West Bengal

Bankura

CC/48/2016

Bijoy Kumar Khandelwal - Complainant(s)

Versus

Life Insurance Corporation of India Bankura Branch - Opp.Party(s)

Samir Banerjee

31 Jul 2023

ORDER

   IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION, BANKURA

  Consumer Complaint No. 48/2016

Date of Filing: 15.07.2016

Before:                                        

1. Samiran Dutta                              Ld. President.      

2. Rina Mukherjee                          Ld. Member. 

3. Siddhartha Sankar Bhui            Ld. Member.

 

For the Complainant:  Ld. Advocate Samir Banerjee

For the O.P. : Ld. Advocate Nilanjan Dasgupta

Complainant  

Bijoy Kumar Khandelwal, S/o Late Bachulal Khandelwal, at Rabindra Sarani, Bankura

Opposite Party  

1.LIC, Bankura, Nutanchati

2.LIC, Asansol, G.T. Road

 FINAL ORDER / JUDGEMENT                      

                                                                                                                                     

Order No.38

Dated:31-07-2023

Both parties file hazira through advocate.

The case is otherwise ready for disposal.

The Complainant’s case is that he took One Time Health Insurance LIC Policy (Jeevan Arogya) for self and his spouse from O.P. having Policy No.449478104 commencing from 22/06/2012 and valid up to 22/06/2036 on payment of Yearly Premium of Rs.11,197/-.  On 11/08/2015 the Complainant with his wife Smt. Vinita Devi Khandelwal met with an accident while riding on their Motor Cycle and the Complainant sustained serious head injury and his spouse was also injured. Immediately after the accident both the injured persons were to be hospitalized at Bankura Seva Niketan Hospital where the Complainant was admitted and was under treatment since 11/08/2015 to 12/08/2015 under the diagnosis head injury and the Complainant was referred to higher center for better management and accordingly he was admitted at Institute of Neuro Sciences, Kolkata on 12/08/2015 where after having due medical management he was discharged on 13/08/2015. Thereafter the Complainant preferred claim application with the O.P. on 07/09/2015 claiming medical reimbursement of Rs.43,000/- but the O.P.  paid Rs.2,300/- only and refused the rest amount on the ground that the Complainant is not entitled to get the same. Hence the Complainant has approached this Commission for appropriate relief.

O.P. contested the case by filing a written version contending inter alia that the Policy in question is a One Time Health Policy and unlike Mediclaim Policy there is no provision of reimbursement of medical expenses incurred for any surgical treatment. The Complainant was paid Rs.2,300/- towards Hospital Cash Benefit for one day as permissible under the Policy.

                                                                                                                                                                                      Contd……p/2

     Page: 2      

                                                                                          -: Decision with reasons: -

Having regard to the facts of the case, contention, submission and documents on both sides the Commission finds from the Policy document that it does not cover any accidental benefit and no sum is assured for the same in the Policy. Only Initial Daily Benefit for Rs.2,000/- for the Complainant and Rs.1,000/- for his spouse is admissible under the Policy and accordingly Rs.2,300/- has been paid to the Complainant. The medical reimbursement bill of Rs.43,000/- as claimed by the Complainant relates to the Surgical Treatment and Pathological and Investigation charges and as stated above no amount is admissible on such heads as per terms and conditions of the Policy.

Ld. Advocate for the Complainant could not show before the Commission from the terms and conditions of the Policy justifying the reimbursement of Rs.43,000/-

The case therefore fails for want of merit.

Hence it is ordered……..

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

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

 

 ____________________                _________________          _________________

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