LALIT KUMAR MOHATA DHUN HOUSE MISSION ROAD BHADRA , AHMEDABAD Vs. THE NEW INDIA ASSURANCE CO. LTD. II FLOOR BOX NO 4830, ANNA ROAD P,O. CHANNAI 600002

JUDGEMENT

(1.) The complainant was holding a Diners Club International Credit Card issued by Citi Bank India. Being a card holder the complainant was entitled to reimbursement of the medical expenses incurred by him on his treatment as well as the treatment of family members. The said policy known as Good Health Policy for this purpose was taken by Citi Bank from the respondent no.1-New India Assurance Co. Ltd. The complainant submitted claims in respect of the medical treatment taken by 4 persons, namely, Sushma Devi Mohata, Taramani Devi Mohata, Purushottamdasji Mohata and Shashi Kumar Mohata, claiming a total sum of Rs.96,719.86. He however was paid only Rs.19,768/-, in respect of Purshottamdasji Mohata leaving a balance of Rs.22,059.96. Thus, according to the complainant, Rs.76,951.86 remained payable to him in respect of the treatment of above referred 4 persons. The complainant also claimed a sum of Rs.6167.45 in respect of the treatment of taken by his sister Smt. Nayantara Devi Thirani. He claimed that being vahivatdar of the properties of his sister, he was entitled to apply for the said claim in respect of his sister Smt. Nayantara Thirani. The complainant therefore approached the concerned District Forum by way of a complaint seeking payment of Rs.1,30,709.60, which included the interest on the claim amount, compensation and cost of litigation.

(2.) The complaint was resisted by the insurance company. It was admitted in the reply that 5 members of the family of the complainant were covered under the mediclaim policy. It was further stated that 4 claims were lodged by the complainant claiming benefit of the medical insurance. It was stated that the complainant had not furnished the required documents, as regards the claim in respect of Smt. Taramani Devi. As regards the claim in respect of Purshottamdasji Mohata, it was stated that the complainant had accepted an amount of Rs.19,828/- in full and final satisfaction of the claim. Regarding claim in respect of Shashi Kumar Mohata, it was stated that on processing the claim it was found that the claim form was left unfilled and therefore it was returned to the complainant with request to duly fill the same but the complainant did not return the duly filled in form and as a result, the claim could not be processed. As regards the claim in respect of Smt. Sushma Devi Mohata it was stated that there was some discrepancy in the document as regards duration of illness but no clarification to the insurance company was provided by the treating doctor.

(3.) The District Forum vide its order dated 18.02.2005 rejected the complaint in respect of the claim of Smt.Shashi Devi, Smt. Taramani Devi and Shri Puroshttamdasji. The complaint was partly allowed in respect of the claim pertaining to Shri Shashi Kumar Mohta and Smt. Nayan Tara Thirani. Both the opposite parties i.e. bank as well as the insurance company were directed to pay Rs.12,457/- in respect of Shri Shashikumar Mohata and Rs.6167/- in respect of Smt. Nayan Tara Thirani along with interest @ 6% p.a., compensation quantified at Rs.1,000/- and cost of litigation quantified at Rs.1000/-.