Judgment : Dt.28.2.2017

            This is a complaint made by Md. Sayeed Khan, 5/2/H/2, Bhukailash Road, P.O.-Kidderpore, P.S.-Ekbalpore, Kolkata-700 023 against (1) the New India Assurance Company Ltd., OP No.1, (2) the Branch Manager, The New India Assurance Company Ltd., Thakurpukur Branch, 39, Diamond Harbour Road, P.O. & P.S.- Thakurpukur, Kolkata-700 008, OP No.2 and (3) Medicare TPA Services Pvt. Ltd., 6B, Bishop Lefroy Road, P.O.-Elgin Road, P.S.- Bhowanipur, Kolkata-700 020, OP No.3, praying for an order setting aside or quashing the letter bearing IC No.3390811dt.13.7.2015, an order directing the OP No.1 to 3 for settling the medical claim of the Complainant with a stipulated period and payment of Rs.52,870/- along with interest and an interim order, compensation of Rs.2,00,000/- and litigation cost of Rs.10,000/-.

            Facts in brief are that Complainant is holder of a Mediclaim policy from OPs and he used to pay necessary premium against which OPs issued receipt. Unfortunately, on 30.1.2015, Complainant met an accident and sustained fracture and he was admitted in Calcutta Medical Research Institute at Diamond Harbour Road. Further, Complainant has stated that during the period of his admission under OP No.4 he underwent a surgery on 3.2.2015 and after completing treatment he was discharged on 4.2.2015. Further, unfortunately after being discharged from the hospital Complainant misplaced his money receipts of Rs.18,004/- and also hospital discharge certificate. Complainant submitted his claim before the Insurance Company to the tune of Rs.52,870/-. Thereafter, Complainant received a letter and was informed by OP No.3 that his insurance claim was closed on the ground that no reason was given as regards delay in submitting claim intimation and in absence of supporting investigation reports and also non-filing of separate money receipt for Rs.18,004/-. Further, Complainant has submitted that since he has misplaced the money receipt and hospital discharge summary, Complainant informed this fact to the local Ekbalpore P.S. bearing G.D. No.2535 dt.29.5.2015 and basing on that Complainant prayed for allowing rest Rs.18,004/-. But, OP ignored his claim and so Complainant filed this complaint.

            OP No.1 & 2 filed written version and has stated that they are desirous to settle the claim without going deep into the technicalities of the subject of mediclaim policy as resolved by the competent superior authority of the OP. Further, they have stated that the prayer of settling the claim may be made by this Forum.

Decision with reasons

            Complainant filed affidavit-in-chief against which OPs filed questionnaire to which Complainant filed affidavit-in-reply. Similarly, OPs filed affidavit-in-chief against which the Complainant filed questionnaire to which OPs replied.

            Main point for determination is whether Complainant is entitled to the reliefs as prayed for.

            On perusal of the prayer portion of the complaint, it appears that Complainant has prayed for payment  of Rs.52,870/- along with interest @ 10% p.a. and setting aside the letter dated 30.7.2015. Further, on perusal of the letter dated 30.7.2015, it appears that the claim was not settled on the ground of reason for delay in submission of the claim intimation and non filing of original separate money receipt.

            At the time of argument, Ld. Advocate for Complainant stated that his client has received about Rs.3,559/- as settlement of the claim. Surprisingly, this fact was disclosed only at the time of argument and was not furnished in writing by the Complainant with the record. Whatever may be position, we are of the view that the payment of Rs.3,559/-, appears to be sufficient where the original receipt has not been filed. It is because the OPs made attempt to settle the dispute and there is nothing more to be awarded. However, since the amount was awarded during the pendency of this complaint, Complainant is entitled to litigation cost of Rs.10,000/-.

            Hence,

ordered

            CC/304/2016 and the same is considered and allowed on contest in part. OPs are directed to pay Rs.10,000/- as compensation and litigation cost to the Complainant within two months of this order, in default the amount shall carry interest @ 10% p.a. The liability of OPs are joint and several.