In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, Kolkata-700087.
CDF/Unit-I/Case No. 354 / 2011.
- Indrani Dutta,
DL 239, Salt Lake City, Kolkata-700091. …............ Complainant
...Versus...
- United India Insurance Co. Ltd.,
Through Regional Manager.
38B, Chowringee Road, Kolkata-700071.
- Sr. Divisional Manager, United India Insurance Co. Ltd.,
D.O. Vi, B-1, Gillender House,
8, Netaji Subhas Road, Kolkata-700001. …........... Opposite Party
Present : Sri Sankar Nath Das, President.
Smt. Jhumki Saha, Member.
Dr. A. B. Chakraborty, Member
Order No. 7 Dated 30/03/2012.
Complainant Indrani Dutta by filing a petition u/s 12 of the C.P. Act, 1986 has prayed for a direction to be given upon the o.ps. to pay Rs.1,61,000/- along with an interest @ 9% from the date of filing of this complaint till realization, towards medical expenses, compensation for mental agony and the cost of litigation.
Facts of the case in short is that complainant took an insurance from o.ps. and the policy was issued by the o.ps. on payment of insurance premium since 25.3.1999 without any break up and there was no claim for long 11 years against the policy no.030600/48/09/07/00007205, but during the policy period 28.3.10 to 27.3.11, complainant felt a low back pain on 18.2.11 and after consultation with doctor admitted to hospital on the same date, vide annex-A. There he underwent treatment till 22.2.11 and discharged on the same date after incurring an expenses of Rs.34,325/- and further he paid Rs.2125/- towards physiotherapy and other therapy and the total claim to Rs.36,450/- towards such medical treatment for which she lodged her claim but till filing of the case i.e. 24.10.11 o.ps. neither settled the claim nor repudiated the same. So complainant gave several reminders but no fruitful result came out and being frustrated and finding no other alternative complainant filed this instant petition with the aforesaid prayers.
Notices were served upon the o.ps. and o.ps. appeared and filed their w/v, accordingly the matter was heard on merit.
Decision with reasons:
We have gone through the contention made out in the w/v of the o.ps. wherefrom vide para 3 o.ps. have stated that after receiving the claim from the complainant o.ps. repudiated the same through their TPA vide their letter dt.28.3.11 vide annex-A, but not such annexure has been annexed herewith their w/v. O.ps. have also challenged the claim of Rs.1,61,000/- vide para 4 of w/v stating therein that complainant paid only Rs.28,000/- as room charges and Rs.193/- for medicine. They also stated that only medicine of Rs.193/- was used for treatment of the complainant which could have been very well administered in outdoor department. But nowhere they are stating that such treatment is out of the purview of the insurance claim as per the terms and conditions of o.ps. and it is not the luxury on the part of the complainant to get admitted any hospital for 4-5 days and after receiving the due premium from the complainant it becomes binding on the part of the o.ps. to pay the legitimate claim of the complainant. At the same time o.ps. failed to provide any repudiation letter as mentioned in para 3 of w/v which amounts to unfair trade practice adopted by o.ps. towards the complainant. Hence the case succeeds on merit with cost against the o.ps.
Hence, ordered,
That the o.ps. are directed to pay Rs.34,450/- (Rupees thirty four thousand four hundred fifty) only towards medical expenses, compensation of Rs.10,000/- (Rupees ten thousand) only for mental agony and harassment and Rs.5000/- (Rupees five thousand) only for litigation cost to the complainant within 45 days from the date of communication of this order, i.d. an interest @ 9% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.
Supply certified copy of this order to the parties.
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MEMBER MEMBER PRESIDENT
