West Bengal

Bankura

CC/19/2022

Sri Kartick Chakraborty - Complainant(s)

Versus

The Regional Manager, United India Insurance Co. Ltd - Opp.Party(s)

Sankar Chakraborti

20 Oct 2022

ORDER

IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION BANKURA

Consumer  Complaint No. 19 / 2022

Date of Filing : 06.07.2022

Before:

1. Samiran Dutta                Ld. President.      

2. Rina Mukherjee               Ld. Member. 

3.  Sudhakar Ghosh             Ld. Member.

 

For the Complainant: Sankar Chakraborty, Ld. Advocate

For the O.P.:  Pulak Kumar Singha, Ld. Advocate

Sri Kartick Chakraborty, S/o Late Debdas Chakraborty, Vill-Bondalhati, Sonamukhi, Bankura

                                                                                                                                                   ……....Complainant                                                                                                                                        

V e r s u s

Opposite Party No.1 : The Regional Manager, United India Insurance Co. Ltd., Regional Office, Himalaya House, Floor No.2, Door No 38B, Jawaharlal Nehru Road, Kolkata 71

Opposite Party No.2 : The Manager, Heritage Health Ins. TPA Limited., Nicco House, 5^th Floor, 2 Hare Street, Kolkata- 700 001

FINAL ORDER / JUDGEMENT

 

Order No.04

Dt. 20-10-2022

Both parties are present by filing hazira.

The case is fixed for further order subject to payment of confirmation of the claim amount of Rs.2,55,519/- Ld. Advocate appearing for the O.P./Insurance Co. has submitted before the Commission that the claim amount has already been settled at Rs.2,55,519/- and duly credited to the Punjab National Bank Corporate Account vide UTR No.CITIN22349559314, dated: 11-10-2022 with the request to credit the same to the Account of the insured Bank A/c . Though the Ld Advocate for the complainant is absent but the Complainant through his son Raja Chakraborty  is present stating that the claim amount has not yet been credited to their Account.

 

Be that as it may, let the Commission pass final order in this case as the case has already been settled by and between the parties.

                                                                                                                                                             Contd……….p/2

 

Page: 2

 

The Complainant’s case is that Debdas Chakraborty since deceased being the father of the Complainant was during his life time under the cover of Group Medical Insurance Policy No. being 5001002816-P-111524422 & I.D. Card No.HHS8.0700410165 of erstwhile UBI now merged into PNB for the period from October, 2017 to September, 2018 and during that period the deceased was admitted in Hardik Hospital, Rabindra Sarani, Bankura on 16-03-2017 and he was discharged on 19-03-2017 and medical expense of Rs.10,001/- was raised for reimbursement of the same but it was rejected without any cause and thereafter the deceased was again admitted in the Mission Hospital, Durgapur on 31-03-2017 and discharged on 14-04-2017 and here a medical bill of Rs.2,70,892/-  was raised through Heritage Health Insurance Pvt Ltd. TPA/O.P. No.2 for reimbursement of the same and the said claim was processed and settled at Rs.2,55,519/- and it was duly communicated to the insured by letter dated:18-04-2019 and since then the claim amount was lying undisbursed to the insured account in spite of reminder, persuasion and ultimately getting no relief from the Insurance Company the Complainant approached before this Commssion to file this complaint for appropriate relief and the same was entertained by this Commssion condoning the delay due to COVID 19 Pandemic and the death of mother of the Complainant with the prayer  for payment of  said settled amount along with interest and compensation.

 

Immediately after receipt of the notice the O.P. /Insurance Co. made their appearance through their lawyer and Ld Advocate appearing for the O.P. / Insurance Co. has in his usual fairness preferred not to contest the case by filing any W.V. but to accede to the claim amount as it has already been settled by and between the parties.

                                                                                                                                                                                                                                Condt…..p/3

 

Page: 3

 

In view of the full and final settlement between the parties the Commission proceeds to pass the following order :

That the case is disposed of directing the O.P.s to pay to the Insured’s Account the claim amount of Rs.2,55,519/- with compensation of Rs.10,000/- for delay in payment of settled amount within one month from this date and if not paid and credited to the Insured’s Bank Account by this time the Complainant may approach with the copy of this order to the O.P. No.2  and PNB at New Delhi for disbursement of the claim amount to the Insured’s Bank A/c at the earliest.

O.P. No.1 is to pay compensation of Rs.10,000/- to the Complainant within the stipulated time.

Let a copy of this order be given to both parties free of cost. The complainant is directed to serve the copy of this order upon O.P. No.2 as well.

                                      __________________                                            ________________                 ________________

                                      HON’BLE   PRESIDENT                           HON’BLE    MEMBER              HON’BLE    MEMBER