1. Today is Fixed for admission hearing. After the hearing the Ld. Advocate of the complainant perusing the material, placed before us, it is found that this is purely a medical insurance case. The claim of the complainant is that the O.P.  has only approved his claim to the extend of Rs. 1,09,318/- for reimbursement. Although the medical expenses incurred by him was for Rs. 1,54,333/-. The said expenses were incurred due to the complainant’s treatment at Apollo Hospital, Kolkata during the period from 02.10.2020 to 11.10.2020.

2. It is the grievance of the complainant that insurance has unjustly refused to entertain the claim of Rs. 1,54,333.23/-  minus Rs. 1,09,318/-  equal to Rs. 45,015.23/-.

3. The cause of action as stated in the complaint, arose on and from 22.01.2021. On 22.01.2021 the complainant was informed through E-mail about the approval of the claim to the extend of Rs. 1,09,318/-. The letter, dt. 22.01.2021 further states “This is preliminary intimation of claim the detail communication in this regard will be sent shortly by serving office”.

4. The imports of the aforesaid letter cannot be said to be purely negative one. Not that the claim of the complainant for the rest amount i.e. Rs. 45,015.23/- was turned down by the insurer.

5. Therefore, the complainant had no occasion to file this case at this premature stage.

6. Therefore, the complainant cannot be entertained at all. Hence, it is ordered that the case be and the same is dismissed as being not admitted.

Let plain copy be given to the parties free of cost as per C.P.R.

 Dictated and corrected by 

[HON'BLE MR. Lakshmi Kanta Das]
PRESIDENT