In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, Kolkata-700087.
CDF/Unit-I/Case No. 300 / 2006.
1) Mr. Debanjam Kumdu,
16, Rishi Bankim Sarani, P.O. Serampore, Hooghly. ---------- Complainant
---Versus---
1) The New India Assurance Co. Ltd.,
17, Ganesh Ch. Avenue, Kolkata-700013.
2) The New India Assurance Co. Ltd. ,
219, Jodhpur Park, Jodhpur Park Boys School, Kolkata.
3) The New India Assurance Co. Ltd.,
Regd. Office- 87, M.G. Road, Fort, Mumbai-400001. ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri ,MEMBER
Smt. Sharmi Basu ,MEMBER
Order No. 3 7 Dated 2 4 / 0 4 / 2 0 1 2 .
The petition of complaint u/s 12 of the C.P. Act, 1986 has been filed by the complainant Debanjan Kundu and against the o.p. the New India Assurance Co. Ltd. The case of the complainant in short is that Complainant had a mediclaim policy with o.p. nos.1,2 and 3 bearing policy no.510404/48/03/01331 (01052078) which started from 10.3.04 to 9.3.05 with an annual premium of Rs.2499/-. Here it is to be mentioned that o.p. no.4 being TPA subsequently added as party. Further case of the complainant is that the policy was issued after full check up of the complainant with all facilities and on 24.10.04 complainant fell ill owing to swelling of abdomen and shortness of breath and loose stood and he was admitted in CMRI Hospital and discharged on 3.11.04 and thereafter lodged claim of Rs.22,558.60 and 24.3.06 o.p. no.4repudiated the claim on the ground of pre-existing disease at the instance of o.ps. Hence the instant case lodged by complainant with the prayer contained in the prayer portion of the petition of complaint.
O.p. nos.1,2 and 3 had entered their appearances in this case by filing w/v and evidence but o.p. no.4 did not appear despite receipt of notice nor filed w/v and the matter was heard ex parte as against o.p. no.4 accordingly.
Decision with reasons:
We have gone through the pleadings of the parties, evidence and documents in particular. It is settled principle of law that with the payment of premium the liability of insurance company commences on the mere ground of pre-existing disease like hypertension etc. o.p. cannot shirk off its responsibility from making payment of the insurance claim of the complainants and it is the duty of o.ps. to take steps for all sorts of medical check up of the insured prior to giving effect to insurance policy and from the record we do not find any piece of paper in support of the contention of o.ps.
That being the position and on perusal of the entire materials on record we are of the view that o.p. is not justified in repudiating the claim of the complainant being a service provider and had sufficient deficiency to its consumer / complainant within the purview and scope of C.P. Act.
Hence, ordered,
That the petition of complaint is allowed on contest against the o.p. nos.1 to 3 with cost and ex parte against o.p.4 without cost. O.p. nos.1 to 3 are jointly and severally directed to pay to the complainant a sum of Rs.22,558.60 (Rupees twenty two thousand five hundred fifty eight and sixty paise) only together with interest @ 9% p.a. from the date of repudiation of the claim till the date of realization and are further directed to pay compensation of Rs.7000/- (Rupees seven thousand) only for his harassment and mental agony and litigation cost of Rs.3000/- (Rupees three thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 9% 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.
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MEMBER MEMBER PRESIDENT
