In the Court of the Consumer Disputes Redressal Forum, Unit -I, Kolkata, 8B, Nelie Sengupta Sarani, Kolkata-700087. CDF/Unit-I/Case No. 166 / 2007 1) Sri Shayamal Bose, 115, Selimpur Road, Kolkata-31. ---------- Complainant ---Verses--- 1) United India Insurance Co. Ltd., 8, Netaji Subhas Road, Kolkata-700001. 2) Medicare, TPA Services (I) Pvt. Ltd., 6, Bishop Lefroy Road, Kolkata-20. ---------- Opposite Party Present : Sri S. K. Majumdar, President. Sri T.K. Bhattachatya, Member. Order No. 2 2 Dated 1 2 / 1 1 / 2 0 0 9 . In this consumer complaint the complainant prays for direction to be given upon the o.p. no.1 to pay Rs.40,000/- as the claim amount Rs.30,000/- as damages along with an interest @ Rs.8.33% on Rs.40,000/- till realization and such other relief to which the complainant is entitled to under law and equity. The complainant Sri Shyamal Bose took a mediclaim policy bearing no.030600/48/05/02721 for a period of one year covering from 11.10.05 to midnight of 10.10.06, on payment of total sum of Rs.3774/- as premium along with service tax of Rs.349/- from o.p. no.1 through its authorized TPA, who is o.p. no.2 in this present consumer complaint case and he had been taking the same since 2002 on renewal basis. And even before that he was insured with National Insurance. On 11.11.05 complainant was admitted to AMRI Hospital with cerebra vascular accident. And there various clinical examinations and treatment were done by the AMRI and finally on 15.11.05, the complainant was discharged on payment of Rs.37,887/- to AMRI Hospital. And subsequently, the complainant incurred Rs.2113/- for post hospitalization treatment. Thereafter, the complainant lodged the claim of Rs.40,000/- in total with the o.ps. for reimbursement of the same. But letter 28.9.06 o.p. no.2 repudiated his claim as it falls under the clause 4.1 of the policy condition i.e. on the ground of pre-existing disease. The complainant further stated that previously he was admitted to some other nursing home for hypertensive crisis on 3.8.03 and discharged on 7.8.03. And in that case, too, o.ps. repudiated the claim of Rs.10,410/- first and after reviewing the same, they admitted that claim and paid the said amount on 12.10.04 after being satisfied with medical report vide annex-6 of the complaint petition. Therefore, the complainant submitted that it is the normal practice of the o.p. to refuse the legitimate claim of the insured person on the false and fabricated plea and it is nothing but harassment to the complainant who is aged above 65 years. Further, the complainant stated that his claim is genuine and he is entitled to the reimbursement of Rs.40,000/- incurred by him on account of his medical treatment. And there is no such history of pre existing disease. Notices were served upon the o.ps. None appeared and no w/v was filed by either of the o.ps. Decision with reason : Even after the receipt of the complaint petition along with the annexures, neither of the o.ps. appeared. No w/v has been filed by the o.ps. to controvert the allegation made out by the complainant against the o.ps. So, it can be reasonably presumed that the o.ps. have nothing to challenge the allegations of the complainant against them. And for us, too, there is nothing to disbelieve the unchallenged testimony of the complainant. We have also perused the petition of complaint the documents and the evidence on oath. The contents of petition of complainants are corroborated by the evidence both oral and documentary. Accordingly, petition of complainant succeeds. Hence, Ordered, that the o.p. no.1 is directed to pay the claim amount Rs.40,000/- (Rupees forty thousand) only to the complainant. The o.p. no.1 is further directed to pay a compensation of Rs.3000/- (Rupees three thousand) only and litigation cost of Rs.1000/- (Rupees one thousand) only to the complainant. The o.p. no.1 must comply the order within thirty days from the date of communication, in default it will carry an interest @10% p.a. till full realization. Supply certified copy of this order to the parties on payment of prescribed fees. _____Sd-_______ ______Sd-______ MEMBER PRESIDENT | 
