Ram Deo Roy filed a consumer case on 04 Mar 2023 against MD India Health Care Service TPA Ltd. in the Bokaro Consumer Court. The case no is CC/141/2019 and the judgment uploaded on 04 Mar 2023.
Jharkhand
Bokaro
CC/141/2019
Ram Deo Roy - Complainant(s)
Versus
MD India Health Care Service TPA Ltd. - Opp.Party(s)
Dadan Singh
04 Mar 2023
ORDER
District Consumer Disputes Redressal Commission, Bokaro
Date of Filing-08-08-2019
Date of final hearing-04-03-2023
Date of Order-04-03-2023
Case No. 141/2019
Ram Deo Roy S/o Late Mana Roy,
Sector-8/A, Qr.No. 2211, B-Road, Bokaro Steel City, Bokaro
Vs.
1. MD. India Health Care Service (TPA) Pvt. Ltd.
S.No. 46/1 E-Space A-2 Building, 3rd Floor, Pune,
Nagar, Vadagaon, Sheri, Pune Maharashtra, Pin 411014
2. Divisional Manager, Untied India Insurance Co. Ltd.
Plot no. A/17, Second Floor, Sector-4, City Centre,
Sector-4, Bokaro
3. Chief General Manager, Personal Departement
A.D.M. Building Sail, Bokaro Steel Plant,
B.S.City, 827001, Jharkhand
Present:-
Shri Jai Prakash Narayan Pandey, President
Smt. Baby Kumari, Member
PER- J.P.N Pandey, President
-:Order:-
Complainant has filed this case with prayer for direction to O.Ps. to pay him Rs. 26,398/- on account of medical expense incurred during his treatment and compensation of Rs. 10,000/- and legal expense Rs. 5000/-.
Complainant’s case in brief is that he is a retired SAIL, BSL employee and as per policy of the company he opted for Mediclaim policy for himself and his wife. He was provided MIN No. 04716280 which was valid at the relevant time. Further case is that due to eye trouble of the complainant he was admitted in Muskan Hospital and Research Centre, Chas on 17.07.2018 and discharged on same day after eye operation and hospitalization charge Rs. 26,000/- was paid by the complainant who also purchased medicine for Rs. 398/-. Later on complainant claimed said amount from the O.Ps. who kept it pending inspite of repeated requests. Hence this case has been filed with above mentioned prayer.
O.P. No. 1 (TPA) has not appeared nor filed W.S. inspite of due service of notice.
O.P. No.3 & 4 appeared and have filed W.S. admitting the facts of the case but they have submitted that they are not liable to pay the amount related to medical expense.
On behalf of O.P. No.2 (United India Insurance Co. Ltd.) no W.S. was filed rather written notes of argument has been filed by this O.P. admitting the cost of the lense, medicines, implementation total Rs. 19,648/- in lieu of Rs. 26,398/-.
It is very much apparent that O.P. Insurance Co. is admitting the claim for Rs. 19,648/- only in which the fee of the doctor and hospital charges have been excluded without assigning any reason. Ld. Counsel for the O.P. No.2 has not shown any terms and conditions of the policy which is permitting the insurance co. to deduct the operation charge and charge of the hospital. Genuineness of the claim is not in dispute, submission of the claim form has also not been disputed. Therefore, we are of the view that genuine claim of the complainant related to Rs. 26,398/- has not been settled by the O.Ps. for a long period which shows deficiency on the part of O.P. No. 1 & 2. Therefore, complainant is entitled to get relief as indicated below:-
Accordingly prayer of the complainant is being allowed in the following manner:-
O.P. No. 2 United India Insurance Co. Ltd. is directed to pay Rs. 26,398/- to the complainant within 60 days from receipt/production of the copy of this order, failing which this O.P. will pay interest @ 10% per annum on that very amount from 08.08.2019 (i.e. the date on which case was filed). Further O.P. No.2 is directed to pay compensation of Rs. 2,000/- for various types of harassment caused to the complainant for his genuine claim and also to pay Rs. 1000/- as litigation cost within above mentioned period.
(J.P.N. Pandey)
President
(Baby Kumari)
Member
Consumer Court Lawyer
Best Law Firm for all your Consumer Court related cases.