DATE OF FILING                    :     27-01-2014.

DATE OF S/R                            :      07-04-2014.

DATE OF FINAL ORDER      :     19-12-2014.

Smt. Snigdha Hazra,

wife of Sri Samar Kumar Hazra,

13, Beharilal Das Pramanick Lane,

Howrah  711 101…….……………………………………………… COMPLAINANT.

• Versus   -

1. The Claim Executive Officer,

Heritage Health TPA Pvt. Ltd.,

Nicco House, 5^th floor,2, Hare Street,

Kolkata 700 001.

2. The General Manager,

The NewIndia Assurance Co. Ltd.,

registered & head office at

87, Mahatma Gandhi Road, Fort,

Mumbai – 400 001.

3. The  Senior Divisional Manager,

The New India Assurance Co. Ltd.,

4, Lyons Range,

Kolkata – 700 001.

4. The Manager,

The New India Assurance Co. Ltd.,

Howrah Branch, Unit NO. 512200, Madhusudan Apartment,

P-18, Dobson Lane, 2^nd floor,

Howrah 711101. ……………………………………………OPPOSITE PARTIES.

                                                P    R    E     S    E    N     T

President     :     Shri T.K. Bhattacharya, M.A. LL.B. WBHJS.

Member      :      Shri P.K. Chatterjee.

Member       :     Smt. Jhumki Saha.

                                                 F  I   N   A    L       O   R   D    E     R

1. The instant case was filed by complainant U/S 12 of the C.P. Act, 1986 wherein the complainant has  prayed for direction upon the o.ps. to reimburse the medi claim amount to the tune of Rs. 39,573/- and to pay compensation to the tune of Rs. 5 lac together with litigation costs as the o.p. insurance company did not disburse the medi claim amount as aforesaid in spite of proper medi claim.

2. The o.p. insurance company in the written version contended interalia that the complainant already received the 1^st installment of Rs. 25,000/- out of the total claim of Rs. 64,000/-; that there is no negligence on the part of the insurance company. So the petition of complaint should be dismissed.   

3.        Upon pleadings of both parties two points arose for determination :

i)          Is there any deficiency in service on the part of the O.P.  ?

1. Whether the complainant is  entitled to get any relief as prayed for ? 

DECISION  WITH   REASONS      :

4. Both the points are  taken up together for consideration. Admittedly the medi claim was settled to the tune of Rs. 64,000/-.  The insurance authority already disbursed Rs. 25,000/- and only Rs. 39,000/- remains outstanding. As the insurance authority are willing to disburse the same, we are of the view that this is a fit case where the prayer of the complainant shall be allowed. Both the points are accordingly disposed of.

      Hence,

O     R     D      E      R      E        D

      That the C. C. Case No. 38 of 2014 ( HDF 38 of 2014 )  be and the same is allowed on contest with costs as against the o.ps.   

      The O.P. be directed to disburse the sum of Rs. 39,573/- as outstanding amount as medi claim to the complainant within  30 days from the date of this order.

      No order as to compensation.

      The o.p. do pay a sum of Rs. 5,000/- as litigation costs to the complainant within the period as mentioned above. 

      The complainant is at liberty to put the decree into execution after expiry of the appeal period.

      Supply the copies of the order to the parties, as per rule.

DICTATED  &    CORRECTED

BY   ME.  

  (    T.K. Bhattacharya  )                                              

  President,  C.D.R.F., Howrah.