West Bengal

Bankura

CC/150/2014

Sri Prasanta Kr. Mondal - Complainant(s)

Versus

1. Manager Life Insurance Corporation of India.2.Manager, (HI) /KMDO. 3. Sr. Divisional Manager. 4. - Opp.Party(s)

Tapan Dey

18 Jan 2023

ORDER

IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION BANKURA    

Consumer  Complaint  No. No. 150/2014

Date of Filing : 19.11.2014

Before:

1. Samiran Dutta                              Ld. President.      

2. Rina Mukherjee                           Ld. Member. 

3. Siddhartha Sankar Bhui             Ld. Member.

For the Complainant: None

For the O.P. :Ld. Advocate Asim Kumar Mondal

Complainant

Prasanta Kumar Mondal, Rabindra Sarani, Bankura

Opposite Party 

1.Manager, Life Insurance Corpn. Of India, City Branch-6, Kolkata 2. Manager / KMDO-I, Health Insurance Department, LICI, C.R. Avenue, Kolkata 72 3. Sr. Divisional Manager, LICI, Kolkata Metropolitan Divisional Office, Jeewan Prakash, C.R. Avenue, Kolkata- 72 4. Sri Sukhendu Das, Agent Code 99586411, 53/3 Kali Banerjee Lane, Howrah- 711101

FINAL ORDER / JUDGEMENT

Order No.45                                                                             

Dt. 18-01-2023

No step is taken by the Complainant.

Step is taken by the O.P. through Ld. Advocate.

After hearing from the O.P. in view of Section 38 (3) (c) Of Consumer Protection Act, 2019 the Commission decides to dispose of the case as hereunder:

Complainant’s case is that he had a LIC Health Plus Policy No. being 577620489 issued by the O.P. L.I.C. authority with Yearly premium of Rs.5,000/- for 15 years commencing from 28-10-2009. While the Policy was in force the Complainant visited the Chamber of Dr. Partha Pratim Chakraborty on 10-08-2011 who prescribed some medicines and advised him to attend Asian Institute of Gastro Enterology at Hyderabad for better treatment. Accordingly the Complainant was examined by the Doctors on different dates namely on 29-08-2011 &  23-04-2012 at the said Institute at Hyderabad with various medical tests for treatment of his chronic liver disease. As per Doctors’ advice of the said Institute the Complainant was admitted on 01-06-2013 and discharged on 04-06-2013 for which he incurred medical expenses of Rs.51,903/- in all. But the said claim of Rs.51,903/- was refused by the O.P. authority for reasons best known to them. Hence this case for recovery of Rs.51,903/- from the O.P. along with Rs.35,000/- as Compensation and Rs. 10,000/- as Litigation cost.

                                                                                                                                                                               Contd…………p/2

Page: 2

The O.P. contested the case by filing a Written Version contending inter alia that the Complainant is entitled only Rs.500/- per day as Initial Daily Hospital Charges during his admission and treatment at the said Institute from 01-06-2013 to 04-06-2013.

Having gone through the entire materials on record including the terms and conditions of the Policy in question the Commission finds that except in case of Surgery, Accident and Death the Insured is entitled to get Insurance benefit for any medical expenses which is limited to only Rs.500/- per day as Initial Daily Hospital Cash benefit for any admission, treatment and hospitalization. Ld. Advocate for the Complainant could not however refute the contention of the Ld. Advocate for the O.P. on this point but facts of the case reveals that the Complainant has undergone treatment at Hyderabad and incurred medical expenses for Rs.51,903/-. Though the Complainant is not entitled to that amount but his mental sufferings for movement from Bankura to Hyderabad on different occasions in search of better medical treatment should be reasonably compensated in the interest of justice.

Hence it is ordered……..

That the case be and the same is allowed in part against the O.P. authority.

The O.P.s are directed to pay to the Complainant Rs.2,000/- together with Compensation of Rs.8,000/- as Compensation within two months from this date in default the same may be recovered in due process of law.

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

 

                          ____________________                                  _________________                     _________________

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