West Bengal

Bankura

CC/48/2024

Smt. Priya Mallick Chand - Complainant(s)

Versus

Branch Manager, Star Health and Allied Insurance Company Limited - Opp.Party(s)

Sandip Chakraborty

12 Nov 2024

ORDER

IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION, BANKURA

  Consumer Complaint No.48/2024

        Date of Filing:  19/06/2024

Before:                                        

1. Samiran Dutta                                     Ld. President      

2. Siddhartha Sankar Bhui                    Ld. Member

3. Kabita Acharjee (Goswami)              Ld. Member

 

For the Complainant:Ld. Advocate Sandip chakrabarti

For the O.P.: Ld. Advocate Mahadev Chakraborty

 

Complainant:

Smt. Priya Mallick Chand,W/O-Sri Pradip Chand,R/O-Vill-Kuchakone,P.O-Bhutsahar,P.S-Simlapal,Dist-Bankura,Pin-722156,Present R/O-Gandhinagar,Panchbaga,P.O,P.S,Dist-Bankura,Pin-722101,Mob-8101016808   

Opposite Party:

1.Branch Manager,Star Health and Allied Insurance Company  Limited,Branch Office –Durgapur,SM-10,Ambedkar Sarani,City Centre,Durgapur,Paschim Bardhaman-713216,West Bengal,Phone No-18004252255

2.Star Health and Allied Insurance Company  Limited,No-15,Sri Balaji Complex,1^st Floor,Whites Lane,Whites Road,Roy Apettah,Chennai-600014,Contact No-0442888649

 

FINAL ORDER / JUDGEMENT           

                                                                                                                                                

Order No.08

Dated:12-11-2024

Both parties file hazira through Advocate.

The case is fixed for argument.

After hearing argument from both sides the Commission proceeds to dispose of the case as hereunder.

The Complainant’s case is that her husband Pradip Chand has a Family Health Optima Insurance Plan from O.P./Insurance Co. for self and the Complainant and son and daughter commencing from 14/03/2023 to 13/03/2025 with sum assured Rs.5 Lakh Policy No. being 1123025782140.  On 27/04/2024 the Complainant fell ill  by Mumps Parotitis and was admitted in Jeevan Suraksha Hospital, Bankura on the same date as per advice of the attending Dr. where she was hospitalized and discharged on 30/04/2024. During hospitalization she incurred medical expenses of Rs.22,681/- but the mediclaim for the same amount has been denied by the O.P./Insurance Co. Hence this case.

                                                                                                                                                                                      Contd…..p/2

Page: 2

O.P./Insurance Co. contested the case by filing a written version admitting therein the claim of the Complainant to the extent of Rs.21,232/- after admissible deduction of Rs.2,131/-

In view of the admission of claim by the O.P./Insurance Co. the Commission cannot but accept the same as the settled amount. However O.P./Insurance Co. has to bear litigation expenses of Rs.4,000/- for dragging the complainant to file the instant case.

Hence it is ordered…….

That the case be and the same is disposed on contest but without cost.

O.P/Insurance Co. is directed to pay to the Complainant Rs.21,232/- with litigation cost of Rs.4,000/- within a month from this date in default law will take its own course.

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

 

    __________________                                      ________________                              ________________

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