In  the  Court  of  the

Consumer Disputes Redressal Forum, Unit -I, Kolkata,

8B, Nelie Sengupta Sarani, 4^th Floor, Kolkata-700087.

CDF/Unit-I/Case No. 410 / 2010 .

1)                   Mrs. Shail Rani Jaiwal,

            74, Braunfeld Road, Kolkata-27.                                                             ---------- Complainant

---Versus---

1)                   Apollo Munich Health Insurance Co. Ltd.

            9^th Floor, Plot No.44, Park Street,

            Kolkata-16,  P.S. Park Street     

2)                   Apollo Munich Health Insurance Co. Ltd.

            10^th Floor, Tower-B, Building No.10,

            DLFCyberCity, Phase II, Gurgaon, Haryana-122002.                                          ---------- Opposite Parties

Present :           Sri Sankar Nath Das, President.

                        Dr. Subir Kumar Chaudhuri, Member.

                        Smt.  Samiksha Bhattacharya, Member

Order No.   26    Dated 15-07-2013.

          The case of the complainant in short is that complainant took a mediclaim health insurance policy along with cashless insurance card facility for all the insured person under the o.p. and complainant started the policy on 7.4.09 to 8.4.10, agency code 80092459. Policy number is 150100/11001/1000032039-01, insured amount of Rs.3 lakhs, gross premium Rs.11,526.35 and the complainant again renewed the said policy for the year of 8.4.10 to 7.4.11.

            Complainant aged about 60 years and due to urinary problem, as per advised the complainant was admitted Kothari Medical Centre on 12.6.10 and then as per pre-hospitalization facility, the complainant requested the o.p. to sanction the treatment expenditure on 14.6.10 but the o.p. denied the said cashless facility to the complainant and stated that his claim for mental health treatment are excluded from easy health policy.

            Complainant incurred the medical bill relating to medical treatment a sum of Rs.54,429/-.

            Complainant stated that the o.p. duly receipt the said claim form in time and after receipt the same refused to pay the legitimate claim amount on the ground of mental health insurance is not cover under the policy, although they have taken extra premium for the easy health policy. Hence the case was filed by the complainant with the prayer contained in the petition of complaint.

            O.ps. did not contest the case by filing w/v and matter was heard ex parte against both the o.ps.

Decision with reasons:

            We have gone through the pleadings of the parties, evidence and documents in particular and we are of the views that the evidence adduced by complainant has remained unchallenged testimony and o.ps. have not come forward to rebut the same and as such, this Forum is of the opinion that the complainant has been able to prove her case and is entitled to relief.

            Hence, ordered,

            That the case is allowed ex parte with cost against the o.ps. O.ps. are jointly and/or severally directed to pay a sum of Rs.54,429/- (Rupees fifty four thousand four hundred twenty nine) only towards the claim of the complainant and are further directed to pay compensation of Rs.20,000/- (Rupees twenty thousand) only for harassment and mental agony and litigation cost of Rs.5000/- (Rupees five thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 10% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.

            Supply certified copy of this order to the parties free of cost.