Assam

Cachar

CC/20/2014

Rajat Kumar Chakraborty - Complainant(s)

Versus

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

B. Bhattacherjee

12 Sep 2018

ORDER

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Complaint Case No. CC/20/2014
( Date of Filing : 20 May 2014 )
 
1. Rajat Kumar Chakraborty
Rajvilla House No. 9, Subash Nagar, Netaji Road, Silchar, Dist- Cachar.
...........Complainant(s)
Versus
1. United India Insurance Co. Ltd.
Shyamaprasad Road, Shillonpatty, Silchar-1, P/O & P/S- Silchar, Dist- Cachar
2. Medi Assist India Pvt. Ltd.
Shilpa Vidya, 3rd Floor, 1st Main Road, J.P. Nagar, Bangalore.
Karnataka
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MR. JUSTICE Bishnu Debnath PRESIDENT
  Kamal Kumar Sarda MEMBER
 
For the Complainant:
For the Opp. Party:
Dated : 12 Sep 2018
Final Order / Judgement

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

CACHAR :: SILCHAR

 

Con. Case No. 20 of 2014

 

            Sri  Rajat Kumar Chakraborty,

            S/o Lt. Raj Kumar Chakraborty, Rajvilla, House No-9

            Subhas Nagar, Netaji Road, Silchar-4. …………………………..          Complainant.

 

                                                                        -V/S-

 

1.         The United India Insurance Co. Ltd,.

            Shyamaprasad Road, Shillongpatty. Silchar-1                                             O.P NO.1.

 

2.         Medi Assist India Pvt. Ltd,.

            Shilpa Vidya, 3rd Floor, 1st main Road,

            Sarakki Indl. Leyout, 3rd phase,

            J.P Nagar, Bangalore-560078.                                                                        O.P No.2.

 

 

 

Present: -                                Sri Bishnu Debnath,                                                    President,

District Consumer Forum,

                                                Cachar, Silchar.                                            

 

 

                                                            Sri Kamal Kumar Sarda,                                Member,

                                                            District Consumer Forum,

                                                            Cachar, Silchar.                                            

 

Appeared :-Sri Bhabani Bhattacharjee & Joydeep Biswas, Advocate’s for the complainant.

                     Sri Deepak Kumar Deb , Advocate for the O.Ps.

                                                 Date of Evidence                                          04-12-2014, 18-07-2017

                         Date of written argument                            15-06-2018

                         Date of oral argument                                 10-07-2018, 21-08-2018

                         Date of judgment                                         12-09-2018

 

 

                                          JUDGMENT AND ORDER

                              Sri Bishnu Debnath,

                                                           

  1. Sri Rajat Kumar Chakraborty brought the complaint under the provision of Consumer Protection Act 1986 for award of compensation for disservice and order of reimbursement  of his mediclaim of Rs.64,965/- against the United India Insurance Co. Ltd., Silchar and against Medi Assistant India Pvt. Ltd. Banglore.

 

  1. The brief fact is as below:-

The Complainant is holder of Individual Health Insurance Policy No. 130500/48/10/97/00000935. The period of Insurance was from 14/03/2011 to 13/03/2012. But during the force of above policy the Complainant admitted to Appollo Hospital, Chennai on 13/09/2011 for Treatment of his ailment as T2DM, HTN, Old CVA, Prostatomegaly and discharged on 17/09/2011. Subsequently, submitted claim for reimbursement vide claim No. CCN:2094151 of Rs.41,920/- and claim No. CCN:2226759 for Rs.22,984. Both the claim settled by the O.P. for Rs.9,129/- and Rs.7,500/- respectively. The settled amount deposited to the Bank Account of the Complainant. But he being dissatisfied with the above settled amount brought the instant case.

  1. The O.P. in their joint W/S stated inter alia that they settled the aforesaid claim with Rs.8,129 and Rs.7,500 respectively after making deduction application under the policy clause 1.2.

 

  1. During hearing, the Complainant submitted deposition and exhibited documents. The O.P. also submitted deposition of Sri. Dilip Kumar Dey and exhibited some relevant documents. The Complainant’s advocate submitted written argument at the ends of the deposition but the Ld. Advocate of the O.Ps did not avail the scope to submit written argument. Of course I have heard both sides’ counsels and perused the evidence on record including written argument.

 

  1. In this case from the argument of both the side, it is clear that the Complainant received total Rs.18,328/- in respect of his mediclaim vide claim No. CCN:2094151 and claim No. CCN:2226759 through his H.D.F.C Bank Account. But he is not satisfied with the above amount because the submitted total claim of Rs.64,905/-

 

  1. However, to justify the claim settled amount of Rs.9,129/- and Rs.7,500/- the O.P. referred the revised terms & consideration No.1.2 of the Insurance Policy. The said plea of the O.P is remain unchallenged at the time of adducing evidence by the complainant.

 

 

  1. Therefore, in this case I do not find the cogent ground for bringing the instant case. As such in my considered view the complainant has not been able to establish any deficiency of service or disservice of the O.Ps.Therefore, the O.Ps are not liable to pay any compensation and also not liable to any more amount in respect of Mediclaim expenditure of the Complainant.

 

  1. Accordingly, this case is dismissed on contest. Supply free certified copy of judgment to the partied. Given under my hand and seal of the District Forum on this the 12th day of September, 2018.

 

 
 
[HON'BLE MR. JUSTICE Bishnu Debnath]
PRESIDENT
 
[ Kamal Kumar Sarda]
MEMBER

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