In the Court of the Consumer Disputes Redressal Forum, Unit -I, Kolkata, 8B, Nelie Sengupta Sarani, Kolkata-700087. CDF/Unit-I/Case No. 406 / 2008 1) Md. Mobid Kamal, 17/C, Dent Mission Road, Kolkata-700023. ---------- Complainant ---Verses--- 1) TTK Healthcare Services, 88, L2, G.N. Chetty Riad, T. Nagar, Chennai-600017. 2) United India Insurance Co. Ltd. Divisional Office-011100, Sudarshan Building, Old No. 14, Whites Road, Chennai-500014. ---------- Opposite Party Present : Sri S. K. Majumdar, President. Sri T.K. Bhattacharya, Member Order No. 1 2 Dated 0 4 / 0 3 / 2 0 1 0 . The petitioner Md. Mubid Kamal by filing a petiion of complaint u/s 12 of the C.P. Act on 19.12.08 has prayed for issuing direction upon the o.ps. to re-settle the claim of the petitioner and to pay a sum of Rs.6532/- towards pharmacy account and to give other relief or reliefs as the forum may deem fit and proper. Specific case of the complainant in short is that he is a mediclaim policy holder of United India Insurance Co. o.p. no.2 vide policy no.011100/2007/48410064678 for himself, his wife and only daughter and the policy was started on 31.8.07 and end date was 30.8.07. On 9.2.08 Farida Kamal, his wife due to an accident fractured her leg and she was admitted to Bellona Nursing And Diagnostic Centre, o.p. no.3 and she was under the treatment of Dr. Kausik Ghosh. After operation on 10.2.08, she was discharged from the said nursing home on 12.2.08. The petitioner informed it to the o.p. no.1 by a letter and he submitted his claim form along with prescription, cash memo, bills etc. for a claim of Rs,.28228.70. The o.p. no.1 by sending a letter dt.11.6.08 settled the claim of the petitioner on behalf of the o.p. no.2 and approved for settlement of Rs.20880/- by a cheque no.454033 dt.10.6.08 and the petitioner received the same on 13.6.08. It appears from the statement of claim issued by the o.p. no.1 that they have disallowed the claim of Rs.6532.40 on pharmacy account. The wife of the petitioner submitted two letters dt.19.6.08 and 30.7.08 to the office of the o.p. no.1 alleging therein that they have wrongfully disallowed the claim of Rs.6532/- on pharmacy account. The o.p. did not send any reply to the letter of the wife of the petitioner and finding no other alternative on service of lawyer’s notice the petitioner has filed this case with the aforesaid prayer. Decision with reasons:- It appears on perusal of the record that notices were issued upon the o.ps. and 9.2.09 was fixed for S/R. As no S/R was received complainant was directed to file affidavit of service by 25.3.09. Ld. Lawyer of the petitioner on 25.3.09 had shown acknowledgement card in respect of the o.p. nos.1 and 2 regarding the service of notice, but as they did not appear the case was fixed for ex parte hearing. The only point need be decided in this case whether the claim of the petitioner for Rs.6532/- on pharmacy account is permissible and whether the o.p. nos.1 and 2 had wrongfully deducted the amount of Rs.6532/- out of the total billed amount of Rs.28228.70. We have perused the discharged certificate of Farida Kamal, the wife of the petitioner showing that she was under the treatment of Dr. K. Ghosh at Bellona Nursing And Diagnostic Centre and she was under the treatment of the doctor from 9.2.08 and she was discharged there on 12.2.08. The petitioner had informed it to the o.p. no.1 by a letter vide annex-B. We have also perused the claim form submitted by the complainant vide annex-C, wherein he has stated that the date of admission at Bellona Nursing Home was 9.2.08 and the date of discharge was 12.2.08 in respect of Farida Kamal, the wife of the complainant. He has also annexed the bills amounting to Rs.28228.70 including the medicine charge, bed charge, operation charge, pathological charge and other clinical charge, plastering procedure charge etc. and it is the specific grievance of the complainant that the insurance company o.p. no.2 has wrongfully disallowed his claim of Rs.6532.40. It specifically appears from annex-D stating therein that they have approved for settlement of Rs.20,808/- only by cheque no.454033 dt.10.6.08. It is not understood that how arbitrarily they have approved for settlement of Rs.20,808/- only disallowing the complainant Rs.6532.40 as claimed by the complainant. The wife of the complainant has strongly protested against it wherein she has stated that without any lawful excuse they have disallowed her to the extent of Rs.6532.40 which she is lawfully entitled to get for defraying medical expenses, annex-E. Similar is her reflection in her letter dt.30.7.08, vide annex-E1. Her lawyer has ventilated all the grievances of the complainant which has been aptly and squarely reflected in the lawyer’s letter vide annex-F. We have also perused the affidavit of examination in chief of the complainant wherein he has also ventilated all his grievances which have been properly mentioned in his petition of complaint. We have also perused the BNA filed by the complainant. Therefore, considering the facts, circumstances, evidence on record both oral and documentary, we are of the opinion that the complainant has been able to prove his case and he has entitled to get the relief as prayed for. Hence, Ordered, that the petition of complaint is allowed ex parte. The o.p. nos.1 and 2 are directed jointly or severally to pay a sum of Rs.6532/-(Rupees six thousand five hundred thirty two) only to the complainant and to pay compensation of Rs.3000/- (Rupees three thousand) only and litigation cost of Rs.1000/- (Rupees one thousand) only positively within forty five days from the date of communication of this order, failing which it will carry interest @ 10% p.a. till full realization. Fees paid are correct. Supply certified copy of this order to the parties on payment of prescribed fees. _____Sd-_____ _______Sd-_______ MEMBER PRESIDENT | 
