Orissa

Cuttak

CC/6/2019

Mohammad Anamul Haque - Complainant(s)

Versus

United India Insurance Co Ltd - Opp.Party(s)

U N Sahoo

03 Dec 2022

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL COMMISSION,CUTTACK.

                                    C.C.No.06/2019

Mohammed Anamul Haque,

Plot No.2C/178,Sector-9,C.D.A,

Cuttack-753014.                                                                   … Complainant.

 

                                                                Vrs.

1.       The Sr. Divisional Manager,

UII Insurance Co. Ltd., College Square, Cuttack.

 

2.       United India Insurance Company Ltd.,

Division Office 8,Union Co-Op Insurance Building,

5^th Floor,23^rd Sri P.M.Road,Fort,Mumbai-400001.

 

3.       Managing Director,

United India Insurance Co. Ltd.,

24,Whites Road,Chenai-600014.

 

4.       Family Health Plan Insurance TPA Limited,

Ground Floor,Srinilaya,CyberSpazio,Rod No.2,

BanzaraHills,Hyderabad-500034.

 

5.       Family Health Plan Insurance TPA Limited,

16/2 Lake View Road,Kolkata-700029.

 

6.       The Chief Manager(HR),

SBI,ZonalOffice,Bhubaneswar.                                        ... Opp. Parties.

 

 

Present:               Sri Debasish Nayak,President.

                                                Sri SibanandaMohanty,Member.

 

               Date of filing:     09.01.2019

Date of Order:    03.12.2022

 

For the complainant:           Mr.U.Sahoo,Adv.& Associates.

For the O.Ps  No.12 & 3:      Mr. B. Dasmohapatra,Adv. & Associates.

For the O.Ps no.4 & 5:                      None.

For the O.P no.6:                   Mr. P.V.Balakrishna,Adv& Associates.

 

Sri Debasish Nayak,President.             

           Case of the complainant as made out from the complaint petition in short is that he had opted for Group Mediclaim Policy from the O.Ps vide Policy no.1202002817P 115010080 and while the said policy was effective he felt ill at Thane of  Mumbai, for which he was rushed to the Jupiter Hospital and was admitted to the emergency room on 23.4.18 at 7.05 P.M.  He had high blood pressure for which he was shifted to the ICU in the said hospital that night at 9.18 P.M. and was discharged on the very next day i.e.,on 24.4.18 at8.47 P.M.  According to him, he was hospitalised for 25 hours and 47 minutes.  He had paid a sum of Rs.34,727/- at the said hospital towards his treatment and for his medicines.  Thus after discharge, he had lodged his insurance claim before the O.Ps through mail on 9.7.18.  He also had issued reminders on 18.7.18 and on 27.7.18 but he could not receive any response from the O.Ps.  He being a retired SBI employee, as per the policy had paid its premium share of Rs.21,170/- whereas the SBI had paid premium for him of Rs.12,000/-.  Ultimately when his claim was repudiated on 9.7.18, he had to file this case claiming the spent amount of Rs.34,727/- at the Jupiter Hospital,Thanealongwith interest thereon @ 12% per annum with effect from 9.7.18 till the total amount is paid to him in full together with compensation of Rs.5000/- towards his mental harassment and also a sum of Rs.5000/- towards the cost of his litigation.  He has also prayed for any other reliefs as deemed fit and proper.

               The complainant has filed copies of several documents in support of his case.

2.        Out of the six O.Ps as arrayed in this case, having not contested this case, O.Ps no.4 & 5 have been set exparte vide order dt.27.6.19.  However, O.Ps no.1,2,3 & 6 have contested this case but out of them O.P no.6 has filed his separate written version whereas O.Ps no.1,2 & 3 have conjointly filed their written version.

               O.Ps no.1,2 & 3 through their written version have stated that the case of the complainant is not maintainable and the same is , bad for non-joinder and mis-joinder of necessary parties.  According to them, the complainant was hospitalised for less than 24 hours.  Thus, hospitalisation of less than 24 hours is not covered as per the policy terms and conditions for which they had repudiated the claim of the complainant.  O.Ps no.1,2 & 3 together with their written version have filed copies of the policy conditions also. 

               As per the written version of O.P no.6, the case is not maintainable and he has no role to play in the dispute of the complainant and the other O.Ps.

3.            Keeping in mind the averments as made in the complaint petition and the contents of the written version of the O.Ps, this Commission thinks it proper to settle the following issues in order to arrive at a proper conclusion.

i.          Whether the case of the complainant is maintainable?

ii.         Whether there was any deficiency in service on the part of the O.Ps and if the O.Ps had practiced any unfair trade ?

iii.        Whether the complainants are entitled to the reliefs as claimed ?

Issue No.ii.

Out of the three issues, Issue no.ii being the most pertinent issue is taken up first for consideration here in this case.

Admittedly, the complainant was treated at Jupiter Hospital due to hypertension and was admitted therein on 23.4.18 at 7.05p.m.  He was discharged on 24.4.18 at 8.47 p.m and he urges to have been treated at the said Jupiter hospital for 25 hours and 47 minutes.  This contention of the complainant is denied by the O.Ps no.1,2 & 3 through their written version.  According to the said O.Ps, the complainant was hospitalised for less than 24 hours at Jupiter Hospital but they have not filed a single scrap of paper as how could they come to such conclusion.  On perusal of the copies of series of documents as filed by the complainant, it is noticed that admission note of the complainant at Jupiter Hospital on 23.4.18 reflects about the complainant to have been admitted in the said hospital that day at 7.05 p.m. and the said hospital while billing the expenses on various accounts for the complainant has mentioned about the discharge time of the complainant to be at 8.47 p.m. on 24.4.18 that is to say, the complainant was undoubtedly hospitalised at Jupiter Hospital for more than 24 hours and the contention of the O.Ps no.1,2 & 3 in this regard is found to be  erroneous.  Accordingly, this Commission finds the  O.Ps no.1 to 5 to be deficient in their service and they have also practised unfair trade.  Hence it is so ordered:

                                    ORDER

The case is decreed on contest against the O.Ps no.1,2,3 & 6 and exparte against O.Ps no.4 & 5.  O.Ps no.1 to 5 are found to be jointly and severally liable here in this case.  The said O.Ps are thus directed to pay the complainant a sum of Rs.34,727/- alongwith interest thereon @ 12% per annum with effect from 9.7.18 till the total amount is quantified and also to pay the complainant  compensation of Rs.5000/- towards his mental harassment and agony and further to pay his litigation cost to the tune of Rs.5000/- within a period of 30 days from the date of receipt of copy of this order.

Order pronounced in the open court on the 3^rd day of   December,2022 under the seal and signature of this Commission.   

                                                                                                                                Sri Debasish Nayak

                                                                                                                                            President

                       

                                                                                                                                                            Sri Sibananda Mohanty

                                                                                                                 Member