Jharkhand

Bokaro

CC/17/60

Ram Kumar Singh - Complainant(s)

Versus

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

T.N. Thakur

23 May 2023

ORDER

                District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-22-04-2017

Date of final hearing-23-05-2023

 Date of Order-23-05-2023

Case No. 60/2017

Ram Kumar Singh, S/o- D.S. Yadav

          R/o- Bhojpur Colony, Church Road, Yadav Niwas,

Chas, P.O. and P.S.- Chas, District- Bokaro, Jharkhand, 827013

                                      Vrs.

1.E- Meditak (TPA) Services Limited.

    Ground Floor, Plot No. HD-11,  Sector-4,

     City Centre, B.S.City. P.O. and P.S.- Sector-4, 827004

  2. E- Meditak (TPA) Services Limited.

     Plot No. 577, Udog Vihar, Phase- V, Gurgon, Haryana, 122016

3.The Branch Manager, National Insurance Co. Ltd.

              Bye Pass Road Chas, P.O, P.S- Chas,

              District, Bokaro, Jharkhand.

         4. Sr. Divisional Manager, United India Insurance Co. Ltd.

             Himalya House, 8^th Floor, K.G. Marg, New Delhi, 110001

             And Plot No. A/17, City Centre, Sector-4,

             Bokaro Steel City, 827004

Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

PER- J.P.N Pandey, President

-:Order:-

1. Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 80,000/- as medical expense and to pay Rs. 50,000/-  as compensation for various type of harassment and also to pay Rs. 15,000/- as litigation cost to the complainant.
2. Complainant’s case in brief is that he being ex-employee of the SAIL/BSL opted for Mediclaim policy for himself. He was provided MIN No. 04723725 which was valid during relevant period. Further case is that he became ill for which he was treated at CMC Vellore and Angiography was done for which he was admitted in the CMC Vellore who paid Rs. 40,000/- and again Rs. 40,000/- to the hospital. Accordingly he submitted claim before O.Ps. for reimbursement of the bill but inspite of repeated requests there was no response by the O.Ps. Further case is that complainant submitted his claim before the O.Ps. along with all relevant documents but his claim was not settled thereafter, legal notice was served having no positive response, hence this case has been filed with above mentioned prayer.

 

3.   O.P. No.1 & 2 (TPA) have filed W.S. mentioning there in that they are agent of the insurance company having no liability to pay the claim.

 

4. O.P. No.3 National Insurance Company has filed W.S. mentioning therein that during the relevant period related to claim this O.P. was not covering the Insurance of the SAIL/BSL Ex employees hence there is no liability of this O.P.

 

5. O.P. No.4 United India Insurance Company was later on added as O.P. No.4 vide order dated 21.12.2017 and he has filed W.S. mentioning therein that inspite of repeated directions complainant has not filed original discharge summary, bifurcated and consolidated bill, investigation reports, with detailed information of hospital and doctor on it, proof of treatment as in present case angiogram report, of the complainant as hospitalization proof has not been provided by the complainant hence it is prayed to dismissed the case . All other allegations have been  denied.
6. Point for consideration is whether complainant is entitled to get relief as prayed ?

 

7. On perusal of the papers annexed  with the complaint  petition it is apparent that as per complainant he has paid to the hospital Rs. 40,000/- once and again Rs. 40,000/- related to his treatment. But it appears that no any chit of paper in proof of that very payment has been filed by the complainant in this case. Till date paper related to treatment of the complainant at CMC Vellore have not been filed. Discharge summary of the complainant regarding his admission and discharge from the CMC Vellore have not been filed in this case. Complainant has been examined as witness no. 1 and he has given negative reply to the questions put during cross examination. He states that he cannot say from which date till which date he was admitted in the hospital. Further he states that he cannot say about the amount of premium and its date of payment to the insurance company. Further he states that he is not remembering about the papers which were deposited with the claim form. In this way it appears that complainant himself has not supported his claim during his evidence either by documents or by oral evidence.

 

8. In light of above discussion we are of the view that complainant has not proved his case for grant of relief as prayed. Accordingly this case is being dismissed on contest and parties shall bear their own costs.

 

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(J.P.N. Pandey)

                                                                                      President

 

                                                                            

          S/d   

                                                                               (Baby Kumari)

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