Jharkhand

Bokaro

CC/47/2020

Hari Nandan Singh - Complainant(s)

Versus

MD INDIA HEALTH INSURANCE TPA PVT. LTD. - Opp.Party(s)

24 Jun 2022

ORDER

District Consumer Commission, Bokaro.

Case No. 47/2020

  Date of Filing-25-11-2020

 Date of Order-24-06-2022

Hari Nandan Singh S/o Late Budhan Singh

R/o Qr.no. 2363, Sector-4/D, Sector-4, Bokaro Steel City, P.S. Bokaro.

Vr.

 

1. MD India Health Insurance TPA Private Limited, Sector-1, Near City Thana, Quality Circle, Bokaro Steel City Pin 827001
2. MD India Health Insurance TPA Private Limited, C 483, Lake Garden, New Lords Bakery, Kolkata, West Bengal Pin 700045
3. United India Insurance Company Limited, Do XI, E-85, Himalaya House, 8^th Floor, K.G. Marg, New Delhi, Pin 110001
4.  Director In-Charge SAIL, Bokaro Steel Plant,

Bokaro Steel City, Bokaro

Present:-

          Shri Jai Prakash Narayan Pandey, President

           Smt. Baby Kumari, Member

Order

1. Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 4,593/- with 18% per annum interest 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 he is retired SAIL, BSL employee and as per policy of the company he opted for Mediclaim policy vide MIN No. 4733430 for himself and his wife which was valid at the relevant time. During the enforcement of the insurance policy the complainant suffered with some ailments for which he was to purchase medicines outside of the BGH during which he paid Rs. 4,593/- to the medical shop.   Complainant applied for reimbursement of the said  amount but inspite of repeated requests no action was taken by the O.Ps.  Thereafter notice was served on the O.Ps.  having no impact. Hence this case has been filed with above mentioned prayer.  

 

3.   O.P. No.4 SAIL/ BSL Bokaro appeared but no W.S. has been filed by O.P. No.4.

 

4. Inspite of due service of notice in the month of January 2022 O.P. No.1, 2 & 3 have not appeared hence case is being proceeded against them Ex-parte.

 

5. To support its case complainant has produced photo  copy of the premium deposit receipt (Annexure-1), photo  copy of the claim form with annexures (Annexure-2), photo  copy of the acknowledgment slip of submission of claim form (Annexure-3),  and photo  copy of the legal notices with annexures (Annexure-3,4 & 5).
6. On perusal of the photo copies of the documents produced by the complainant it appears that he has submitted claim form on 10.06.2019 along with all relevant papers with due acknowledgment slip dt. 10.06.2019 in the office of  the O.Ps. but no action has been taken on it till date. On receipt of notice of this Commission also those O.Ps. except O.P. No.4 have not preferred to appear before this Commission to show that why payment to the complainant has not been made.
7.  It is well known to all concerned that retired BSL employees are being covered with mediclaim policy and they are entitled to get re-imbursement of the medical expense as per policy. In light of above discussion we are of the view that complainant has well established his case for re-imbursement of medical expense incurred on purchase of the medicines i.e. Rs. 4,593/-.
8. Accordingly prayer of the complainant is being allowed in  the manner indicated here in below:-

O.P. No. 3  ( the United India Insurance Co. Ltd.) is directed to pay Rs. 4,593/- to the complainant within 60 days from today otherwise this O.P. shall pay interest @ 10% per annum from 25.11.2020 (the date on which complaint was filed). Further O.P. No.3 is directed to pay Rs. 1000/- as compensation for various type of harassment and also to pay Rs. 500/- as litigation cost within 60 days from today. Further O.P. No.3 is directed to procure all documents in coordination with other O.Ps. and comply this order within specified period. Let the copy of this order be provided free of cost to all parties.