Date of filing:- 03/08/2023.

Date of Order:-15/07/2024.

DISTRICT CONSUMER DISPUTE REDRESSAL COMMISSION

B A R G A R H (ODISHA).

Consumer Complaint No. 108 of  2023.

            Roshni Rani Patra, D/o Ashok Kumar Patra, aged about 19(nineteen)years, Occupation- Law Student, R/o W.No.10(ten), Bargarh, Sivananda Nagar, Po/Ps/Dist. Bargarh (Odisha)                                                            .....       ....     .....           Complainant.

-: V e r s u s :-

1. Branch Manager, Aditya Birla Health Insurance Company Ltd, 1^st Floor, 5 B, Janpath, Unit-3 Kharavela Nagar, Bhubaneswar-751001 (Odisha).
2. Area Manager Cum Regional Manager, Aditya Birla Health Insurance Company Ltd, 1^st Floor, 5 B, Janpath, Unit-, Kharavela Nagar, Bhubaneswar-751001(Odisha).
3. Dr. Abhijit Ghosh, Authorized Signatory, Aditya Birla Health Insurance Company Ltd., Claims Team, 5^th Floor, Modi Business Centre, Kasarvadavali, Near Hipercity Mall, Thane (Maharashtra) Pin-400615.
4. Chief Executive Officer, Aditya Birla Health Insurance Company Ltd., 9^th Floor, Tower-I, One World Centre, Jupiter Mills Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai-400013, Maharashtra.    .....       .....   Opposite Parties.

Counsel for the Parties:-

For the Complainant :-            Sri M.K.Satapathy, Advocate with associates.

For the Opposite Parties :-                   Miss Nitu Roy, Advocate with associates.

                                                            -: P  R  E  S  E  N  T :-

Smt. Jigeesha Mishra               .....       .....       .....       .....       .....       P r e s i d e n t.

Smt. Anju Agrawal             .....            .....       .....       .....       .....       M e m b e r (W).

Dt.15/07/2024.                                 -: J   U  D   G  E  M  E  N  T:-

Presented by Smt. Anju Agrawal, Member(w):-   

1)         The case of the Complainant is that the Complainant  is a bonafide policy holder of the Opposite Parties vide policy No. 21-22-3522235-00 and Membership No.TP86308553. For the aforesaid policy the Complainant had paid the requisite premium. On Dt.18-02-2023 at about 2:30 PM, the Complainant felt breath problem and was admitted in Kishori Nursing Home, Bargarh and after treatment on 20-02-2023, she was discharged from the hospital. For the treatment the Complainant has placed the insurance claim before the Opposite Parties but instead of settling the claim, the Opposite Parties deffered the matter and did not settle the claim, being harassed by the act of the Opposite Parties, the Complainant filed the complaint before this Commission praying that the Opposite Parties be directed to pay a sum of ₹ 1,00,000/-(Rupees one lakh)only in total to the Complainant along with pendentilite and future interest @ 18% per annum and addition to it a sum of ₹ 30,000/-(Rupees thirty thousand)only towards litigation expenses.

2)         The case of the Opposite Parties is that the Opposite Parties have jointly filed a memo that the claim of the policy holder/Complainant is settled on Dt.05-10-2023 and ₹ 17,472/-(Rupees seventeen thousand four hundred seventy two)only has been paid to the Policyholder vide UTR No. N277232668747357 on Dt.05-10-2023 to Bank Account No. 32550100004028. As the claim of the Complainant has been settled, the case to be disposed off accordingly.

3)         Perused the documents filed by the Parties and it reveals that the Complainant has lodged claim to the Opposite Parties regarding hospitalization but on Dt.10-07-2023 the claim was repudiated for which the Complainant had to file case on Dt. 03-08-2023 against the Opposite Parties for harassment.

            The Opposite Parties have stated that on Dt.05-10-2023 ₹ 17,472/-(Rupees seventeen thousand four hundred seventy two)only regarding insurance claim has been paid to the Complainant but the Opposite Parties has repudiated the claim which amounts to deficiency in service on the part of Opposite Parties.

            Due to repudiation of claim the Complainant got harassed and for harassment and deficiency in service the Complainant is running pillar to post. The Complainant is entitled for compensation and litigation expenses.

            Accordingly it is ordered.

                                                            O  R  D  E  R

9)         The case is allowed against the Opposite Parties. The Opposite Parties are jointly and severally directed to pay ₹ 20,000/-(Rupees twenty thousand)only for deficiency in service and ₹ 10,000/-(Rupees ten thousand)only towards litigation expenses to the Complainant within one month of this order, failing which, the entire awarded amount shall carry 12%(twelve percent) interest per annum till realization.

8)         Accordingly the order is pronounced in the open Commission to-day i.e.  Dt.15/07/2024 and the case is allowed against the Opposite Parties and disposed off.

                                                                                             Typed to my dictation

                                                                                              and corrected by me.                                                                                                     

                                    I agree,                                              ( Smt. Anju Agrawal)

                                                                                                     M e m b e r(w).

                       (Smt. Jigeesha Mishra)

                              P r e s i d e n t.