Delhi

North East

CC/245/2023

Sh. Pratap Bhanu - Complainant(s)

Versus

M/s Reliance General Insurance Co. - Opp.Party(s)

06 Aug 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No.245/23

In the matter of:

	Sh. Pratap Bhanu, S/o Sh. Tej Singh, R/o CA 90A, Thane Road, Gali No. 1/4A, Amba Band Vali Gali, Garhi Mandu, Bhajanpura, North East Delhi 110053	Complainant
	Versus
	M/s Reliance General Insurance, Through it’s Director/AR R Care Health No. 1-89/3/B/40 to 42/KS/301, 3rd Floor, Krishe Block, Krishe Sapphire, Madhapur, Hyderabad, Telengana 500081	Opposite Party

 

DATE OF INSTITUTION:         JUDGMENT RESERVED ON:                         DATE OF ORDER  :

12.09.2023 18.03.2024 06.08.2024

 

CORAM:

Surinder Kumar Sharma, President

Adarsh Nain, Member

ORDER

 

Surinder Kumar Sharma, President

The Complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019.

Case of the Complainant

1. The case of the Complainant as revealed from the record is that on 13.07.2022 he purchased/renewed a policy namely Cover Type Floater, Room Category single Private air-conditioned room for sum insured of Rs. 3,00,000/-. The tenure of the policy was 01 year and renewable date was 18.07.2023. Complainant stated that he approached Eye 7 Hospital Pvt. Ltd. Centre, Lajpat Nagar for his eye treatment. Complainant stated that doctors of said hospital told Complainant that the disease namely Cataract with Vivity Toric Iol was found in the eye of the Complainant and suggested for a surgery. Complainant stated that doctors of said hospital told that expenses of surgery would be  Rs. 1,02,000/-.  Complainant stated that he wanted to avail the service of Medi- claim policy which was given by the Opposite Party and Eye 7 Hospital sent the request for cashless hospitalization to the Opposite Party along with all the required documents for approval. Complainant stated that on 20.12.2022, he got the approval through e-mail for a sum of Rs. 1,02,000/- and he got himself admitted to the Chaudhary Eye Centre for the surgery. Complainant stated that the surgery was successfully completed on 22.12.2022, and after surgery Chaudhary Eye Center has received an e-mail from Opposite Party for a payment of Rs. 32,000/-. Complainant stated that the referred hospital sent a legal notice dated 19.07.2023 to the Complainant for recovery of an amount of Rs. 70,000/- and Complainant replied the same. Complainant sent several requests to Eye Seven Hospital for payment of Rs. 70,000/- but Opposite Party intentionally and deliberately did not make the payment of the approval claim amount. Hence, this shows the deficiency of service on the part of Opposite Party. Complainant has prayed to direct the Opposite Party for making the payment of Rs. 70,000/- along with interest @ 18 % p.a. from the date of maturity till date of realization. Complainant also prayed for an amount of Rs. 2,00,000/- on account of mental harassment and Rs. 55,000/- on account of litigation expenses.  
2. None has appeared on behalf of the Opposite Party to contest the case despite service of notice. Therefore, Opposite Party was proceeded against ex-parte vide order dated 29.11.2023.

Ex- Parte Evidence of the Complainant

3. The Complainant in support of his case filed his affidavit wherein he has supported the assertions made in the complaint.

Arguments & Conclusion

4. We have heard the Ld. Counsel for the Complainant. We have also perused the file and the written arguments filed by the Complainant. The case of the Complainant is that he was having a health insurance policy given by the Opposite Party. The Complainant had to undergo some eye surgery/treatment and this surgery was done and treatment was given to the Complainant by Chaudhary Eye Centre. The case of the Complainant is that the Opposite Party has approved an amount of Rs. 1,02,000/- and this approval was sent to the Chaudhary Eye Centre as well as to him. The total cost of the treatment was Rs. 1,02,000/-. The case of the Complainant is that subsequently another correspondence was done wherein the amount approved was Rs. 32,000/- and a legal notice has been sent to him by Chaudhary Eye Centre for recovery an amount of Rs. 70,000/-.
5. The case of the Complainant as reveal from the record is that the Opposite Party did not pay the complete amount i.e. Rs. 1,02,000/- to the Chaudhary Eye Centre whereas the actual cost of the treatment was Rs. 1,02,000/- and for this reason Chaudhary Eye Centre sent him a legal notice for recovery of the said balance i.e. Rs. 70,000/-.
6. Thus, it is clear that the whole case is based upon the legal notice issued by Chaudhary Eye Centre to the Complainant for recovery of Rs. 70,000/- but the Complainant has not filed the said legal notice issued by the Chaudhary Eye Centre to him. Therefore, under these circumstances, we are of the opinion that the Complainant has failed to prove its case. Hence, the complaint is dismissed.
7. Order announced on 06.08.2024.

Copy of this order be given to the parties free of cost

File be consigned to Record Room.

(Adarsh Nain)		(Surinder Kumar Sharma)
(Member)		(President)