THE DIST.CONSUMER DISPUTES REDRESSAL COMMISSION, KHURDA, BHUBANESWAR:

                                                -ooOoo-

C.D.CASE NO.108 / 2022

1. Shri Pradyumna Kumar Routray, aged 57 years,

S/o Prafulla Chandra Routray, At Qr.No.2RA-10/1, Kalpana Flat,

BJB Nagar, Bhubaneswar, Pin – 751014, Dist – Khurda

Bhubaneswar, Odisha

2. Dali Routray, aged about 47 years,

W/o - Pradyumna Kumar Routray,

At Qr.No.2RA-10/1, Kalpana Flat,

BJB Nagar, Bhubaneswar, Pin – 751014, Dist – Khurda

Bhubaneswar, Odisha

3. Adyasha  Routray, aged about 22 years,

D/o - Pradyumna Kumar Routray,

At Qr.No.2RA-10/1, Kalpana Flat,

BJB Nagar, Bhubaneswar, Pin – 751014, Dist – Khurda

Bhubaneswar, Odisha

                                                                             ….     Complainants

          -Vrs.-

1.       Future Generali India Insurance Company Ltd.,

          2^nd  Floor, Kalinga Complex Unit – 1,

          Bhubaneswar, Odisha.

2.       The Insurance Ombudsman, 62, Forest Park,

          Bhubaneswar, Odisha – 751009                                   

                                                                             ….     Opp. Parties

For the complainant                :   M/s S.S Rath & Associates (Adv.)

For the O.Ps.                           :   Exparte

DATE OF FILING                  :         06/04/2022

DATE OF ORDER                 :         15/03/2023

ORDER

K.C.RATH, PRESIDENT

1.       This is an application U/s 35of the C.P.Act, 2019.

2.       The complainants’ case in brief is that, they were insured against the decease Corona  with the OP.1 under the policy “Future Generali Corona Rakshak policy” . They paid premium for the said policy. The insurance policy was effective from 8/8/2020 to 5/5/2021.  Pradyumna Routray, complainant No.1,  was found Covid-19 positive on 15/08/2020. Dali Routray & Adyasha Routray, the complainant Nos. 2 & 3, i.e. the other two insured persons,  were also found covid-19 positive on 17/08/2020. Complainant No.1 and complainant No.3 were admitted  in Hi-tech hospital on 17/08/2020 and discharged from the hospital on 23/08/2020 and 26/08/2020, respectively. The complainant No.2 was admitted  in the said hospital on 20/08/2020 and was discharged on 26/08/2020. After discharge from the hospital, the complainants lodged their claims  with the OP.1 as per the insurance policy issued in their favour.  But the OP.1 repudiated the claim on the ground that there was no need of hospitalization and the patients were asymptomatic in nature and in addition to that, they were yet to submit the required documents for the purpose of claim. Thereafter, the complainants lodged the claim before the Insurance Ombudsman,  who rejected the claim thereafter. Then the complainants filed this complaint before this Commission.

3.       On the other hand, the OP.1 i.e. the Insurance Company filed written version  contending therein that, the patients  ( complainants) were hospitalized for the purpose of isolation/ observations and evaluation and there were no clinical symptoms that was necessary for hospitalization of the patients.  Besides, they have not followed the claim procedure  nor they submitted the required documents  for which the claim was rightly rejected.  As the complaint bears no merit, it is liable to be dismissed.    

          Similarly, the OP.2 i.e. the Insurance Ombudsman, briefly submits that the complaint is liable to be dismissed for  mis-joinder of party and the insurance ombudsman  is neither a necessary nor appropriate party for the complaint petition. Therefore, it is liable to be dismissed against the OP.2.

          However, on the date of hearing, the OPs 1 & 2 remained absent, hence they were set exparte and exparte hearing was taken up on 21/02/2023.

4        Perused the materials on record.  Admittedly, the complainants were insured  with the OP.1 under the policy namely “Future Generali Corona Rakshak policy” . The insured persons  were also admitted in the hospital during the validity of the policy. They remained in the hospital for more than 72 hours. But the discharge certificates issued in favour of the complainants indicate that, there was no active line of treatment for Covid-19. They were given some vitamin tablets and were discharged in a stable condition. On  going through the entire materials on record, we find that, the hospitalization of the insured persons was not necessary keeping in view the mild symptoms of Covid-19  present in those patients. Further,   keeping in view the terms & conditions  of the insurance policy, we do not find that the insured persons are entitled to the insurance claim  amount as per the policy issued in their favour.  In this backdrop,     the complaint bears no merit.  Hence it is ordered.      

ORDER

The complaint is  dismissed  exparte against the OPs  being devoid of merit.

The order is pronounced on this day the  15^th March,  2023  under the seal & signature of the President and Member  of this  Commission.

                                                                                      (K.C.RATH)

                                                                                       PRESIDENT

 Dictated & corrected by me

          President                                                                                    

I agree                                                                            

(S.Tripathy)                                               

Member (W)                                                                             

Transcribed by Smt. M.Kanungo, Sr.Steno