In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, Kolkata-700087.
CDF/Unit-I/Case No. 105 / 2007
1) Arnab chatterjee
2) Supriya Chatterjee
20, Rupnarayan Nandan Lane, Kolkata-25 ---------- Complainant
---Versus---
1) The New India Assurance Co. Ltd.
DO-16, 3rd Floor, 120, Lenin Sarani, Kolkata-25
2) Medicare TPA Services (I) Pvt. Ltd.
6, Bishop Lefroy Road, P.S. Bhowanipore, Kolkata-20 ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri, Member
Smt. Sharmi Basu, Member
Order No. 44 Dated 13/09/2012.
The petition of complaint has been filed by the complainants Arnab chatterjee and Supriya Chatterjee against the o.ps. The New India Assurance Co. Ltd. and another. The case of the complainants in short is that complainants had mediclaim policy from o.ps. since 2002 renewed year by year upto 12/07 after payment of premium under policy no.511600/48/06/02/70002540 and membership no.02100257874B under cashless policy. On 8.12.06 complainant no.2 had a stomach pain and was admitted at Heath Point Nursing Home for surgery for the disease of Primary Common Bile Duct Calculi and was admitted on 18.12.06 and was operated upon on 22.12.06 and was discharged on 3.1.07 and thereafter complainant filed the claim with o.ps. on 1.3.07 with all documents. But the said claim was repudiated by o.p. no.1 stating that the disease related to past medical condition (Chole Systectomy in 1982) which was there prior to the inception of policy. On being aggrieved by the said repudiation complainants have put forward before this Forum for redressal.
O.p. nos.1 and 2 had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them. Ld. lawyer of o.ps. in the course of argument submitted that the instant case has got no merit and is liable to be dismissed.
Decision with reasons:-
We have gone through the pleadings of the parties, evidence and documents in particular. It is crystal clear from the record that complainants had mediclaim policy with o.ps. and complainants were not defaulter at the relevant point of time and repudiation of the claim of the complainants by o.ps. is not justified since a common man is not supposed to know from which disease he is suffering and o.ps. ought to have been got complainants examined by their panel doctors prior to inception of policy.
So, mere invoking the provision of pre-existing disease cannot be construed as a good ground for repudiation while in particular complainants duly paid premium regularly and were not defaulter at the relevant point of time.
So we hold that the o.ps. had sufficient deficiency in repudiating the claim of the complainants being service provider to its consumer / complainant and complainant is entitled to relief.
Hence, ordered,
That the petition of complaint is allowed on contest with cost against o.p. no.1 and without cost against o.p. no.2. O.p. no.1 is directed to pay the medical expenses incurred for complainant no.2 for Rs.30,000/- (Rupees thirty thousand) only together with interest @ 9% p.a. from the date of repudiation till the date of realization and is further directed to pay to the complainants 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 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 free of cost.
