Haryana

Kurukshetra

62/2016

H.C.bansal - Complainant(s)

Versus

Medsave Health - Opp.Party(s)

Sharvan Malik

17 Jan 2018

ORDER

BEFORE THE  DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, KURUKSHETRA.

 

Complaint no.62/16.

Date of instt. 1.3.16. 

                                                Date of Decision: 17.1.18.

 

H.C. Bansal son of Kishori Lal, resident of House No.1292, Ward No.8, Salarpur Road,  Kurukshetra.

 

                                                                ……….Complainant.      

                        Versus

                                                            

1. M/s Med save Health Care, (TPA) Ltd. F-701 A, Lado Sarai, behind golf course, New Delhi through its authorized signatory.
2. National Insurance Company Limited, Railway Road, Kurukshetra through its Senior Manager.

 

..………Opposite parties.

 

    Complaint under section 12 of Consumer Protection Act.               

 

 

Before       Sh. G.C. Garg, President.    

Dr. Jawahar Lal Gupta, Member.

                Smt. Viraj Pahil, Member     

                                               

Present :        Sh. Sharvan Malik, Advocate for complainant.

Sh. Rajive Gupta, Advocate for opposite parties.

                                    

ORDER

                                                                                                         

                    This is a complaint under Section 12 of the Consumer Protection Act, 1986 moved by complainant against M/s Med save Health Care and another, the opposite parties.

2.             It is stated in the complaint that the complainant obtained Med Save policy No.420403/48/14/8500000157 from the Ops valid for the period w.e.f. 3.10.2014 to 2.10.2015. The complainant has paid the premium in cash. Under the above said policy, the insured persons are the complainant and his wife Ved Kumari. In the month of July, 2015, the complainant suffered from Urine Problem and doctor advised him for operation. As per advice of doctor, the complainant got admitted in Sir Ganga Ram Hospital, New Delhi on 12.8.2015 where the complainant was operated and a sum of Rs.1,30,085/- was calculated to be the expenses for operation and medicines and the bills in this regard was duly issued to the complainant.  The complainant completed all the formalities and sent all the bills along with relevant form and documents to the OP for releasing the above said amount of Rs.1,30,085/- but the Ops have made the payment of Rs.58,100/- and the remaining amount of Rs.71,985/- was not paid to the complainant. The complainant requested the Ops many a times to pay the remaining amount of Rs.71,985/- but they lingered the matter on one pretext or the other and flatly refused to pay the same. The complainant also served a legal notice through his counsel, but they did not pay any heed. Thus, it amounts to deficiency of service on the part of the opposite parties towards the complainant. Hence, in such like circumstances, the present complaint was moved by the complainant with the prayer to direct the Ops to pay the balance claim amount of Rs.71,895/- along with 18% interest, to pay Rs.50,000/- as compensation for mental agony and physical harassment and Rs.5,500/- as litigation expenses.

3.             Upon notice, opposite parties appeared and contested the complaint by filing reply taking preliminary objections that the complaint is not maintainable; that the complainant has not come to this Forum with clean hands and has suppressed the true and material facts. In fact, the complainant was admitted in Sir Ganga Ram Hospital with the diagnoses of (i) Benign Prostatic Enlargement, (ii) Bladder Outlet Obstruction, (iii) Bothersome Luts and Underwent Procedure of Transurethral Resection of the Prostrate (TURP) + Optical Internal Urethrotomy  (OIU) on 12.8.2015 as per discharge summary of the hospital and the complainant preferred the claim under cashless scheme and a total sum of Rs.58,100/- were approved to the Hospital on two occasions i.e. on 12.8.2015 and 13.8.2015, the said approval of Rs.58,100/- was made on PPN rates for the said procedure as per the rate list of the said hospital and accordingly the said amount was approved and made and thus the further amount is not payable to the complainant. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of Ops and as such, the complaint of the complainant is liable to be dismissed. On merits, the contents of the complaint were denied to be wrong. Preliminary objections were reiterated. Prayer for dismissal of the complaint was made.

4.             Both the parties led their respective evidence.

5.             We have heard learned counsel for the parties and have gone through the record carefully.

6.            As per document Ex.C6, the payment of Rs.58,100/- has already been made by the OPs to the complainant. The contention of the complainant is that the remaining payment of Rs.71,985/- has not been made by the Ops to the complainant. This is true.

7.            In view of our above said discussion, the complaint of the complainant is allowed and the Ops are directed to make the payment of remaining amount of Rs.71,985/- to the complainant within a period of 60 days from the date of passing of this order, failing which penal action under Section 27 of the Consumer Protection Act, 1986 shall be initiated against the Ops and in that case the complainant shall be entitled to simple interest @ 6% per annum on the above said amount of Rs.71,985/- from the date of order till its payment. File be consigned to record after due compliance.

                 Copy of this order, be communicated to the parties.

 

Announced:    

Dt.17.1.2018.                               (G.C.Garg)

                                                  President

                                                  District Consumer Disputes           

                                                Redressal Forum, Kurukshetra.

 

       

                                                   

       (Dr. Jawahar Lal Gupta)               (Viraj Pahil)       

            Member                                   Member