Jharkhand

Bokaro

CC/23/2022

Hari Bishnu Mishra - Complainant(s)

Versus

The Branch Manager, Life Insurance Corporation of India, - Opp.Party(s)

Manoj Kumar Tiwari

10 Jun 2023

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-09-02-2022

Date of final hearing-10-06-2023

 Date of Order-10-06-2023

Case No. 23/2022

Hari Bishnu Mishra S/o Rama Shankar Mishra

 R/o DS/2/1A, Railway Colony P.O.- Railway Colony,

 P.S.- Balidih District- Bokaro Jharkhand

                                      Vrs.

1. The Branch Manager, Life Insurance Corporation of India,

City Centre Sector-4, Branch-1, P.O. and P.S.- Sector-4,

Bokaro Steel City, District- Bokaro, Jharkhand, 827001

2. Manager CRM

Life Insurance Corporation of India

Divisional Office, Julu Park Hazaribagh, Jharkhand-825301

Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

PER- J.P.N Pandey, President

-:Order:-

1. Complainant’s case in brief is that he purchased LIC Jeevan Arogya Policy No. 835621775 from O.P. which was commenced on 26.02.2020 for Rs. 2,00,000/- coverage in respect to treatment facility. Further case is that due to Covid-19 complainant was admitted in K.M. Memorial Hospital and Research Centre, Bye Pass Road, Chas, District – Bokaro on 26.04.2021 and discharged on 11.05.2021 for which he paid total Rs. 2,62,000/- to the hospital, for which claim was submitted before the O.P. but only Rs. 31,500/- was paid by the O.P. instead of coverage of the policy to the tune of Rs. 2,00,000/-. Complainant demanded remaining amount Rs. 1,68,500/- but it was not paid. Hence this case has been filed with prayer to direct the O.P. to pay Rs. 1,68,500/- with 12% per annum interest from the date of filing of claim, for payment of compensation of Rs. 25,000/- and litigation cost of Rs. 20,000/-.
2. O.P. (LIC) appeared in this case on 30.03.2022 filing Vakalatnama but has not filed W.S. hence O.P. has been debarred from filing W.S. However, written notes of argument has been filed by the O.P. for perusal and consideration.
3. As per complainant he is entitled to get rest of Rs. 1,68,500/- from the LIC. As per O.P. the payment has already been made to the complainant as per terms and conditions of the policy concerned.
4. Complainant has filed photo copy of the terms and conditions of the insurance policy.  As per para 2 of the terms and conditions the policy under consideration it is having coverage of major surgical benefit, day care procedure of surgery and other surgical benefits upto Rs. 2,00,000/- only and it is having terms and conditions that in case of general treatment as indoor patient initial daily benefit of Rs. 2,000/- per day will be payable which may be enhanced @ 5% per year. Therefore, here in this case since complainant was admitted in the hospital from 26.04.2021 to 11.05.2021 hence LIC has paid Rs. 31,500/- @ Rs. 2100/- per day for 15 days. Therefore, we are of the view that complainant has failed to prove his case that the policy concerned is covering Rs. 2,00,000/- in case of general treatment also. Hence we are of the view that complainant is not entitled to get any more amount than the amount already paid by the LIC. Therefore, there is no any deficiency in service by the O.P.
5. In light of above discussion case is dismissed on contest. In the facts and circumstance of the case parties shall bear their own costs.

                                                                           S/d

(J.P.N. Pandey)

                                                                                      President

 

 

                                                                 S/d

                                                                               (Baby Kumari)

                                                                                       Member