Punjab

Ludhiana

CC/15/155

Ashok Bhatia - Complainant(s)

Versus

Max Bupa Health Ins.Co.Ltd - Opp.Party(s)

GPS Kahlon Adv.

10 Jun 2015

ORDER

District Consumer Forum Ludhiana
Room No. 7, Old Wing, New Judicial Complex, Ferozepur Road Ludhiana.
Final Order
 
Complaint Case No. CC/15/155
 
1. Ashok Bhatia
21, G.F.HIG Flats, Rani Jhansi Road, Ghumar Mandi Ludhiana
...........Complainant(s)
Versus
1. Max Bupa Health Ins.Co.Ltd
D-1, 2nd Floor, New Delhi
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MR. Roshan Lal Ahuja PRESIDENT
 HON'BLE MR. Sat Pal Garg MEMBER
 
For the Complainant:
For the Opp. Party:
ORDER

Present:       Sh.G.P.S.Kahlon, Adv. for complainant.

                   Sh.Gurjeet Singh, Kalyan, Adv. for OP1 and OP2.

                   OP3 exparte.

 

                   Ms.Babita, Member has not come present today. Sh.Gurjeet Singh, Kalyan, Adv. for OP1 and OP2 has suffered a statement that the company has disallowed the claim of the complainant  on account of non submission of original mandatory documents for claim, but as per mail dated 11.5.15 the company is ready to consider the claim of the complainant on supply  of original discharge summary, original main bill with detailed breakup with payment receipts, investigation report/lab report in support of diagnosis done during the hospitalization (if original is not available then legible self attested copies of the above said claim documents alongwith application and affidavit be supplied ). The company contacted the customer for the same, but he first agreed to provide them, but later on said that he will submit the documents in the court. The company will able to consider the claim of the complainant, as per policy terms and conditions on receipt of abovesaid documents within 45 days from the receipt of order.

                   On the other hand, Ld. counsel for complainant has suffered a statement that Sh.G.P.S.Kahlon, Adv. for complainant has suffered a statement that he has heard the statement of Ld. counsel for OP1 and OP2, but the complainant had already supplied the original documents to the OPs on 20.8.14 alongwith the claim form. Now the complainant is again ready to supply the self attested copies of the abovesaid documents alongwith application and affidavit within 15 days from the receipt of the order.

                   In view of the statement suffered by Ld. counsel for parties, the present complaint stands disposed off with a directions to the complainant to supply the self attested copies of the documents to the OPs within 15 days from the receipt of the copy of the order and Ops are directed to consider the claim of the complainant and to settle and pay, as per policy terms and conditions within 45 days from the receipt of the copies of the documents from the complainant. Parties shall remain bound by statements suffered by their counsel today. File be consigned to record room.

 

 

 
 
[HON'BLE MR. Roshan Lal Ahuja]
PRESIDENT
 
[HON'BLE MR. Sat Pal Garg]
MEMBER

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