District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No.74/2023.
Date of Institution:01.02.2023.
Date of Order: 28.02.2024.
Chanderhas son of Shri Jeet Ram. Resident of Nangla Guhran Khatela Sarai Palwal Haryana at present R/o H.NO. 928, Sector-8, Faridabad.
…….Complainant……..
Versus
1. M/s. ICICI Lombard General Insurance Co. Limited registered office 414, Veer Saverkar Marg, near Siddhi Vinayak Temple, Prabhadevi Mumbai – 400 025 through its authorized person.
2. ICICI Lombard General Insurance Company Limited Ist floor, SCO 17, Sec.-16, Faridabad – 121002 through its authorized person.
…Opposite parties……
Complaint under section-12 of Consumer Protection Act, 1986
Now amended Section 34 of Consumer protection Act 2019.
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
Indira Bhadana………….Member.
PRESENT: Sh. Deepak Sharma , counsel for the complainant.
Sh. Rakesh Dabaas, counsel for opposite parties .
ORDER:
In this case, the complaint filed by the complainant with the prayer to make the hospitalization cash benefit of Rs.10,000/- per day and the hospital attendant cash benefit of Rs.10,000/- for 5 days of the admitted of the complainant in Krishna Nursing Home total amount which comes to Rs.1,00,000/- alongwith interest @ 18% p.a. to the complainant as per the policy of the terms and conditions of the insurance policy.
2. As per discharge summary vide Ex.C-3 as well as claim settlement letter vide C-4 the complainant admitted in Krishna Nursing Home, Plot N0. 71,Sector-10, HDBC, near Milan Sweet House, Faridabad on 16.05.2021 and discharged on 21.05.2021 and the hospital raised a bill of Rs.48,162/- which was paid by the Health Insurance TPA of India Ltd. and settled the claim with the hospital.
3. During arguments, Shri Rakesh Dabaas, counsel for the opposite parties has made a statement that “I being the authorized representative of M/s. ICICI Lombard General Insurance Company, I am ready to settle the present matter for total amount of Rs.50,000/- in full and final settlement towards the claim of the complainant. A period of 60 days may be given t make the payment of said amount by the insurance company.”
4. It is evident from insurance policy vide Ex.C1 in which it has been mentioned in Sl.No.2 Details of the insured Event alongwith the benefits (as per table below):
Cover name | Sum insured | No. of days/events |
Hospitalization cash benefit | 10000 | 90 |
Hospital Attendant Cash Benefit | 10000 | 90 |
Please Note:1.The sum insured mentioned above is the per day or per event sum insured, as applicable.
2. The No. of days/events mentioned above are the number of days of number of events available per policy year, as applicable.
3.Initial waiting period of 30 days is applicable (Except in case of accidents and/or on renewal)
As per the terms & conditions of the policy vide Ex.C1, the insurance company are liable to pay the hospitalization cash benefit of Rs.10,000/- per day and hospital attendant cash benefit of Rs.10,000/- per day. But the opposite parties are not paying the attendants payment because the complainant has failed to prove that any attendant was working at the time of admission or after that admission. In the interest of justice, the complaint is allowed. Opposite parties are directed to pay Rs.50,000/- for the hospitalization cash benefit and 50% of hospital attendant cash benefit total amounting to Rs.75,000/-. There are no order as to costs. Compliance of this order be made within 30 days from the date of receipt of copy of order. Copy of this order be given to the parties concerned free of costs and file be consigned to record room.
Announced on: 28.02.2024. (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
