Goa

StateCommission

A/72/2013

Mrs. Anita Yuvraj Naik - Complainant(s)

Versus

The Senior Manager, Life Insurance Corporation & another - Opp.Party(s)

Agnelo D'Costa

29 Nov 2013

ORDER

Goa State Consumer Disputes Redressal Commission
Panaji-Goa
 
First Appeal No. A/72/2013
(Arisen out of Order Dated 12/08/2013 in Case No. CC/13/46 of District North Goa)
 
1. Mrs. Anita Yuvraj Naik
R/o H. No. 646/1,Kadamba Depot Road, Porvorim, Bardez Goa
...........Appellant(s)
Versus
1. The Senior Manager, Life Insurance Corporation & another
EDC Complex, Panaji Goa
2. Paramount Health Service(TDP) Pvt. Ltd.
Elite Auto House, 54-A, Chakala,M. Vasanji Road, Off Andhri -Kurla Road, Andheri(E) Mumbai
...........Respondent(s)
 
BEFORE: 
 HONABLE MR. JUSTICE N.A.Britto PRESIDENT
 HONABLE MRS. Smt.Vidhya R. Gurav MEMBER
 
PRESENT:
Adv. Ms. R. Ferrao
......for the Appellant
 
Adv. Shri. Moye-Respondent No. 1
......for the Respondent
ORDER

The complainant was paid a sum of Rs. 2,400/- by cheque dated 15/09/12 which has been returned by the complainant vide her letter dated 31/10/12. This amount was paid to the complainant by the OP in terms of Clause 2(I) of the policy. Clause 3(II) (vii) of the policy provides that no payment shall be made under this benefit for the operations performed, which are not listed in the surgical benefit Annexure. All surgical procedures claimed should be confirmed as essential and required, by a qualified physician or surgeon, to the satisfaction of the Corporation. The list of surgical procedures is attched to the policy by way of surgical benefit Annexure and in case of an accident the complainant would have been entitled to expenditure incurred for total replacement of the hip or knee joint or amputation of arm or hand or foot or leg due to trauma or accident. The minor injuries suffered by the complainant to her right foot are not covered under the policy. No fault can be found with the impugned order.

We find there is no merit in this appeal and accordingly the same is hereby dismissed. The complainant may be paid, in case she so desires, the said amount of Rs. 2400/- earlier sent to her. 

 
 
[HONABLE MR. JUSTICE N.A.Britto]
PRESIDENT
 
[HONABLE MRS. Smt.Vidhya R. Gurav]
MEMBER

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