In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, 4th Floor, Kolkata-700087.
CDF/Unit-I/Case No.482/2009.
1) Adit Dhikari,
7, Kshetra Banerjee Lane, Flat 3A, 3rd Floor,
P.O. Shibpur, P.S. Shibpur, Dist. Howrah. ---------- Complainant
---Versus---
1) United India Insurance Co. Ltd.
Divisional Office No.X, Apeejay House, 7th Floor, ‘A’ Block,
15, Park Street, Kolkata-16, P.S. Park Street.
2) Ms. Mita Chakraborty,
Asstt. Manager,
3) United India Insurance Co. Ltd.
Divisional Office No.X, Apeejay House, 7th Floor, ‘A’ Block,
15, Park Street, Kolkata-16, P.S. Park Street ----------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri, Member.
Smt. Samiksha Bhattacharya, Member
Order No. 35 Dated 23-08-2013.
We have gone through the pleadings of the parties, evidence and documents in particular and we find that complainant is the holder of the policy no.032200/48/08/97/0001136 of the o.p. no.1. During the continuance of the said policy the wife of the complainant viz. Mrs. Moumita Adhikary was fallen ill due to her abdomen pain and increased flow for continuous bleeding during menstruation and was under treatment of one physician viz. Dr. Abhijit Ghosh.
Complainant states that thereafter that as per advice of Dr. Abhijit Ghosh the wife of the complainant another doctor viz. Dr. P. Kundu was consulted by the complainant for taking second opinion. As per advice of both the aforesaid two doctors the wife of the complainant was advised to admit in the hospital for emergent abortion for the treatment of the said ailment and as per their advice the wife of the complainant was admitted to a hospital viz. Bhagirathi Neotia Women and Child Care Centre at 2, Lowdon Street, Kolkata-17 on 2.5.09. Complainant duly intimated the o.p. no.1 about the treatment of his wife through the concerned hospital vide a letter dt.28.4.09.
After due operation on the schedule date the wife of the complainant at the time of discharge she was advised for complete bed rest and further advised to take decapepty injection at least three in numbers at the interval of 28 days and as per advice of the concerned doctor the said treatment was duly continued at the intervention of the concerned doctor.
Complainant on 14.5.09 filed the claim form duly filled up with all original documents unto the o.p. no.1 for claiming certain amount towards the expenses incurred for the treatment of the prior operation including the expenses till the date of discharge on 14.5.09 which was duly acknowledged by the concerned authority of o.p. no.1.
On 18.6.09 complainant had filed another claim form duly filled up before the o.p. no.1 for the expenses incurred for post operation period for the treatment of his wife as per advice of the concerned doctor which was duly acknowledged by o.p. no.1.
Complainant received one letter on 22.7.09 issued by Heritage Health Services Pvt. Ltd. being the representative of o.p. no.1 stating therein that the original documents as supplied by complainant along with the claim form was not allegedly received and subsequently which was clarified on 30.7.09 by complainant and concerned department admitted the same.
Complainant received another letter issued by the concerned authority of o.p. no.1 addressed to his old address the complainant again clarified the said mistake case by the side of the concerned authority of o.p. no.1.
Thereafter the complainant received the letter dt.17.9.09 issued by o.p. no.2 on behalf of o.p. no.1 on a subsequent date and it transpires from the said letter that o.p. no.1 shall not pay any single furthering to the complainant in respect of the said claim as the claim is not allegedly maintainable as per the ‘exclusion clause’ being no.4.12 of the said policy which is illegal arbitrary and high handed action on the part of o.p. no.1 including the o.p. no.2. Hence the case was filed by the complainant with the prayer contained in the petition of complaint.
O.ps. had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them and prayed for dismissal of the case. Ld. lawyer of o.ps. in the course of argument submitted that the case has got no merit and the same is liable to be dismissed.
Decision with reasons:
We have gone through the pleadings of the parties, evidence and documents in particular and we find that the complainant received the letter dt.17.9.09 issued by o.p. no.2 on behalf of o.p. no.1 on a subsequent date and it transpires from the said letter that o.p. no.1 shall not pay any single farthing to the complainant in respect of the said claim as the claim is not allegedly maintainable as per the ‘exclusion clause’ being no.4.12 of the said policy which is illegal arbitrary and high handed action on the part of o.p. no.1 including the o.p. no.2.
In view of the findings above and on perusal of the entire materials on record we find that we find that no voucher for the cost of medicines has been filed by the complainant. This is a case of pregnancy and is not of any disease nor there was any tumor found and exclusion clause 411 of the policy has been attracted herein which seems to be justified.
In view of the findings above and on careful scrutiny of the entire materials on record we find that o.ps. did not have any deficiency on their part and complainant is not entitled to relief.
Hence, ordered,
That the case stands dismissed on contest without cost.
