Jharkhand

Bokaro

CC/18/22

Ram Sawari Devi - Complainant(s)

Versus

E-Meditek (TPA) Service Ltd. - Opp.Party(s)

P.P. Singh

18 Mar 2019

ORDER

Complainant Ram Sawari Devi Filed this complainant for a claim of Rs. 34,462/- and compensation of Rs. 30,0000/-.

2          The case is short is that Complainant is wife of Pradumn Choudhry,  ex- employee of the SAIL and paid premium for mediclaim Scheme of SAIL having MIN No 4706612.

            Complainant is suffering from CKD and 2 Anemia, HTN, ROD disease for which treatment 24 hours time is required, a certificate has been issued by doctor. For this treatment, complainant was admitted on 17-04-2014 to 18-04-2014 at Bokaro General Hospital and paid money to hospital and thereafter continues treatment herself.

            Complainant claimed expenses of Rs. 11,422/- and Rs. 11,618/- on 18-02-2015 and Rs. 11,422/- on 20-03-2015.

            It is alleged that O.P. paid expenses till Jan, Feb, March and Dec. 2014. But now O.P. is not clearing the bill, hence this case is filed.

3          The following documents is filed for the claim:-

            Anx-1- Photo Copy of the receiving copy by E- Meditek with medicine Slip

            Anx-2- Photo copy of pass book of S.B.I.

            Anx-3- Photocopy of a summary Report by B.G.H. or. M. Rajak.

            Anx-4- Photocopy of MIN No. of patient.

            Anx-5- Photocopy of Legal Notice sent to O.P. parties.

            Anx-6- Photocopy of Repudiation letter of E- Meditek.

            Anx-7- Photocopy of letter to management by complainant

            Anx-8- Photocopy serving legal notice of registry.

            Anx-9- Photocopy of legal notice sent by O.P. No.3 National Insurance.

4          The case of the O.P. is that the case is not maintainable as it is barred under law of limitation, also barred a resjudicata as the matter of dispute has already been decided earlier it is further stated that there is no deficiency of services by O.P. No.3 it is further stated in Para 11 or W.S. filed by O.P. No.3 that “earlier the complainant had filed a Consumer Case No. 23/2015, for reimbursement of his bill amount Rs. 90,421/- as because the said claim amount had not been paid by this Opp. Party/Insurance Co. because the claimant/patient was being admitted in Bokaro General Hospital only of the purpose of administration for Mircera injection. Hence, the claim had been repudiated” it further stated that C.C. No. 23/2015 has been settled and Rs. 90,421/- has been paid. It is further submitted that complainant send a legal notice through his lawyer Sri Param Punit Singh dt. 24-01-2018 demanding a fresh claim of Rs. 34,462/- for the month of February or march for which the complainant never lodge any complain before insurance co. as such repudiation does not arise  

FINDINGS

5          Heard the parties and perused the record. We find and hold that complainant is consumer and this case has been filed with in limitation.

We find that O.P. No.3 has paid Rs. 90,421/- for the claim up to 24-11-2014 compromise on 22-12-2017 in C.C. 23/2015. Thereafter complainant has submitted bill of her treatment in the month of February 2015 to March 2015 as the complainant is suffering from C.K.D. 2 and anemia H.T.N. road diseases and she has to take medical treatment in her lifetime. It is life time treatment and she has to visit every month in hospital the claim amount is as follows  

Sl.No.	Date of Statement of her claim	Amount claim
1	18/02/2015	11,422/-
2	18/02/2015	11,618/-
3	30/03/2015	11,422/-

 

We have perused the record of C.c. No. 23/2015 from which we find that 90,421/- is claim up to 24-11-2014 thereafter claim for the month of February and March  2015 is required to paid by the O.P.

We direct the O.P. to Pay Rs. 34,462/-  within 60 days from the date tof the order falling which along with interest there on @ of 8% p.a from 20-02-2018 to till realization of money

            We further direct O.P. No.2 to pay compensation of Rs. 2000/- (Rs. Two thousand) only for mental harassment and litigation cost of Rs. 1000/-(Rs. One thousand) only. This payment must be paid directly in the saving bank account of the complainant within 60 days of this order.