This case has been filed U/s.12 of the Consumer Protection Act, 1986 by the complainant that since long year the complainant had taken vide policy no. 153602/48/16/8500003538 from the opposite party company for himself, wife and mother and he is the sole proposal of said policy and the complainant since long years has been paid regular premium in respect of said policy to opposite party authority concern and at the time of renewal of the said policy the complainant each and every year has submitted all relevant documents like Voter Card, PAN card each insured person to opposite party authority concern and after perusing all documents submitted by the complainant opposite party authority concern issued the policy certificate in favour of the complainant and collected premium money for the said policy and on 2.1.2018 he paid premium to opposite party authority concern against the policy certificate to opposite party authority concern and after receiving the said amount issued policy certificate being no. 153602501710000042 and valid to 1.1.2019 and on 3.10.2017 the complainant was suffering from serious knee pain and he was treated by doctor who advised/referred him to any state General Hospital or Medical College for that treatment and thereafter on 10.10.2017 the complainant went to Swasthya Nivas Nursing Home for his said treatment wherein R.M.O. after considering the serious pain along with situation of the patient took admission in the nursing home for his treatment and thereafter the complainant since 10.10.2017 to 13.10.2017 was admitted and under treatment by the nursing home and thereafter he was discharged from that nursing home on 13.10.2017.
The complainant also states that all original medical bills and expenses were submitted by the complainant to opposite party Authority concern and requested them to pay the said expensed amounting of near about Rs. 25,000/- in favour of the complainant and thereafter opposite party authority concern on 7.3.2018 repudiated the said claim without giving proper reason and on 4.7.2019 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 amounts of Rs. 25,000/- 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 and the opposite party 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.
The complainant also states that the complainant has every right to get the said medical amounting of near about Rs. 25,000/- from opposite party authority concern as because since long year the complainant regularly use to pay policy premium amount to opposite party authority concern and moreover as per advice of Doctors the complainant was admitted before the nursing home for his treatment and so that the complainant is the bona fide consumer under the said policy and have every right to get said medical expenses amounting of near about Rs. 25,000/- from opposite party authority concern and the cause of action of this case arose on 10.10.2017 when this complainant was admitted in the said nursing home and thereafter on 7.3.2018 when the opposite party repudiated the said claim and lastly on 4.7.2019 when the complainant through his ld. Advocate sent a legal notice and requested to the opposite party 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. 25,000/- along with interest and to pay a sum of Rs. 20,000/- for mental agony and to pay a sum of Rs. 10,000/- for 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 party when the original medical bills and expenses were submitted by the complainant to the opposite party authority concerned and requested them the said expense amount but the opposite party authority concerned repudiated the said claim without giving proper reason thereafter the complainant sent legal notice to the opposite party 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 party.
The complainants state and argued that all original medical bills and expenses were submitted by the complainant to the opposite party authority concerned and requested them to pay the said expense amounting near about Rs. 25,000/- in favour of the complainant but the opposite party 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 party with a request to pay the said claim amount of Rs. 25,000/- in favour of the complainant but the opposite party 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 party.
Though received notice, the opposite party 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 party.
It is hold that the complainant has been abled to prove the deficiency of service against the opposite party. In this connection to prove this case some documents have been filed by the complainant such as brief note of argument, claim application sent by the complainant to the opposite party, original medical papers, original policy certificate, letter of repudiated notice.
The opposite party 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. 25,000/- from opposite party authority concerned as because since long year the complainant regularly use to pay policy premium amount the opposite party 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. 25,000/- from opposite party 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 party with a litigation cost of Rs. 5000/-.
The opposite party is directed to pay the sum of Rs. 25,000/- 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.
