one of the insured namely Panchanan Pan was hospitalized due to his serious illness and thereafter opposite party concern has duly paid the said medical expenses amount in favour of the complainant and said policy was valid till 1.1.2019 and during that said policy period one of the insured namely Panchanan Pan was hospitalized on 28.7.2018 due to his serious illness and he was discharged on 3.8.2018 and all medical bill and expenses were submitted by hospital to opposite party concern and requested to the opposite party to pay the said expensed amounting of Rs. 85,000/- in favour of the complainant and thereafter opposite party concern in the month of August 2018 has issued a notice to the hospital regarding the correction of age of patient Panchanan Pan and on 16.1.2019 the complainant through her ld. Advocate has sent legal notice through registrar post with A/D to the opposite party with a request to pay the said claim amounting to Rs. 85,000/- in favour of the complainant but the opposite party after receiving the said legal notice neither gave any reply nor pay any claim amounts to the complainant so which is tantamount to deficiency in service by the opposite party.
The complainant also states that thus, the opposite aprty failed to provide that service to the complainant and performed unfair trade practice and the opposite parties are guilty of deficiency of service and they have caused mental agony and harassment to the complainant and the complainant has every right to get the said medical amounting to Rs. 85,000/- from opposite party as because since in the year 2002 the complainant regularly use to pay policy premium amount to opposite party and submitted all necessary documents at the time of renewal of the said policy each and every year and moreover, previously opposite party had also paid medical expenses in respect of insured Panchanan Pan and so that the complainant is the bona fide consumer under the said policy and has every right to get said medical expenses amounting of Rs. 85,000/- from opposite party and the cause of action of this case arose on 28.7.2018 when one of the insurer namely Panchanan Pan was admitted in the said nursing home and on 16.1.2019 when the complainant through his ld. Advocate by legal notice requested to the opposite parties to pay the said claims amounts to the complainant and after receiving the said legal notice the opposite party keep silent regarding the said claims and till is continuing.
Complainant filed the complaint petition praying direction upon the opposite party to pay sum of Rs. 85,000/- along with interest and to pay a sum of Rs. 30,000/- for mental agony for deficiency in service and to pay a sum of Rs. 15,000/- as compensation as well as litigation cost.
Issues/points for consideration
- Whether the complainant is the consumer of the opposite party or not?
- Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?
- Whether there is any deficiency of service on the part of the opposite party?
- Whether the complainant is entitled to get relief or not?
DECISIONS WITH REASONS
All the points are taken together for easiness of the discussions of this case.
- In the light of the discussion hereinabove and from the materials on record, it transpires that the complainant is a Consumer as provided by the spirit of Section 2 (1) (d) (ii) of the Consumer Protection Act, 1986, the complainant here in is a consumer of the opposite party.
- Both the complainant and the opposite party are residence/having their office addresses within the district of Hooghly. For mental agony and other expenses which is within Rs. 2,00,000/- limit of this Forum. So, this Forum has territorial/pecuniary jurisdiction to entertain and try the case.
- The complainant stated that there is deficiency of service on the part of the opposite parties when the original medical bills and expenses were submitted by the complainant to the opposite parties authority concerned and requested them the said expense amount but the opposite parties authority concerned repudiated the said claim without giving proper reason thereafter the complainant sent legal notice to the opposite parties but the opposite party neither gave any reply nor pay any claim amount to the complainant which tantamount of deficiency of service on the part of the opposite parties.
The complainants state and argued that all original medical bills and expenses were submitted by the complainant to the opposite parties authority concerned and requested them to pay the said expense amounting near about Rs. 25,000/- in favour of the complainant but the opposite parties authority concerned on 7.3.2018 repudiated the said claim without citing proper reason. Thereafter the complainant on 4.7.2019 sent a letter through his ld. Advocate Md. Rajib by registered post with AD to the opposite parties with a request to pay the said claim amount of Rs. 25,000/- in favour of the complainant but the opposite parties after receiving the said legal notice neither gave any reply nor paid any claim amount to this complainant. The complainant contents that there is clear deficiency of service on the part of the opposite parties.
Though received notice, the opposite parties in this case neither appeared nor filed any steps or written versions and failed to contest the case and the case is fixed for ex parte hearing against the opposite parties.
It is hold that the complainant has been abled to prove the deficiency of service against the opposite parties. In this connection to prove this case some documents have been filed by the complainant such as brief note of argument, letter sent by the complainant to the opposite parties, medial prescription, bill, advocate notice.
The opposite parties also did not come to the ld. Forum to challenge the case of the complainant as alleged. The uncontested and unchallenged testimonies of the complainant prove the case of the complainant. Thus, the case succeeds ex parte and as such the complainant to get the relief as prayed for. There is nothing to disbelief the complaint of the complainant.
- The complainant has every right to get the medical expenses amounting of near about Rs. 85,000/- from opposite parties authority concerned as because since long year the complainant regularly use to pay policy premium amount the opposite parties authority concerned. Moreover as per advice of doctors the complainant was admitted before the nursing home for his treatment. So, the complainant is the bonafide consumer under the said policy and has every right to get medical expenses amounting near about Rs. 85,000/- from opposite parties authority concerned. So, he is entitled to get relief as prayed for.
Hence,
it is
ordered
that the complaint case is allowed ex parte against the opposite parties with a litigation cost of Rs. 5000/-.
The opposite parties are directed to pay the sum of Rs. 85,000/- and to pay the sum of Rs. 10,000/- as compensation for mental pain, agony and harassment to the complainant.
All the payments are made within 45 days from the date of this order. At the event of failure to comply with the order opposite party shall pay cost of Rs. 50/- for each day delay, if caused on expiry of 45 days by depositing the amount in the Consumer Legal Aid Account.
