Jharkhand

Bokaro

CC/2/2019

Dhrup Singh - Complainant(s)

Versus

Apollo Munich Health Insruance co. Ltd. - Opp.Party(s)

Sushila Kumari

03 Nov 2022

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-05-01-2019

Date of final hearing-03-11-2022

 Date of Order-03-11-2022

Case No. 2/2019

Dhrup Singh S/o Late Ganesh Singh,

R/o Shivpuri Colony, Near Balidih Thana,

P.O. & P.S. Balidih, District- Bokaro, Jharkhand

Vs.

1. Apollo Munich Health Insruance co. Ltd.

    Central Processin Centre, 2^nd & 3^rd Floor, ILABS centre,

     Plot NO. 404, 405, Udoy Bihar, Phase-III,

     Gurgaon-122016, Haryana

 2. Branch Manager, Canara Bank,

     Main Branch, Western Avenye, Naya More,

     Bokaro Steel City, District- Bokaro, Jharkhand 

 

                             Present:-

                             Shri Jai Prakash Narayan Pandey, President

        Shri Bhawani Prasad Lal Das, Member

          Smt. Baby Kumari, Member

 

PER- J.P.N Pandey, President

-Judgement-

 

1.   Complainant has filed this case with prayer to direct the O.Ps. to pay Rs. 9,557/- as medical expense and also to pay Rs 30,000/- and Rs. 10,000/- respectively as compensation and litigation cost respectively.

2. Complainant’s case in short is that he obtained Easy Health Group Insurance Policy No. A007631 from O.P. No.1 Apollo Munich Health Insurance Co. Ltd. and paid Rs. 13,198.30 as premium and policy was valid from 26.08.2017 to 25.08.2018. Further case is that during that very period complainant met with an accident and was admitted at Bokaro General Hospital on 24.11.2017 and discharged on 25.11.2017 after treatment during which he paid Rs. 9,557/- as medical expense to the Hospital concerned but inspite of submission of claim his medical expense was not paid by O.Ps. hence legal notice was served having no impact thereafter, this case has been filed.

3.W.S. has been filed by O.P. No.1 (Insurance Co.)  mentioning therein that inspite of demand for submission of the papers complainant has not provided it, hence vide letter dt. 02.08.2018 his claim has been repudiated with observation that company can re-open the claim & decide on admissibility. But till now those required documents have not been provided to the company, therefore, there is no question of nonpayment of the amount. Further reply is that case is pre-matured because no documents have been provided to the insurance co. within prescribed period of 30 days  hence there is no cause of action for the case. Further reply is that it is true that the complainant has obtained alleged insurance policy for the alleged period. Further it is reply that since no cause of action has arised hence case is liable to be dismissed.

       O.P. No.2 (Bank) has filed reply mentioning therein that Bank is having no liability to pay the mediclaim.  

       From perusal of the papers submitted by both the parties it appears that the complainant has obtained insurance policy from O.P. No. 1. As per insurance Co. some papers were wanting hence for want of fulfillment of legal criteria claim has been repudiated with liberty to the complainant to provide required documents on which O.P. will  re-consider the claim .  

           In the given facts we are of the opinion that this case is liable to be disposed off with certain observations in the following manner:-

1. That the complainant shall provide all required documents to the O.P. No.1 (Insurance Co.) expeditiously. On receipt of those documents as demanded vide letter dt. 02.08.2018 O.P. No.1  Insurance Co. shall process the claim of the complainant within 60 days from the date of receipt of those documents and also shall pay the medical expense incurred during relevant period. It is made clear that except the documents demanded vide letter dt. 02.08.2018 O.P. No.1 (Insurance Co.) shall not demand any more document.

Accordingly this case is being disposed off.

 

(J.P.N. Pandey)

                                                                                      President

 

                                                                                               

    (B.P.L Das)

   Sr. Member

 

 

                                                                              (Baby Kumari)

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