Order No.  18  dt.  03/10/2016

       The case of the complainant in brief is that the complainant had one mediclaim insurance policy and the payment was made towards the premium and the said policy till the year 2013 and the same assured amounting to Rs.1 lakh each of the complainant and his wife. During the continuation of the said policy the wife of the complainant became ill and she was treated by doctors for the treatment of cancer. After the said treatment the complainant paid the amount to the hospital and subsequently she was treated in Chennai whereby complainant had to bear the expenses of Rs.76,513/-. After travelling to Chennai for treatment and bearing all the expenses the complainant claimed Rs.1,12,540/- and the complainant claimed the said amount along with a necessary documents but the o.ps. did not give any response. Subsequently lawyer’s letter was sent but no action was taken by o.ps. In view of the said fact the complainant has claimed Rs.1,12,540/- and also prayed for compensation.

            The o.ps. did not contest this case by filing w/v and as such, the case has proceeded ex parte against the o.ps.

            In order to prove the case the complainant submitted all the documents including the medical treatment of his wife and correspondences made with the o.ps., the copy of the policy was also filed.  On perusal of the documents it appears that the complainant’s wife became ill and she was treated at Sri Aurobindo Sevakendra, Kolkata and also at Apollo Specialty Hospital, Chennai and the claim made by complainant substantiated with the documents filed by him. It also appears that the policy remained valid at the time of treatment of wife of the complainant. Since the insurance coverage was Rs.1 lakh at the relevant point of time therefore the compliannt will be entitled to get Rs.1 lakh from the o.p. nos.2 and 3.

            Hence, ordered,

            That the CC No.753/2013 is allowed ex parte with cost against the o.p. nos.2 and 3 and dismissed ex parte without cost against the o.p. no.1. The o.p. nos.2 and 3 are jointly and/or severally directed to pay to the complainant a sum of Rs.1,00,000/- (Rupees one lakh) only along with compensation of Rs.10,000/- (Rupees ten thousand) only for harassment and mental agony and litigation cost of Rs.2000/- (Rupees two thousand) only within 30 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.