Jharkhand

Bokaro

CC/29/2022

Indra Pari Devi - Complainant(s)

Versus

The Divisional Manager, Untied India Insurance Co. Ltd. - Opp.Party(s)

Navin Kumar

15 Feb 2023

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-03-03-2022

Date of final hearing-15-02-2023

 Date of Order-15-02-2023

Case No. 29/2022

Indra Pari Devi W/o Late Yogindra Singh

 R/o Qr.No. 512, Sector-3/B, P.O.- Sector-3/D,

 P.S.- Bokaro Steel City, District- Bokaro, Jharkhand Pin 827003

Vs.

 1. The Divisonal Manager, United India Insurance Co. Ltd.

      Divisional Office- Plot No. A-17, city Centre,

      Sector-4, Bokaro Steel City, District- Bokaro, Jharkhand 827004

 2. The Manager, MD India Healthcare Service TPA Pvt. Ltd.

     Branch Office situated at- Near City Thana

     and Quality Circle, Sector-1, Bokaro Steel City, Pin 827001 

 3. Director In-Charge, Bokaro Steel Plant,

      Bokaro Steel City, District- Bokaro, Jharkhand 827001

 

 Present:-

                             Shri Jai Prakash Narayan Pandey, President

Shri Bhawani Prasad Lal Das, Member

                  Smt. Baby Kumari, Member

PER- J.P.N Pandey, President

-:Order:-

1.  Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 3,28,647/- on account of medical expense incurred during treatment of her husband and for grant of compensation of Rs. 50,000/- and for Rs. 25,000/- as legal expense.
2. Complainant’s case in brief is that her husband late Yogendra Singh was a retired SAIL, BSL employee and as per policy of the company he opted for Mediclaim policy for himself and his wife. He was provided MIN No.4728866 which was valid at the relevant time. Further case is that due to illness of the complainant he was admitted in B.G.H. thereafter he was referred to Medanta Hospital, Ranchi for treatment where he was admitted on 28.04.2019 and discharged on 07.05.2019 for which payment of Rs. 3,28,647/- was made to the Hospital by the complainant. Further case is that lastly the husband of the complainant died on 08.05.2019 at Bokaro. Inspite of repeated requests O.Ps. have not paid said amount. Hence this case has been filed with above mentioned prayer.
3. Inspite of due service of notice O.P. No.1 & 2 have not  appeared nor  W.S. has been filed by them. However, O.P. No.3 SAIL/ B.S.L. Bokaro has filed W.S. admitting most of the facts of the case and has not denied any of the contents of the complaint petition.
4. In support of the claim complainant has filed photo copy of the premium payment paper (Annexure-I), photo copy of medical book of the deceased Yogendra Singh (Annexure-II), photo copy of certificate and bills of the Medanta Ranchi (Annexure-III), photo copy of receipt issued by Om Tour & Travels (Annexure-IV), photo copy of discharge ticket issued by BGH (Annexure-V), photo copy death certificate (Annexure-VI), photo copy of letter written by the complainant (Annexure-VII), photo copy of postal receipts (Annexure-VIII), photo copy of legal notice issued by the complainant (Annexure-IX), photo copy of postal receipts and track report (Annexure-X & XI).

5. On careful perusal of the papers annexed with the complaint petition it is very much clear and evident that husband of the complainant was treated at Medanta, Ranchi where complainant paid Rs. 3,11,097/- to the hospital for which she is entitled to be reimbursed. There is no dispute regarding capacity of the deceased as ex –BSL employee and also regarding his coverage with Mediclaim policy of the O.P. insurance Co. Therefore, we are of the view that there is deficiency on the part of O.Ps. who have not settled the claim of the complainant for a long period and still they have kept it pending. Therefore, we are of the opinion that complainant is entitled to get relief as indicated below:-

6  Accordingly prayer of the complainant is being allowed in the following manner:-

         O.P. No. 1 United India Insurance  Co. Ltd. is directed to pay Rs. 3,11,097/- to the complainant within 60 days from receipt/production of the copy of this order, failing which this O.P. will pay interest @ 10% per annum  on that very amount from 03.03.2022 (i.e. the date on which case was filed). Further O.P. No.1 is directed to pay compensation of Rs. 10,000/- for various types of harassment caused to the complainant for his genuine claim and also to pay Rs. 5000/- as litigation cost within above mentioned period.

 

(J.P.N. Pandey)

                                                                                      President

 

 

(B.P.L Das)

   Sr. Member

                                                                            

                  

                                                                               (Baby Kumari)

•