DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM

WEST TRIPURA : AGARTALA

 

CASE NO:  CC – 89  of   2017

 

      1. Mrs. Helen Chakma,

W/O- Late Angajoy Mog,

 

      2. Miss Maomi Mog,

D/O- Late Angajoy Mog,

 

      3. Master Niraj Mog,

S/O- Late Angajoy Mog.

 

All are Resident of: 

Nutan Palli, Gurkhabasti,

P.S: New Capital Complex,

P.O: Kunjaban, West Tripura. ........…...Complainants.

 

          -VERSUS-

 

      1. The Manager,

Tata AIG General 

Insurance Company Ltd.,

Registered office:

Peninsula Business Park, 

Tower A, 15th Floor,

G.K. Marg, Lower Parel, 

Mumbai- 400 013, 

Maharastra, India.

 

      2. Branch Manager,

Tata AIG General 

Insurance Company Ltd.,

Registered Office: 

1st Floor, 14 T.G. Road, 

Bank of Baroda Building, 

Ramnagar, Agartala,

Agartala, West Tripura- 799001. ........... 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 Sampad Choudhury

  Faruk Miah,

  Advocate.

 

For the O.Ps : Mrs. Pushpita Chakraborty, 

  Advocate.

 

 

 

JUDGMENT  DELIVERED  ON:  27.02.2018.

 

J U D G M E N T

This case arises on the petition filed by one Helen Chakma along her minor daughter and son. They filed this petition  U/S 12 of the Consumer Protection Act to get redress against the deficiency of service of Tata AIG General Insurance Company Ltd. Petitioners case in short is that she along with her husband purchased Tata AIG General Insurance Life Health Policy through their Corporate Agent Axis Bank. The name of the Policy was 'Medi Prime Policy'. Sum assured was Rs.2,20,000/- per person. Premium was Rs.6,512/-.  After purchase of policy on 13.01.15 she paid the premium regularly. Policy was renumbered after premium payment. Unfortunately her husband, Angajoy Mog suffered cancer. Ultimately after prolonged treatment he died on 22.09.2015. After death of her husband in the month of July, 2016 petitioner approached the O.P. for payment of the Medical bill. All documents were produced but no step was taken. Cause of action arose on 05.01.2017 when after lapse of 4 months no step taken for payment. Petitioner suffered for such deficiency of service of O.P. Claimed the insured amount of Rs.2 lacs and also  Rs.1,50,000/-, total Rs.3,50,000/- for harassment and litigation cost. 

 

2. O.P. Tata AIG appeared, filed W.S. denying the claim. It is stated that documents relying to death of her husband by illness not produced even the information of death not given in right time therefore, O.P. prayed for dismissal of the claim.

 

3. On the basis of contention raised by both the parties following points cropped up for determination:

(I) Whether the petitioner being a customer of Mediclaim policy is entitled to get the insured amount from the O.P.?

(ii) Whether there is deficiency of service by the O.P. and petitioner is entitled to get compensation?

 

4. Petitioner produced original Mediclaim Policy of Tata AIG,  Medi Prime Policy (Renewal) Policy, Treatment papers of Tata Memorial Centre,  Death certificate. Petitioner also produced the statement on affidavit of one witness i.e., the complainant of case.

 

5. O.P. on the other hand, produced no evidence. So on the basis of all these evidence on record we shall now determine the above points.

 

Findings and Decision:

6. Helen Chakma stated in her deposition that policy of Tata AIG was purchased on 13.01.2015. Policy commenced on 13.01.15 and expiry date was 12.01.2016. She also stated that her husband was diagnosed cancer in the month of April, 2015. His treatment continued on 08.09.15 and he died on 22.09.15. She also stated that she submitted all documents on 21.07.2016 before O.P. No.2, Branch Manager, Tata AIG. O.P. given no evidence. 3 chances given for producing evidence but they failed to give any evidence. 

 

7. We have gone through the treatment papers and also death certificate of the husband of the petitioner. From the treatment papers it is found that at the Tata Memorial Hospital Centre petitioner spent Rs.2,70,000/- up to 02.05.2015. After 02.05.15 again there was treatment in the Tata Memorial Centre and huge amount was spent. Ultimately her husband died. From the death certificate it is found that on 02.03.2016 at Mogbari he died. 

 

8. We have gone through the policy documents and found that sum insured was Rs.2,00,000/- in the name of Angajoy Mog Husband of the petitioner. Rs.6,390/- was paid as premium on 21.01.16. receipt was also given. 

 

9. Schedule I given description of the Impatient Benefits. These includes Room rent, boarding expenses, Nursing, Intensive Care Unit, Medical Care Unit, Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs and consumables, Diagnostics procedures, cost of prosthetic and other devices or equipment if implanted internally during a surgical procedure. The policy was renewed and during the continuation of the policy the policy holder i.e., the husband of the petitioner died. The contention of the O.P. is that the documents relating to death/ treatment not produced before them. But petitioner stated that those treatment papers were produced. But failed to produce any communication paper to support that those documents were placed before the O.P. No.1, Branch Manager of the Tata AIG. The correspondence between the petitioner and the O.P. not produced. 

 

10. It is established fact that the O.P. did not take any step for the payment of the bill for the patient as per terms of the policy. The treatment cost expenditure for treatment in the Tata Memorial Centre was not paid even after filing of the case. Initiative was not taken. It is true that coverage for the policy was up to Rs.2 lacs. Even though petitioner spent more amount she is not entitled to get as the policy coverage up to Rs.2 lacs. In order to prove the deficiency of service petitioner is to show that O.P. intentionally delayed to satisfy the claim. However, we can not disbelieve the petitioner who clearly stated that documents were produced through the Axis bank corporate Agent. Axis Bank however is not made party. But being corporate agent Axis Bank is also liable to ensure the payment by approaching Tata AIG. It is admitted fact that husband of the petitioner suffered from a deadly disease and spent a huge  amount. She is entitled to get the coverage amount of Rs.2 lacs. along with the interest from the date of filing of the claim. According to her she filed the claim on 21.07.16, cause of action arose on 05.01.17 after lapse of 6 months. So, she is entitled to get interest @ 8% per annum till the date of payment over the amount of Rs.2 lacs. For the deficiency of service for non payment of the amount by Tata AIG Rs.5,000/- is given and Rs.3,000/- given for cost of litigation. In total petitioner is entitled to get Rs. 2,08,000/- along with interest as stated above. Two points are decided accordingly.

 

11. In view of our above findings over the two points we decided the case in favour of the petitioner partly. As a result we direct the O.Ps to pay the insured amount of Rs.2 lacs to the petitioners along with 8% interest from 05.01.2017 and also Rs.5,000/- as compensation and Rs.3,000/- as litigation cost. 

 

 

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