DATE OF FILING : 07-05-2013. DATE OF S/R : 03-06-2013. DATE OF FINAL ORDER : 29-11-2013. Sri Ratan Mandal, son of late Paresh Ch. Mandal, residing at c/o. Tapas Kumar Ghosh, 19/1, Nabin Banerjee Lane, P.O. Santragachi, P.S. Shibpur, District – Howrah. ------------------------------------------------------------ COMPLAINANT. - Versus - 1. The New India Assurance Co. Ltd., having its Howrah D.O. at Madhusudan Apartment, 2nd floor, P-18, Dobson Lane, P.S. Golabari, District – Howrah, PIN – 711106. 2. Medicare TPA Services (I) Pvt. Ltd., Flat no. 10, Paul Mansions, 6B, Bishop Lefroy Road, Kolkata – 700020.--------------------------------------------------OPPOSITE PARTIES. P R E S E N T President : Shri T.K. Bhattacharya, M.A. LL.B. WBHJS. Member : Shri P.K. Chatterjee. Member : Smt. Jhumki Saha. F I N A L O R D E R 1. The instant case was filed by complainant U/S 12 of the C.P. Act, 1986 wherein the complainant, Ratan Mandal has prayed for direction upon the o.p. no. 1 to disburse the sum of Rs. 19,650/- towards medi-claim together with interest @ 14% p.a. till repayment with further prayer of compensation of Rs. 50,000/- for causing unnecessary harassment and mental pain together with the litigation costs as the O.P. company in spite of repeated reminders and submission of the documents has been sitting tight over the file. 2. The o.p.no. 1 in the written version denied the material allegations and contended interalia that non submission of original receipt by the complainant stood in the way of disbursement 3. Upon pleadings of both parties two points arose for determination : i) Is there any deficiency in service on the part of the O.Ps. ? ii) Whether the complainant is entitled to get any relief as prayed for ? DECISION WITH REASONS : 4. Both the points are taken up together for consideration. Admittedly the complainant is a medi-claim policy holder since 29-11-2001 and renewed on dates till 28-11-2013. The instant policy commenced on 29-11-2011 being no. 51220034110100001382 with a premium of Rs. 5,272/- and the insured sum was Rs. 1 lac. The policy was valid till 28-11-2012. The complainant for his chest pain was admitted to Woodland Hospital on 18-07-2012 and discharged on 19-07-2012 and incurred a sum of Rs. 19,650/- for his treatment. But on several pretexts his claim was not disbursed in spite of submission of the genuine documents. 5. The reason assigned by the O.P. no. 1 for non disbursement appears to us to be too fragile to merit acceptance. In fact, the admitted position is that the complainant submitted all the original receipts before the O.P. no. 1 and only for the dilly-dallying on the part of the O.P. no. 1 the amount could not be disbursed. We have scrutinized the documents submitted before us. We find no reason as to how the prayer of the complainant shall not be allowed. In fact this is a fit case where the prayer of the complainant shall be allowed. Both the points are accordingly disposed of as we trace gross deficiency in service on the part of the O.P. no. 1. Hence, O R D E R E D That the C. C. Case No.144 of 2013 ( HDF 144 of 2013 ) be allowed on contest with costs against the O.P. no. 1, New India Assurance Company Ltd. and dismissed without cost against the O.P no. 2, Medicare TPA Service ( I ) Pvt. Ltd. The O.P. no. 1 be directed to pay a sum of Rs. 19,650/- towards hospital bill and consultation fees to the complainant together with an interest @ 9% p.a. since 24-09-2012 till full payment against his medi-claim policy no. 51220034110100001382 within 30 days from the date of this order The o.p. no. 1 be further directed to pay a sum of Rs. 20,000/- as compensation for causing mental pain and prolonged harassment to the complainant. The complainant is further entitled to a litigation costs of Rs 5,000/- from the O.P. no. 1. The complainant is at liberty to put the decree into execution after expiry of the appeal period. Supply the copies of the order to the parties, as per rule. DICTATED & CORRECTED BY ME. ( T.K. Bhattacharya ) President, C.D.R.F.,Howrah. | 
