In  the  Court  of  the

Consumer Disputes Redressal Forum, Unit -I, Kolkata,

8B, Nelie Sengupta Sarani, 4^th Floor, Kolkata-700087.

CDF/Unit-I/Case No.284/2010.

1)                   Mrs. Jamuna Das,

            56/1-A, Babul Bona Road, Raikanan,

            P.O. Berhampur, P.S. Berhampur,

            Dist. Murshidabad, West Bengal, Pin-742101.                                         ---------- Complainant

---Versus---

1)                   The Chief Manager,

            United India Insurance Co. Ltd.  

            Kolkata Regional office at Himalaya House,

            38-B, Jawaharlal Nehru Road, 2^nd & 3^rd Floor,

            P.S. Park Street,  Kolkata-71.

2)       Sr. Branch Manager,

United India Insurance Co. Ltd.

3/20/A, K.K. Banerjee Road, 1^st Floor,

PO & Dist. Berhampur, 742101, West Bengal.                                         ---------- Opposite Parties.

Present :           Sri Sankar Nath Das, President.

                        Dr. Subir Kumar Chaudhuri, Member.

Order No.   28    Dated  22-10-2013.

          The case of the complainant in short is that Mrs. Jamuna Das, wife of Sri Kalyan Kumar Das,
Sri Kalyan Kumar Das and his daughter Miss Sanjukta Das was covered under Mediclaim Policy No.031405 / 48 / 09 / 00000379 for the period of 28.7.09 to 27.7.10 with a sum of Rs.2 lakhs each.

            Complainant was suffering from osteoarthritis in both knees and was under treatment at Berhampur as well as in Kolkata under Dr. M.S. Ghosh but without any result.

            Complainant found from website of SBF Health Care, Bangalore, a new method of treatment for osteoarthritis through (rotational field quantum magnetic resonance) treatment which would cost around Rs.1,35,000/- for both the knees. Complainant admitted during 24.6.09 to 14.7.09. MRI report was also done by them. Complainant was treated for 21 consecutive days up to 14.7.09.

            On completion of complainant’s treatment she submitted her claim to the ‘United India Insurance Co. Ltd.’ at their Berhampur Office, West Bengal on 24.6.09 and on 14.7.09 along with her all relevant documents including all medical bills for reimbursement.

            O.p. company served a letter vide their Memo No.031405 / Med. Cl./ 0407 / 09 dt.22.10.09 to the complainant’s husband Sri Kalyan Kr. Das for the medical treatment which the complainant incurred for her treatment at Bangalore. Hence the case was filed by the complainant with the prayer contained in the petition of complaint.

            O.ps. had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them and prayed for dismissal of the case. Ld. lawyer of o.ps. in the course of argument submitted that the case has got no merit and the same is liable to be dismissed.

Decision with reasons:-

            We have gone through the pleadings of the parties, evidence and documents in particular and we find that stay in hospital / nursing home was not for 24 hours as per policy condition and complainant was not admitted as per advice of any doctor nor there is any prescription. Clinic cannot be considered neither as hospital nor as nursing home and it was a pre-existing disease.

            In the context of the above position we are of the views that complainant has failed to prove her case and is not entitled to relief.

            Hence, ordered,

            That the case is dismissed on contest without cost.