- Sri Benoy Chandra Sengupta,
85, R.K.M. Bye Lane, Doctor Bagan,
Champdani, Baidyabati, Dist. Hooghly, Pin-712222. _________ Complainant
____Versus____
- Universal Sompo General Insurance Co. Ltd.
42A, Shakespeare, 7th Floor, Kolkata-17,
P.S. Shakespeare Sarani.
- Family Health Plan Ltd.,
16/2, Lake View Road, Kolkata,
P.S. Tollygunge, Pin-700029. ________ Opposite Parties
Present : Sri Sankar Nath Das, Hon’ble President
Dr. Subir Kumar Chaudhuri, Member.
Smt. Samiksha Bhattacharya, Member
Order No. 18 Dated 12-02-2014.
We have gone through the pleadings of the parties, evidence and documents in particular and we find that complainant being a retired employee of Allahabad Bank and was enrolled under the Group Mediclaim Insurance Policy provided by the bank to its retired employees amongst whom the complainant held one insurance policy issued by o.p. no.1 thereby insuring the complainant and his wife namely Smt. Kajal Sengupta. The said policy was issued to the complainant on 1.4.11 with coverage till 31.3.12 and thereafter the said policy was renewed thereby covering the period commencing from 1.4.12 till 31.3.13 under the cashless benefit scheme for sum insured of Rs.1 lakh the bearing no.2816/51338480/01/000. The complainant all of a sudden on 30.4.12 suffered severe abdominal pain and was admitted at RE-LIFE, a multi-disciplinary hospital (among their network hospitals) under Dr. Debasish Sarkar.
We further find that after pathological testing, investigations, etc. the disease of the complainant was diagnosed to be Acute Cholecystitis, treated with laparoscopic GP operation followed by post-operational complications followed by fever and retention of urine and the complainant was discharged from hospital on 8.5.12. The complainant had to stay in the hospital for seven days in the ICCU and two days in ICU indicating the gravity of the operation and post-operation crisis. At the time of discharge of the complainant the hospital management charged a sum of Rs.71,533/- towards of the treatment and allied expenses and o.p. no.1 disbursed Rs.20,000/- directly to the hospital management vide Claim CID No.255514, but the management did not discharge the complainant unless and until the entire amount of Rs.71,533/- is paid. Complainant was compelled to make the payment of the residual amount of Rs.51,533/- and get the discharged from the hospital. The payment of the residual amount was made through cheque vide no.811520 dt.8.5.12 for Rs.36,533/- drawn on SBI, Baidyabati Branch and cheque vide no.461673 dt.8.5.12 for Rs.15,000/- drawn on SBI, Bardhaman Court Compound Branch. To the complainant’s dismay and shock, o.p. no.1 vide their letter dt.19.7.12 repudiated the claim of the complainant. Hence the case was filed by the complainant with the prayer contained in the petition of complaint.
O.p. no.,1 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.p. in the course of argument submitted that the case has got no merit and the same is liable to be dismissed. O.p. no.2 did not contest the case by filing w/v and accordingly the matter was heard ex parte against o.p. no.2.
Decision with reasons:
In view of the findings above and on perusal of the entire materials on record we find that o.ps. had sufficient deficiencies on their part being service providers to their consumer / complainant and complainant has substantiated and proved his case and is entitled to relief.
Hence, ordered,
That the case is allowed on contest with cost against o.p. no.1 and ex parte without cost against o.p. no.2. O.p. no.1 is directed to reimburse a sum of the Rs.51,533/- (Rupees fifty one thousand five hundred thirty three) only to the complainant and is further directed to pay a sum of Rs.20,000/- (Rupees twenty thousand) only for harassment and mental agony and litigation cost of Rs.5000/- (Rupees five thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 10% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.
