National Insurance Co v ShiDistrict Consumer Forum, Bokaro
Consumer Case No.-61 /2009
Shila Devi w/o Brij Kishor Prasad
R/o H.S.C.L. Colony, Co-opertive Colony, Telgaria More, Chas, Dist.- Bokaro.
Vs.
The Divisional Manager,
National Insurance Co. Ltd., Sector-1, Bokaro Steel City, Dist.- Bokaro.
Present-
S.M. Alam, President
Sri Vijay Bahadur Singh, Member
Shabnam Praveen, Member
Date of Judgment- 20/11/2009
Date of Case filing-27/07/2009
-: Judgment:-
The complainant has filed this Consumer Case
against the opposite party for payment of Rs. 6733/- claim amount for treatment, besides Rs. 25000/- as compensation and Rs. 10000/- cost of litigation.
2 Brief fact of the case is that the complainant Shila Devi was admitted in Maa Nursing Home on 07.09.2008 for the treatment of burning urination and stress in continuance since 12 days. Due to non improvement at Maa Nursing Home she was referred to Bokaro General Hopsital on 08.09.2009. At Bokaro General Hospital investigation and treatment was given on 09.09.2008 and the treatment continued till 08.11.2009. The receipt of admission for BGH Pathological diagnosis and medicines purchased by the complainant worth Rs. 6733/- was claim for reimbursement on 27.11.2008. The opposite party having its office at Sector I/B has not passed the bill asking for the bill incorrect at Maa Nursing Home. The opposite party several times informed and also through letters that Maa Nursing Home has not given adequate treatment and relief and has not charged any amount. But the Divisional Manager is building pressure to submit false bills. The opposite party has frame the complaint mental and physically. The complainant has also sent a legal notice to the Divisional Manager on 09.05.2009 and the replied of the said legal notice, the Divisional Manager has alleged the complainant to submit false bills saying the whole bill to be unbelievable. The B G H is a reputed hospital and the treatment could have been taken there without refer also. The Divisional Manager has behaved intentionally to harass and defame in all manner. But the complainant has not been paid by the opposite party on account of which there is deficiency on the part of the opposite party and as such, the complainant is entitled to get the aforesaid amounts from the opposite party.
3 In spite of issuance of notice, the opposite party neither appeared nor filed any written statement and as such the proceeding of the present case preceded Ex-parte.
4 The complainant was heard. The opposite party failed to argue the case on its behalf. Upon perusal of the case records and documents available in the case records, it is observed that the claimant was insured with the opposite party under Hospitalization and domiciliary hospitalization benefit policy. The claim of the complainant against medical treatment has not been settled and paid by the opposite party.
5 It is further observed that in voices/ cash memo/ are available in the case records in respect of the complainant’s treatment are as bellow-
i) Cash Receipt No. 60568 dated 08.11.2008
of BGH Rs. 100/-
ii) Case Memo No. 958 dated 08.11.2008 of X-ray house
and Pathological Lab 72 co-operative Colony
B.S.City Rs.320/
iii) Cash Memo No. 8513 dated 11.11.08 of
Friend Medical Hall, City Centre, B.S.City Rs. 807/-
iv) Cash Memo 8582 dated 15.11.08 Rs. 807/-
v) BGH cash receipt no. 50452 dated 09.09.08 Rs.100/-
vi) Friends Medical cash Memo No.6120
dated 10.09.2008 Rs.43.50/
vii) Friends medical cash Memo No.6366
dated 16.09.2008 Rs.146.20/
viii) Receipt no. 3733 dated 23.09.2008 of
Dr. Lal Pathlabs Pvt. Ltd.City Centre, B.S.City Rs. 2250/-
Total Rs.4573.70/-
6 In view of the above we hold the opposite party negligent and deficient in service towards the complainant on account of none payment of her medical treatment amount detailed in above para. The opposite party is therefore, held liable to pay the same to the complainant.
7 Under the facts and circumstances of the case, the opposite party Divisional Manager, National Insurance Co. Ltd. Sector- 1, Bokaro Steel City is directed to pay Rs. 4573.70 (Rs. Four thousand five hundred seventy three and paise seventy) only to the complainant within 30 days from the date of this order. The above opposite party is also directed to pay Rs. 200/- (Rs. Tow hundred) only to the complainant within 30 days from the date of this order.
Member (lady) Member President
la Devi