Jharkhand

Bokaro

CC/18/13

Ram Suresh Ray - Complainant(s)

Versus

Iffco Tokio General Insurance Co. Ltd. - Opp.Party(s)

Dhanjee Choudhery

02 Feb 2023

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-01-02-2018

Date of final hearing-02-02-2023

 Date of Order-02-02-2023

Case No. 13/2018

Ram Suresh Roy died during pendency of the case

Hence Devmani Devi W/o Late Ram Suresh Roy

 R/o Prabhat Coloney, Chas Near Shiv Mandir, District- Bokaro

Vs.

1. IFFCO Tokyo General Insurance Co. Pvt. Ltd.

C/o Corporate Office, Iffco Tower-II, Plot No.3, Sector-29,

Gurgaon, Haryana- 122001

2. IFFCO Tokyo General Insurance Co. Pvt. Ltd.

Raksha TPA- C/o- Escorts Corporate Cenrer, 15/5,

Mathura Raod, Faridabad, Haryana

3. The C.E.O. Bokaro Steel Plant, Adm. Building B.S.City,

P.O.- Sector-4, District- Bokaro, Jharkhand.

 Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

 

PER- J.P.N Pandey, President

-Judgment-

1.  Initially this case was filed by one Ram Suresh Roy who was original complainant but later on during pendency of the case he died hence his wife has been substituted in his place to continue the case. Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 51,235/- on account of rest of  medical expense incurred during his treatment and for grant of compensation Rs. 30,000/- and for Rs. 10,000/- as legal expense.
2. Complainant’s case in brief is that he is a retired SAIL, BSL employee and as per policy of the company he opted for Mediclaim policy for himself and his wife. He was provided MIN No.4722253 which was valid at the relevant time. Further case is that due to illness of the complainant he was admitted in B.M. Birla Heart Research Centre, Kolkata for treatment whose bill was Rs. 1,93,582/- but only Rs. 1,42,347/- was paid by the O.Ps. to the Hospital and rest of the amount Rs. 51,235/- was paid by the complainant. Inspite of repeated requests O.Ps. have not paid said amount. Hence this case has been filed with above mentioned prayer. 

 

4.   O.P. No. 3 SAIL/ BSL Bokaro appeared and has filed W.S. in which there is no comment on all the contents of the complaint petition.
5. On behalf of O.P. No.1 (IFFCO-TOKIO General Insurance  Co. Ltd.) W.S. has been filed in which it is mentioned that  the claim of the complainant has already been settled however, this O.P. cannot be held liable to pay more than a sum of Rs. 23,966/- which is the maximum sum payment to the complainant after the necessary deductions based on the terms and conditions of the policy and those deductions are related to Rs. 27,269/- which has been deducted as per the norms of the policy.
6. On the basis of above pleadings we have to see whether complainant is entitled to get relief as claimed or not?
7. On careful perusal of the reply of the O.P. Insurance co. it is very much clear that at para 4 of the W.S. from page 3 to 4 it has been admitted by the O.P. Insurance Co. that complainant is also entitled to get payment of Rs. 23,966/- more and rest of the amount Rs. 27,269/- is related to deductions as per terms and conditions of the policy as indicated in the table mentioned at page 4 of the reply. Therefore, it is very much clear that genuine claim of the complainant related to Rs. 23,966/- has not been settled earlier rather after filing of the case during reply it has been admitted by the O.Ps. which shows deficiency on the part of O.P. No.1 and 2. Therefore, complainant is entitled to get relief as indicated below:-
8.   Accordingly prayer of the complainant is being allowed in the following manner:-

         O.P. No. 1 IFFCO-TOKIO General Insurance  Co. Ltd. is directed to pay Rs. 23,966/- to the complainant within 60 days from receipt/production of the copy of this Judgment, failing which he will pay interest @ 10% per annum  on that very amount from 01.02.2018 (i.e. the date on which case was filed). Further O.P. No.1 is directed to pay compensation of Rs. 15,000/- for various types of harassment caused to the complainant for his genuine claim and also to pay Rs. 5000/- as litigation cost within above mentioned period.

 

(J.P.N. Pandey)

                                                                                      President

                                                                                               

 

                                                                               (Baby Kumari)

                                                                                       Member