Order dictated by:

Sh.Anoop Sharma, Presiding Member

1.  Bhupinderpal Singh complainant has brought the instant complaint under section 12 & 13 of the Consumer Protection Act, 1986  on the allegations that complainant got health benefit mediclaim Insurance for himself from opposite party  by virtue of Punjab Govt. employee and pensioner health Insurance  Scheme covering the risk period from 1.1.2016 to 31.12.2016 for the sum assured Rs. 5 lacs.  Unfortunately on 26.5.2016 complainant fell ill and he was to be hospitalized at Fortis Escort Hospital, Amritsar  and he incurred an expenditure of Rs. 20,536/- on his treatment. The opposite party was immediately informed about the hospitalization and the treatment taken thereof as the policy was issued on cashless basis. The complainant has made number of calls and visits to the opposite party, but the opposite party did not settle the claim of the complainant.  The complainant has sought for the following reliefs vide instant complaint :-

1. Opposite party be directed to pay the amount of Rs. 20,536/- alongwith interest @ 12% p.a. from 26.5.2016 till realization.
2. Opposite party be also directed to pay compensation to the tune of Rs. 50000/- alongwith adequate litigation expenses.

Hence, this complaint.

2.       Opposite party did not opt to put in appearance and as such it was ordered to be proceeded against ex-parte.

3.       In his bid to  prove the case  Sh. Deepinder  Singh, Adv.counsel for the complainant has tendered into ex-parte evidence  duly sworn affidavit of the complainant Ex.C-1, copy of Insurance policy Ex.C-2, copy of discharge card Ex.C-3, copy of hospital bill Ex.C-4, copy of hospital cards Ex.C-5 and closed the evidence on behalf of the complainant.

4.       We have heard the ld.counsel for the  complainant and have carefully gone through the record on the file.

5.       From the perusal of the record, it becomes evident that complainant got Health Benefit Mediclaim Insurance for himself under Punjab Government Employee and Pensioner Health Insurance Scheme for the period from 1.1.2016 to 31.12.2016 with sum assured Rs. 5 lacs, copy of Insurance  policy accounts for Ex.C-2 on record. It has been the case of the complainant that on 26.5.2016 i.e. during the subsistence of the policy period, complainant fell ill and was to be hospitalized at Fortis Escort Hospital, Amritsar  , copy of discharge card of hospital accounts for  Ex.C-2 on record. The complainant incurred Rs. 20,536/- on his treatment, copy of hospital bill is Ex.C-4.  The complainant immediately informed the opposite party regarding the hospitalization as the policy was on cashless basis. But the opposite party has not settled the claim of the complainant. The complainant has  not produced any document to show that the  opposite party has declined the claim of the complainant. So the end of justice would be met if we dispose of the complaint by giving certain directions.

6.       Consequently we dispose of  the instant complaint with directions to opposite party to decide the claim within 30 days from the date of receipt of copy of order . Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum. Copies of the orders be furnished to the parties free of costs. File is ordered to be consigned to the record room.

Announced in Open Forum

Dated : 24.1.2017

/R/                                                                        (Anoop Sharma )

Presiding Member

                                                                             ( Rachna Arora)

                                                                                      Member