This day is fixed for exparte order. The complainant files hazira . The case of the complainant is brief is that the complainant is an “Easy Health Insurance Policy Holder of Apollo Munich Health Insurance Co. Ltd.” City palace, 2^nd floor, plot no.9659, beside sunny tower, P.O.- Sevoke Road, Siliguri -734001,vide policy No.150800/11001/AA00256182. Under this policy the complainant cover the Health Insurance  of his mother Smt. Monorama Ghosh. The amount of sum insured was 2,00,000/- and premium amount of Rs.13,743,47/- was paid by the complainant regularly .On 04.02.2016 the mother of the complainant fell ill due to gum bleeding and she was admitted in Neotia Getwel Health care Centre, Siliguri  on & from 5.2.16 up to 10.2.16.

 The Neotia Getwel Health Care Centre sent mail to the OP for Pre-authorization request for Smt. Monorama Ghosh and the OP, after clearing all the querries rejected the complainant‘s pre authorization claim request without showing any cause. The Neotia Getwel Health Care Centre gave clarification of all the doubts of the Op through mail along with final bill, discharge summary of the patient. On 26.2.2016 the Op have registered the complainant’s claim of Rs. 84,626/- and sent a claim acknowledge letter to the complainant confessing complainant’s claim is under process. The OP sent first query letter on 1.03.2016 to the complainant and the complainant replied the same. After that the complainant several times gave answer to the querries of the Op with proper documents and being hopeless the complainant sent legal notice to the Op but the Op did not reply of the same. Thus the complainant filed this case.

 The OP appeared but did not file w/v. Hence the case proceeds exparte against the Op.

 The complainant files the following documents in support of these contentions:-

1. Photo copy of health Insurance Policy(150800/11001/AA00256182).
2. Photo copy of Medical Bills.
3. Photo copy of case summary.
4. Photo copy of E. Mail dt. 09.02.2016.
5. Photo copy of E. Mail dt.10.02.2016.
6. Photo copy of E. Mail dt.09.02.2016.
7. Photo copy of E. Mail dt.09.02.2016.
8. Photo copy of E. Mail dt.10.02.2016.
9. Photo copy of E. Mail dt.10.02.2016.
10. Photo copy of E. Mail dt.10.02.2016.
11. Photo copy of  Cash less acknowledgement dt. 05.02.2016.
12. Photo copy of  Cash less Query letter dt.05.02.2016.
13. Photo copy of  Cash less Query letter dt. 09.02.2016.
14. Photo copy of  Cash less Rejection letter dt. 09.02.2016.
15. Photo copy of  Cash less Query letter dt. 10./02.2016.
16. Photo copy of  Cash less Rejection letter dt. 10.02.2016.
17. Photo copy of  Claim acknowledgement dt. 26.02.2016.
18. Photo copy of  Query letter dt. 01.03.2016.
19. Photo copy of  Query letter dt. 15.03.2016.
20. Photo copy of  Query letter dt. 18.04.2016.
21. Photo copy of  Claim Closure Letter dt. 20.04.2016.
22. Photo copy of  Claim Closure Letter dt. 25.04.2016.
23. Photo copy of  Claim Closure Letter dt. 12.05.2016.
24. Photo copy of  Claim Closure Letter dt. 21.05.2016.
25. Photo copy of  Doctor’s Certificate.
26. Photo copy of  Claim Closure Letter dt. 01.06.2016.
27. Photo copy of  Legal Notice dt. 07.07.2016.
28. Copy of Money receipt of first visit issued by Neotia Getwel amounting Rs. 650/-.
29. Copy of advance receipt for admission of Rs.1,000/-.
30. Copy of balance of final bill money receipt amounting Rs. 77,293/-
31.  Copy of final bill.
32. Copy of money receipts of blood bank.
33. Copy of two bills of medicine.

 The complainant files evidence.

            On Meticulous perusal of the evidence and unchallenged documents filed by the complainant we are of the view that there is nothing to disbelieve the complainant and the complainant succeeds to prove his case.

Hence it is,

O R D E R E D

That the case no. 1/S/2017 be and the same is allowed exparte against the OP.

            The Op is directed to pay the complainant the claim amount             of Rs.84, 626/-

along with interest along with compensation of Rs.5000/- totaling Rs.89,626/-.

            The OP is directed to pay the above sum through an A/C payee cheque within 45 days to the complainant failing which the complainant is entitled to have interest of the above sum @ 9% per annum from the date of this order till realization.

In case of default of payment as ordered above the complainant is at liberty to execute this order through this forum as per law.

            Copies of this judgement be supplied to the parties free of cost.