Jharkhand

Bokaro

CC/21/2019

Sumitra Devi - Complainant(s)

Versus

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

Mithilesh Kumar

17 Mar 2023

ORDER

                District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-19-01-2019

Date of final hearing-17-03-2023

 Date of Order-17-03-2023

Case No. 21/2019

Sumitra Devi W/o  Manoj Kumar Mandal,

 R/o House No. 2035, St-05, Sector-2/C, Bokaro Steel City

District, Bokaro, Jharkhand.

Vs.

1. MD India Health Insurance TPA Pvt. Ltd.

Sector-1, Near Nity Thana, Bokaro Steel city, Bokaro.

2. Samuhik Durghtna Bima Samiti,

Bokaro Steel Plant,Bokaro Steel City  

3. Divisinol Manager, United India Insurance Co. Ltd.

A/17, Floor No.2, City Centre, Sector-4,

Bokaro Steel city, Bokaro

 Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

PER- J.P.N Pandey, President

-Order-

1. Complainant has filed this case with prayer for direction to O.Ps. to pay her Rs. 31,357/- on account of medical expense incurred during her treatment and compensation of Rs. 50,000/-.
2. Complainant’s case in brief is that she being ex-employee of the SAIL/BSL opted for Mediclaim policy for herself. She was provided MIN No. 4736359 which was valid at the relevant time. Further case is that she was admitted in Nav Jyoti Eye Clinnic, Co-operative Colony, Bokaro and discharged on 27.07.2018 after eye operation for which she paid Rs. 31,357/- but Inspite of repeated requests O.Ps. have not paid  claim. Hence this case has been filed with above mentioned prayer. 

 

3.   Inspite of due service of notice O.Ps. have not appeared hence vide order dt. 20.09.2022 case is being proceeded ex-parte against O.Ps. thereafter, O.Ps. appeared but they have not taken any step for recall of the ex-parte order rather later on O.P. No.3 has filed written notes of argument.

 

4. On perusal of the papers annexed  with the complaint  petition it appears that complainant has filed photo copy of her Adhar Card, Medical Card issued by Insurance Co., certificate of treating doctor, final bill-cum-money receipt related to payment of Rs. 31,357/- to the hospital concerned, medical papers,  money receipt and paper related to renewal of the Mediclaim policy valid from 11.04.2018 to 10.04.2019 after deposit of premium.

 

5. On careful perusal of the photo copy of the papers it is very much clear that from 24.07.2018 to 27.07.2018 medical insurance policy was valid in respect to complainant who was operated by the hospital concerned to whom she paid Rs. 31,357/- on 27.07.2018 which was to be reimbursed by the O.P. No. 3 United India Insurance Co. Ltd. but it has not been done. Therefore, we are of the view that there is deficiency on the part of the O.Ps. accordingly complainant is entitled to get relief as prayed in the following manner.

 

6.   Accordingly prayer of the complainant is being allowed in the following manner:-

         O.P. No. 3 United India Insurance  Co. Ltd. is directed to pay Rs. 31,357/- to the complainant within 60 days from receipt/production of the copy of this Judgment, failing which this O.P. will pay interest @ 10% per annum  on that very amount from 19.01.2019  (i.e. the date on which case was filed). Further O.P. No.3 is directed to pay compensation of Rs. 5,000/- for various types of harassment caused to the complainant for her genuine claim within above mentioned period.

 

 

(J.P.N. Pandey)

                                                                                      President

                                                                  

         

         

(Baby Kumari)

                                                                                                    Member