Present case has been filed by the complainant with prayer to direct the O.P. No.1 and 2 for immediate issuance of mediclaim policy, cashless card and to pay Rs. 15000/- compensation and Rs. 5000/- litigation cost.
2. Case of the complainant in short is that he was employee of Bokaro Steel Plant who retired from service on 30.09.2015. Further case is that as per policy of the BSL he obtained mediclaim policy having index No. 4741982 but cashless card and policy paper were not issued till filing of the case causing various problem to the complainant. Further case is that due to it he deferred the treatment of his ailments aggravating his ailment, who also having cataract and due to non supply of those papers he suffered a loss. It is further case that the complainant approached the O.Ps. for the same but cashless card has not been issued.
3. O.P. No.1 and 3 have filed their W.S. mentioning therein that they are having no pecuniary are financial interest in the matter, rather entire liability is on insurance co. It is further case of these O.Ps. that there is no communication from the complainant to the O.Ps. in respect to non supply of cashless card, however, complainant suffered no loss because during that very period i. e. from 01.10.2015 to 31.03.2016 three claims as mentioned at para 4 of the W.S. have been settled, hence allegations are baseless.
4. O.P. No.2 has also filed W.S. mentioning therein that no comments on para 1,5,6,7(b) of the complaint petition. It is said that cashless cards are being send by Third Party Administration on the address declared by the member for which this O.P. is not responsible. Further case is that cashless facility may be availed by showing membership enrolment/renewal/confirmation slip at the listed hospitals, hence, there is no deficiency in service and complaint is liable to be dismissed.
5. O.P. No.4 has also filed W.S. mentioning therein that the statements made in para 1 to 7 of the complaint petition are matter between complainant and O.P. No.1 and 3. It is further case of this O.P. that firstly no proper documentation was done by the complainant for cashless card nor any application was made for its issuance and treatment facility may be availed without such card, hence case is liable to be dismissed.
6. Complainant has produced copy of first page of his medical book, copy of Authority letter and copy of application of renewal of membership for mediclaim scheme. Except these papers no any other paper or any evidence has been produced.
7. On careful perusal of the pleadings of the parties it is apparent that facts related to opening of mediclaim policy are admitted by both the parties.
8. It has been brought on record that during relevant period three medical claims of the complainant have been settled. This fact has not been denied by the complainant. It has also been brought on record that in absence of the cashless card, cashless medical facility may be availed by the complainant in listed hospital by showing the membership enrolment/renewal/ confirmation slip. This fact has also not been denied or controverted by the complainant. It has been brought in the W.S. that complainant never approached the O.Ps. by making complaint for issuance of cashless card or for non supply of said card. No any paper to show that complainant raised his grievance before the O.Ps. for its redressal. In this way without raising grievance before the O.Ps. complainant has approached this Commission without any cause of action. It is also apparent that concerned policy was effective from 01.10.2015 to 30.09.2016 in this way at present after expiry of the policy period prayer is infructuous.
9. In light of above discussion we are of the opinion that this complaint is liable to be dismissed on the ground (a) That it is not disclosing cause of action of the case rather it has been filed without any cause of action.(b) That no loss has been suffered by the complainant especially in view of settlement of his three claims as mentioned at para 4 of the W.S. of O.P. No. 1 and 3. (c) That as per provision of the policy in absence of cashless card complainant was entitled to avail cashless facilities in listed hospitals on the basis of membership enrolment/renewal/confirmation slip.(d) That since concerned policy was effective from 01.10.2015 to 30.09.2016 in this way at present after expiry of the policy period prayer is infructuous and liable to be rejected.
10. In result, this complaint is being dismissed as it is meritless as discussed above. However, parties shall bear their own costs.
