West Bengal

Bankura

CC/83/2016

Somnath Garai - Complainant(s)

Versus

Branch Manager - Opp.Party(s)

Jayanta Kr. Mukhopadhyay

22 Feb 2023

ORDER

IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION BANKURA

Consumer  Complaint  No. 83/2016

Date of Filing :14-12-2016

Before:                                                                                         

1. Samiran Dutta                              Ld. President.      

2. Rina Mukherjee                          Ld. Member. 

3. Siddhartha Sankar Bhui            Ld. Member.

For the Complainant:  Ld Advocate Jayanta Kumar Mukhopadhyay

For the O.PLd Advocate Asim Kumar Mandal

Complainant   

Somnath Garai, Vill Onda (Mishra Para), Onda, Bankura

Opposite Party          

1.The Branch Manager, LICI, Bishnupur Branch, Bankura 2.Divisional Manager, LICI, Asansol 3.The Calcutta Medical Research Institute, 7/2 Diamondharbour Rd., Kol-27.

 

FINAL ORDER / JUDGEMENT 

Order No.35

Dated:22-02-2023

Hazira is filed on behalf of the Complainant through Advocate.

Step is taken on behalf of the O.P./LICI praying for direction upon the Complainant for submission of Claim Intimation form, Hospital treatment & Claim form and documents for re-imbursement of claim.

The Complainant is a bona fide Policy holder of O.P./LICI with family coverage number being 469688174, dt.28-03-2012 and paid premium from time to time for Rs.3,428/- . In the last week of January, 2015 his wife felt pain in abdomen and vomiting and consulted at Bankura Sammilani Medical College & Hospital, Bankura and remained hospitalized and thereafter she was taken to CMRI, Kolkata for proper treatment and remained hospitalized therein from 30-01-2015 to 07-02-2015 and in course of such treatment several investigations were carried out and diagnosis was done. Thereafter she was again hospitalized at CMRI, Kolkata on 24-02-2015 and discharged on 27-02-2015.

The Complainant therefore has sought relief from the O.P.s./LICI for reimbursement of medical expenses incurred at CMRI, Kolkata but without endorsement of O.P. No.3 / CMRI, Kolkata the claim application could not be submitted before LICI authority.  LICI authority has not yet submitted any written version but O.P. No.3 has submitted written version denying all the material allegations made in the written complaint.

                                                                                                                                                                                              Contd…..p/2

Page: 2

It is a long pending case and the Ld. Advocate appearing for the Complainant has agreed with the Ld. Advocate appearing for the LICI authority that without submission of the Claim Application with the endorsement of O.P. No.3 the Complainant cannot get any relief or reimbursement of medical expenses from the LICI Authority.

On going through the entire complaint and the written version including the documents on record it is found that the spouse of the complainant Rinku Garai was treated at CMRI, Kolkata at the relevant time and it is the bounden duty of the O.P. No.3 to co-operate with the claimant/ complainant by signing / endorsing on the Claim form to be submitted by the complainant before LICI Authority and the refusal thereof amounts to deficiency in service according to Consumer Protection Act. Unless the claim application is submitted before the LICI Authority / O.P. No.1 & 2 it is not possible by them to dispose of the claim application and to facilitate reimbursement and disbursement of medical expenses as referred to above the claim form, to be produced by the complainant, must get duly signed and endorsed by the competent authority of O.P. No.3 and this case is pending for the same.

Accordingly the case is disposed of by directing the O.P. No.3 to co-operate with the Complainant by putting necessary signature and endorsement to the Claim form to be submitted by the Complainant forthwith. The LICI Authority / O.P. No.1 & 2 after receipt of the Claim form duly signed and endorsed by O.P. No.3 and other requisite documents will dispose of the Claim Application of the Complainant within a month from this date. In case of repudiation of the claim if any liberty is given to the complainant to approach this Commission for appropriate relief.

Both parties be supplied copy of this Order free of cost.

The complainant is directed to serve the copy of the Order upon O.P. No.3 for necessary compliance.                                                                                    

 

  ____________________                   _________________               _________________

HON’BLE   PRESIDENT                HON’BLE MEMBER           HON’BLE MEMBER