Jharkhand

Bokaro

CC/18/146

Phul Devi - Complainant(s)

Versus

MD India Health Care Service (TPA) Pvt. Ltd. - Opp.Party(s)

Amardeep Jhaa and Poonam

25 Jan 2023

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-22-11-2018

Date of final hearing-25-01-2023

 Date of Order-25-01-2023

Case No. 146/2018

     Phul Devi  

     R/o Qr.No. 463, St. 14, Sector-09/B,

     O.P. & P.S.- Sector-9 , Harla, District Bokaro, Jharkhand

Vs.

    1. MD India Health Care Service (TPA) Pvt. Ltd.

        S.No. 46/1 E-space A-  2 building, 3rd floor, pune, Nagar Road,

        Vadgaon, Sheri, Pune (Maharashtra), Pin 411014

    2. Divisional Manager, United India Insurance Co. Ltd.

        At Plot No. A/17, Second Floor, Sector-4, City Centre,

        Sector-4, Bokaro Steel City

     3. D.G.M. Personal SAIL Corporate Office,

         SAIL Ispat Bhawan, Lodhi Road, New Delhi                         Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

 

PER- J.P.N Pandey, President

-Judgment-

  1. Both parties are absent. None turned up on behalf of complainant or O.Ps. on repeated call. It reveals from the record that this case is pending at the stage of argument since long. In the given facts as per provision of Section 38 (3) (c) Consumer Protection Act. 2019 case has been taken up for decision on merit on the basis of materials available on record.

 

  1. Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 50,571/- on account of medical expense incurred during treatment of complainant  and to pay Rs. 20,000/-  as compensation and Rs. 10,000/- as litigation cost.
  2. Complainant’s case in brief is that her husband is retired SAIL, BSL employee and as per policy of the company he opted for Mediclaim policy for himself and his wife (complainant) and O.Ps. have provided  MIN No. 4711537 for herself which was valid at the relevant time. Further case is that due to illness complainant got herself admitted in Bokaro Health Care Hospital at Plot No. 109, Co-operative colony, Bokaro Steel City, District Bokaro (Jharkhand)  on 07.02.2018 and discharged on 14.02.2018 from the hospital for which Rs. 50,571/- was paid to the hospital by the complainant. Complainant applied for reimbursement of the above amount but inspite of repeated requests no action was taken by the O.Ps.  Thereafter legal notice was served having no impact. Hence this case has been filed with above mentioned prayer.  

 

  1.   O.P. No.1 & 3 TPA and SAIL/ BSL Bokaro respectively have not  appeared inspite of due service of notice.
  2. On behalf of O.P. No.2 (United India Insurance Co.) W.S. has been filed in which it is mentioned that as per policy contract claim has  to be ascertained and original discharge summary, bifurcated and consolidated bill, investigation report with detailed information of hospital and doctor on it, of the complainant as hospitalization proof is not provided by the complainant for verification. Further reply is that as per rules of IRDA “Hospital” means any institution established for in-patient care and day care treatment of sick-men and for injuries and which has been registered as a hospital with the local authority wherever applicable and is under the supervision of registered and qualified medical practitioner,
  3.  
  1. Has at least 10 inpatient bed in those towns having a population of at least 10,00,000 and 15 inpatient beds in all other places.
  2. Has qualified nursing staff under its employment round the clock.
  3.        Has qualified practitioners round the clock.
  4. Has fully equipped operation theater of its own where surgical procedures are carried out.
  5. Maintain daily records of patients and will make their accessible to the insurance authorized personal.

Further reply is that the claim has been repudiated as there is manipulation in claim documents. Further reply is that during investigation/enquiry it was found that ‘ there is no existence of any hospital namely Bokaro Health Care Hospital. The hospital is permanently closed for last five-six months’. In this way under collision with the complainant it is attempt to grab the mediclaim amount. Further reply is that as per IRDA norms concerned hospital is not fulfilling the criteria of hospital hence claim has been rightly repudiated and case is liable to be dismissed.

  1. On the basis of above pleadings we have to see whether complainant is entitled to get relief as claimed or not?
  2.  On careful perusal of the papers annexed with the complaint petition it appears that complainant claims herself to be treated at Bokaro Health Care Hospital about which it is said that during investigation it was found closed from last five to six months. About that very hospital it is said that it is not fulfilling criteria of a hospital as per IRDA norms. To meet that very objection there is no any evidence by the complainant to prove that those objections are not correct. On this aspect also there is no evidence of the complainant. There is no evidence on record to show that there was need of admission of the complainant in the hospital.
  3.  Therefore, in light of above discussion we are of the view that complainant is not able to prove its case for grant of relief as prayed. Accordingly this point is being decided against the complainant.

9. Accordingly prayer of the complainant is being dismissed. In the facts of the case parties shall bear their own costs.

 

(J.P.N. Pandey)

                                                                                      President

                                                                                               

 

 

                                                                               (Baby Kumari)

  •  

 

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