IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
MURSHIDABAD AT BERHAMPORE.
CASE No.CC/115/2015.
Date of Filing: 21.08.2015. Date of Final Order: 11.09.2017.
Complainant : Sri Swapan Chowdhuri , S/O Late Fatechand Chowdhury, Vill. Dakshin
Sudarshanganj, P.O.&P.S. Lalgola, Dist. Murshidabad. Pin 742148.
-Vs-
Opposite Party: The National Insurance Company Ltd., Berhampore Divisional Office,
26/23/1, S.S.Sen Road, P.O.&P.S. Berhampore, Dist. Murshidabad, Pin 742101.
Present: Sri Anupam Bhattacharyya …………….. President.
Smt. Chandrima Chakraborty ……………….Member.
Sri Manas Kumar Mukherjee….……………. Member.
FINAL ORDER
Sri Anupam Bhattacharyya Presiding Member.
The instant complaint has been filed by the complainant U/S 12 of C. P. Act, 1986 praying for payment of Rs.45,946/- towards mediclaim for the cost of treatment of the daughter of the complainant along with interest @10 p.a and compensation of Rs.40,000 for mental pain and agony.
The complainant’s case, in brief, is that the complainant has a family mediclaim policy for himself, his wife and daughter from OP National Insurance Company Ltd year after year. The daughter of the complainant Neha Chowdhury became seriously ill due to Cervical Radiculopathy and also suffering from Back and Neck pain facial Spasms. She was treated under Dr. Amitabha Sen at Nightingale Hospital since February, 2015 as per advise of the doctor she was admitted Woodland Multispecialty Hospital Ltd, Kolkata on 20.05.2015 for treatment Dr. Amitabha Sen has treated her and after one day she was discharged on 21.05.2015 and he spent Rs.45,946/- for such treatment and he is entitled to get the same from OP-Insurance Company on the strength of aforesaid mediclaim policy. The complainant informed the same to OP-Insurance Company. On 4.5.15 and filed filled in claim application on 3.6.2015. The OP illegally repudiated the claim on the ground that the impugned treatment is not covered under the circular issued by NIC dt. 26.3.15 of Circular No. 050/14-15 on 30.6.15. No such circular was issued to the complainant previously or at the time of issuance of last policy. Hence, the instant complaint case.
The written version filed by the OP-National Insurance Co. , in brief, is that they OP has denied the allegation of the complainant categorically. The complainant is not entitled to get any relief as per Circular No. 050/2014-15 dt. 26.3.15 of OP-Insurance Co. issued to the complainant on 30.6.15. The complaint is liable to be dismissed. Hence, the instant written version.
Considering the pleadings of both parties the following points have been raised the disposal of the case.
Points for Decision
- Whether the case is maintainable in the present form and in law?
- Whether the case is bad for mis-joinder and non-joinder of parties.
- Whether the complainant is entitled to get relief as prayed for?
- To what other relief/reliefs the complainant is entitled to get?
Decision with Reasons.
Point Nos. 1 to 4.
All the points are taken up together for the sake of convenience.
The instant complaint is fir payment of Rs.45,946/- along with interest @10% p.a. for medi-claim towards medical expenditure and for compensation of Rs.40,000/- for mental pain and agony.
The complainant’s main case is that the complainant has not got medi-claim of Rs.45,946/- for medical expenditure for the treatment of his daughter against family medi-claim being illegally repudiated by the OP-Insurance Co. on the basis of the Circular No. 050/14-15 dt. 26.3.15 issued to the complainant on 30.3.15.
On the other hand, the OP’s case is that they have rightly repudiated the claim on the basis of the Circular No. 050/14-15 dt. 26.3.15 issued on 30.3.15.
To prove the case the complainant has adduced evidence on affidavit along with the relevant documents including the concerned policy and medical papers namely prescription, bills of Woodland Multispecialty Hospital.
Also, the complainant has filed written argument.
On the other hand the Ld. Lawyer for the OP-Insurance Co has filed the documents of their company to mediclaim policy to the effect that the OP-Insurance Co. will pay the medical expenditure but not exceding the sum insured during the policy period.
In this regard, the Ld. Lawyer for the complainant has advanced argument referring the documents, as impugned Insurance Policy that the impugned policy is the family mediclaim policy where the sum insured shown in the document in respect of Insured Person towards the complainant, his wife ,his son and his daughter showing the sum insured as Rs.30,000/-, Rs.20,000/- and Rs.25,000/- for all the insured persons and thus insured sum in respect of each Insured Person particularly the daughter for which the particular claim has been preferred before this OP- Insurance Company which is Rs.75,000/- and here the claim amount is Rs.45,946/-.
Further the complainant has filed the discharge summary of Woodland Hospital including the bill for Rs.37, 807.00 , professional fee of the doctor Rs.17,000/- against the receipt of Rs.13,000/-.
On the other hand, we do not find any rebuttable evidence as to the expenditure incurred for the treatment of daughter of the complainant in medi-claim policy and that being so, relying upon the bills and vouchers filed by the complainant towards the treatment of his daughter in mediclaim policy where the insured sum is more than the claim and as such we are of view that the complainant is entitled to get the mediclaim of Rs.45,946/- towards the treatment of his daughter.
On the basis of the above discussions, as a whole, we can safely conclude that all the points are disposed of in favour of the complainant in part and as such the complainant is entitled to get Rs. 45,946/- along with interest @7% p.a. from the date filing of this case till realization.
Relying upon the settled principle where interest is allowed, compensation should not be given, we are of view that in this case, as interest is allowed, the complainant is not entitled to get any compensation.
Hence,
Ordered
That the Consumer Complaint No. 115/2015 be and the same is allowed on contest in part against the OP without any order as to cost.
The complainant is entitled to get Rs. 49,946/- towards medi-claim policy for the expenditure incurred by the complainant for treatment of his daughter. He is also entitled to get interest @7% p.a. from the date of filing of this case till realization.
The OP –National Insurance Co. Ltd is directed to pay Rs.49,946/- along with interest @7% p.a. from the date of filing of this case (i.e. 21.08.2015) till realization to the complainant within 60 days from the date of this order, failing which the OP is to pay fine for delay @Rs.50/- per day by Demand Draft and the amount so accumulated shall be deposited in the Consumer Legal Aid Account.
Let a plain copy of this order be made available and be supplied free of cost, to each of the parties on contest in person, Ld. Advocate/Agent on record, by hand under proper acknowledgment / be sent forthwith under ordinary post to the concerned parties as per rules, for information and necessary action.
