Delhi

North East

CC/48/2022

BHARATI MALHOTRA - Complainant(s)

Versus

LE CREST HOSPITAL - Opp.Party(s)

SHIV LAL KANNAUJIYA

09 Mar 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No. 48/22

 

 

 

In the matter of:

 

	Smt. Bharti Malhotra W/o Lt. Shri Naresh Kumar Malhotra R/o C-311, Street No. 14, Bhajan Pura, Garhimendu, North East, Delhi-110053	Complainant
	Versus
1.         2.         3.	M/s Le Crest Hospital A Unit of Garg Heart and Multispeciality Private Ltd., Plot No. INS-13, Sector No.4 Vasundhara Ghaziabad-201012   National Insurance Co. Ltd. Shahdara Branch 1/11955, Ist Floor, Muskaan Building, Naveen Shahdara, Delhi-110032   Vipul Med Corp TPA Pvt. Ltd. 219, Ansal Chamber, Bhikaji Cama Place New Delhi-110066	Opposite Parties

 

DATE OF INSTITUTION:        JUDGMENT RESERVED ON:                           DATE OF ORDER:

02.03.22 19.12.22 09.03.23

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

Adarsh Nain, Member

ORDER

Anil Kumar Bamba, Member

The Complainant has filed the present complaint under Section 35 of the Consumer protection Act, 2019.

Case of the Complainant

1. The case of the Complainant as revealed from the record is that the Complainant purchased a Medical Policy bearing no. 366003502010002419 dated 22.02.21 vide receipt no. 366003812010006373 dated 22.02.21 by paying Rs. 26,896/- for insurance cover upto 3,00,000/- which covers the following family members Shri Naresh Kumar Malhotra and Smt. Bharti Malhotra. The Complainant stated that her husband was admitted to hospital on 19.04.21 IPD No.2021/367 and UHID No. MR/21/002529 as the Complainant husband oxygen level was going down, having fever, cough and passed away on 29.04.21. The treatment incurred expenses of Rs. 3,24,999/-. The Complainant stated that the insurance company only approved Rs.1,30,983/- instead of having insurance cover upto Rs. 3,00,000/-. The insurance company stated that these deductions were made on account of restriction imposed by the Govt. on hospitals to charge upto Rs. 1,50,000/- for the treatment. The Complainant submitted that insurance company had made arbitrary deduction of Rs. 1,79,462/- and Rs.14,554/- on account of Co- payment without there being any clause of deduction of Co-payment in the insurance contract. The Complainant stated that she had raised the grievance though email dated 06.07.21. The Complainant has also visited Vipul Med Corp TPA Pvt. Ltd. (agent of insurance company) but all in vain. The Complainant also visited insurance company Shahdara Delhi branch to meet representative of M/s Vipul Med Corp TPA Pvt. Ltd and after then the Complainant made calls to said representative but they did not give any response. The Complainant stated that as per Govt. guidelines hospitals are restricted to charge only upto Rs. 1,50,000/- for treatment all inclusive. The hospital was raised a bill of Rs. 3,24,999/- vide bill no. IPB/21-22/0000431 dated 07.05.21 for treatment and package charges of Rs. 15,000/- per day in violation of Epidemic Disease Act 1897. The Complainant stated that he sent repeated emails and whatsapp messages to Doctor who is communicating on behalf of hospital, but Complainant did not get any response. The Complainant stated that hospital has charged extra amount of Rs. 1,74,999/- which is violation of Govt. guidelines. Hence, this shows deficiency on the part of Opposite Parties. Complainant has prayed to pay Rs. 2,28,570/- as compensation of extra charges and Rs. 50,000/- for mental harassment. She has also prayed for Rs. 5,000/- for postal and other miscellaneous expenses.  
2. None has appeared on behalf of Opposite Parties despite service of notice. Therefore, all the Opposite Parties were proceeded against Ex-parte vide order dated 18.05.22.

Evidence of the Complainant

3. The Complainant in support of her complaint filed her affidavit wherein she has supported the averments made in the complaint.

Arguments & Conclusion

4. We have heard the Ld. Counsel for the Complainant and we have also perused the file. The averments made by the Complainant in the complaint are supported by her affidavit and documents filed by her. The Opposite Parties did not appear and did not file any written statement. Therefore, the averments made in the complaint are to be believed.
5. In view of the above discussion, the complaint is allowed. Opposite Party No.2 is directed to pay the balance amount of insurance i.e. Rs. 1,69,017/- (Rs. 3,00,000-Rs. 1,30,983/-) to the Complainant along with interest @ 6 % p.a. from the date of filing the complaint till recovery. Opposite Party No.2 is further directed to pay Rs. 30,000/- on account of mental harassment and litigation expenses with interest @ 6 % p.a. from the date of this order till recovery.
6. Order announced on 09.03.2023.

Copy of this order be given to the parties free of cost.

File be consigned to Record Room. 

 

(Anil Kumar Bamba)           Member

(Adarsh Nain) Member

(Surinder Kumar Sharma) President