West Bengal

Paschim Midnapore

CC/122/2017

Rakiba Begam - Complainant(s)

Versus

Universal Sompo General Insurance Co.Ltd. - Opp.Party(s)

Asim Kumar Dutta

23 Mar 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

    Bibekananda Pramanik, President,

     Pulak Kumar Singha, Member. 

and 

Sagarika Sarkar, Member.

 

Complaint Case No.122/2017

 

                                      Rakiba Begum, W/o-Delawar Hossion at Mahatabpur,

                                      P.O.-Midnapore, P.S.-Kotwali, Dist- Paschim Medinipur.  

                                                                                             ………..……Complainant.

                                                                              Vs.

                                 Universal Sompo General Insurance Co. Ltd. Midnapore Branch,  

                                 Station Road, P.O.-Midnapore, P.S.-Kotwali, Dist-Paschim Medinipur.

                                                                            .....……….….Opp. Parties.                                                    

              For the Complainant: Mr. Ashim Kumar Dutta, Advocate.

              For the O.P.               : Mr. Pinaki Sengupta, Advocate.

                                                          

                                                                                      Date of filling:-  28/07/2017

Decided on: -    23/03/2018

                               

ORDER

                          Pulak Kumar Singha , Member –In short the case of the complainant is that complainant’s son, Zulfikar Hossain purchased on Health Insurance policy for himself,  Samima Begam, complainant and Nabhan Ahamad from O.P. which was sum assured of Rs.1,00,000/- (Rupees one lakh) only and said policy was valid 17/02/2015 to 16/02/2016. Zulfikar Hossain again purchased the same policy which was valid from 22/02/2016 to 21/02/2017 from the O.P. On 22/06/2016 complainant suffered from abdomen pain with vomiting and treated by Dr. S. N. Tripathi and after clinical examination, found that a calculus in gall bladder in the abdomen and as per advise of said doctor she admitted at K.G. Medicare Nursing Home at Midnapore where her gallbladder

                                                                                                                                                Contd……………P/2

 

( 2 )

 stone was removed by operation by said Doctor.  Complainant intimated the matter to the O.P. and submitted documents but O.P. repudiated the claim on the ground of non-discloser of any material fact. Complainant approached before this Forum for getting relief as per prayer of complaint.

                O.P. contested the case by filing written statement denying the allegations of complainant, stating interalia that the complaint is not maintainable, that complainant did not intimate the company in time, and complainant is a chronic patient of diabetes mellitus and said matter was suppressed by the insured, O.P. rightly repudiated the claim and this O.P. has no deficiency of service as such O.P. pray for dismissal of complaint. Complainant to prove her case adduced evidence and tendered herself as P.W.-1 and submitted some documents which are marked (Exhibit 1 to 11). Witness was cross-examined by O.P. and O.P. could not collect any material in cross-examination from P.W.-1.

O.P. did not adduce any evidence or produce any documents on their behalf for taking defence.

It appears from the documents filed by complainant, that Health Insurance Policy vide no.2827/54860862/00/000 was valid from 22/02/2016 to 21/02/2017 as renewal policy and covered four persons including complainant as insured and sum assured was of Rs.1,00,000/-. Other medical treatment documents including  bill of nursing home and medicine for treatment and operation of complainant Rakiba Begum, which are all marked (Exhibit 1 to 11). From the documents it is established that complainant was suffering abdominal pain due to gallbladder stone and it was removed through  operation by Dr. S.N. Tripathi at K.G. Medicare hospital at Paschim Medinipur. Complainant submitted medical bills total Rs.31,157/- which are according to submitted copy of bills and admitted by the O.P.

From the documents and evidence it reveals that O.P. repudiated the claim on the ground that complainant was a patient of diabetes mellitus on insulin, admitted in K. G. Medicare for surgery of chronic calculus  cholecystitis on 28/07/2016 but complainant suppressed the material fact at the time of taking policy. But O.P. did not prove such statements of their repudiation letter by adducing any cogent evidence as such  mere comments in the repudiation letter has got no evidenciary  value unless it is prove by any cogent evidence and for such O.Ps. defence has got no merit and no  leg to stand in evidence. O.P. is deficient in rendering service to his consumer.

 In view of the discussion herein above we find that complainant proved her case and she is entitled to get relief as per prayer of complaint.                                                                                                               

                                                                                                                                                          Contd……………P/3

 

  ( 3 )                    

                                     Hence, it is,

                                                      Ordered 

                                                      that the case be and the same is allowed on contest against O.P. with cost.  

                  O. P. is  directed to pay Rs.31,000/- as medical expense, Rs.5,000/- as  compensation for harassment, mental pain  and Rs.1,000/- as litigation cost to the complainant within one month from the date of order of this Forum.

                  Failure to comply the order O.P. shall be liable to pay Rs.2,000/- per month as penal cost to the account of Legal Aid Fund of this Forum till full realization.   

 

             Dictated and Corrected by me

                         Sd/-P.K. Singha                                Sd/- S. Sarkar                          Sd/-B. Pramanik. 

                               Member                                          Member                                     President

                                                                                                                                    District Forum

                                                                                                                                 Paschim Medinipur