BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, U.T. CHANDIGARH

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Ashwani Kumar Uppal, R/o H.No.1138, Sector 12-A, Panchkula.

….…Complainant

                                V E R S U S

1.        ICICI Lombard General Insurance Company Ltd., ICICI Bank Towers, Bandra, Kurla Complex, Mumbai through its Managing Director.

2.        ICICI Lombard Health Insurance Company Limited, Quiet Office No.10, Sector 40-B, Chandigarh, through its Branch Manager.

3.        TTK Health Care TPA Private Limited, 7 Jeewan Bimba Nagar, Main Road Hall-III Stage, Banglore 560075.

4.        TTK Health Care TPA Private Limited, ALF House, 3^rd Floor, Lok Bharti Complex, Marol 400059

                                        ..…Opposite Parties

CORAM:    SH.RAJINDER SINGH GILL     PRESIDING MEMBER

                MRS. MADHU MUTNEJA                MEMBER

Argued by:         Sh.D.K.Singal, Adv. for complainant.

Sh.Sandeep Suri, Adv. for OPs.

PER MRS. MADHU MUTNEJA, MEMBER

               Briefly stated, the complainant had got himself insured under Health Insurance Policy of OP Company.  He had paid Rs.13,421/- as premium. The policy was effective from 9.9.2008 to 8.9.2010. The complainant was rushed to Alchemist Hospital, Sector 21, Panchkula in emergency condition on 1.10.2009 and remained admitted there for 8 days under the treatment of Dr.Vikas Bhadu.  The said hospital also sought authorization from third party-TTK Health Services Centre Pvt. Ltd. i.e. OP-3 & 4 for cashless facility to the complainant as it was one of the approved hospital of OPs, but the same was not granted.  On 9.10.2009 when the complainant was discharged from hospital, a sum of Rs.81,565/- was paid on account of his treatment.  Thereafter, the complainant filed a claim with OP Insurance Company for reimbursement of the amount spent on the treatment as envisaged in the policy.  On demand by the OPs, a fresh claim was once again filed along with all requisite documents but inspite of this and several oral requests, the OPs failed to pay the claimed amount.  Therefore, the complainant has filed the instant complaint alleging the above act of OPs to be gross deficiency in service and unfair trade practice, causing harassment and mental torture to the complainant.

2]             In the reply filed by the OPs, it has been stated that the amount under the policy of insurance has already been paid by TPA (Third Party Administrator) and the same has also been received by the complainant, who has encahsed the same without raising any objections thereof.  The settlement voucher was received by the Insurance Company on 24.2.2010 and the amount claimed was Rs.81,565/-, which was paid vide cheque No.15762393, dated 7.4.2010 in favour of Ashwani Kumar Uppal.  It is also stated that there was no delay and deficiency on the part of OP Insurance Company as the claim has been processed and payment made within 42 days of receipt of claim voucher.  Rest of the allegations have been denied and it is prayed that the complaint be dismissed.

3]             Parties led evidence in support of their contentions.

4]             We have heard the ld.Counsel for the parties and have also perused the record.    

5]             The complainant submitted his claim before the OPs on 24.2.2010.  The OPs processed his claim and the payment was made to him on 7.4.2010.  In the mean time, the complainant also instituted the present complaint before this Forum on 29.3.2010 with a prayer to direct the Ops to make payment of the amount due. 
6]             The payment has been made by the OPs to the complainant within 42 days of filing the claim.  We do not find that the time period of 42 days was an overly long time for processing the claim of the complainant. In fact, the OPs have acted quite promptly in processing the claim and making payment to the complainant. Rather, the complainant has acted in a haste in filing this complaint, and has not given enough time to the OPs to settle his claim.

7]             In view of the above findings, we do not find any merit in this complaint.  Therefore, the complaint is dismissed.

              Certified copies of this order be sent to the parties free of cost.  The file be consigned.