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. 208 / 2011.

1)                   Sri Tanmoy Lahiri,

            51/7, Brojonath Lahiri Lane,

            Ram Raja Tola, Howrah – 711104.                                                          ---------- Complainant

---Versus---

1)                   United India Insurance Co. Ltd.

            Regional Office at 38/B, J.L. Nehru Road,

            Himalaya House, P.S. Park Street, Kolkata-71 and

            Divisional Office IV,

            8. Netaji Subhash Road, Kolkata-1.                                                        ---------- Opposite Party

Present :           Sri Sankar Nath Das, President.

                        Dr. Subir Kumar Chaudhuri, Member.

                        Smt.  Samiksha Bhattacharya, Member

Order No.   20    Dated  17-07-2013.

          The case of the complainant in short is that complainant is a policy holder of o.p. insurance company vide Health Insurance Policy No.030600/48/10/97/00002595 for the period of 7.8.10 to 6.8.11 that the aforementioned policy was covered for the complainant for Rs.1,25,000/-, his wife Soma Lahiri for Rs.1,00,000/- and his daughter Barsha Lihiri for Rs.50,000/-.

            On 14.2.11 complainant’s daughter Barsha Lahiri was admitted to R.N.TagoreHospital for kidney transplantation along with the donor and wife of the complainant Soma Lahiri (mother of Ms. Barsha Lahiri).

            Accordingly the complainant lodged two claims on 6.3.11 for his daughter Barsha Lahiri for an amount of Rs.3,45,000/- towards expenses for kidney transplantation and another for his wife Soma Lahiri (mother of Barsha Lahiri) for Rs.76,749/-.

            O.p. admitted the claim and disbursed only Rs.50,000/- towards the claim of Barsha Lahiri.

            It is alleged that in the said policy condition “the expenses towards organ transplantation incurred on Donor will be borne within the sum insured of the recipient”.

            The complainant submits that the sum insured on account of Soma Lahiri was Rs.1,00,000/- during the claim period and the claim amount is only for Rs.76,749/-. Hence the case was filed by the complainant with the prayer contained in the petition of complaint.

            O.p. 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.p. 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 complainant is a policy holder of o.p. insurance company vide Health Insurance Policy No.030600/48/10/97/00002595 for the period of 7.8.10 to 6.8.11 that the aforementioned policy was covered for the complainant for Rs.1,25,000/-, his wife Soma Lahiri for Rs.1,00,000/- and his daughter Barsha Lihiri for Rs.50,000/-.

            We further find that on 14.2.11 complainant’s daughter Barsha Lahiri was admitted to R.N.TagoreHospital for kidney transplantation along with the donor and wife of the complainant Soma Lahiri (mother of Ms. Barsha Lahiri).

            And accordingly the complainant lodged two claims on 6.3.11 for his daughter Barsha Lahiri for an amount of Rs.3,45,000/- towards expenses for kidney transplantation and another for his wife Soma Lahiri (mother of Barsha Lahiri) for Rs.76,749/- and o.p. admitted the claim and disbursed only Rs.50,000/- towards the claim of Barsha Lahiri.

            The complainant submits that the sum insured on account of Soma Lahiri was Rs.1,00,000/- during the claim period and the claim amount is only for Rs.76,749/-.

            It is found from the record that o.p. already made payment of Rs.3,45,000/- towards the expenses incurred by complainant for his daughter Barsha Lahiri towards expenses of kidney transplantation. It is further seen from the record that complainant lodged a claim of Rs.76,749/- for his wife Soma Lahiri i.e. mother of Barsha Lahiri and from written version of o.p. we find that o.p. paid Rs.50,000/- out of claim of Rs.76,749/-.

            In view of the findings above and on perusal of the entire materials on record we do not find any deficiency / lapse on the part of o.p. and complainant is not entitled to relief and the case is liable to be dismissed.

            Hence, ordered,

            That the case is dismissed on contest without cost.

            Supply certified copy of this order to the parties free of cost.