Delhi

New Delhi

CC/799/2010

Pradeep Gaur - Complainant(s)

Versus

M/S. Reliance Insurance & Anr. - Opp.Party(s)

02 Mar 2015

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI), ‘M’ BLOCK, 1^STFLOOR,

VIKAS BHAWAN, I.P.ESTATE,

NEW DELHI-110002.

 

Case No.CC/799/10                                                                                                                                                                               Dated:

In the matter of:

SH. PRADEEP GAUR,

S/O SH. SHIRIBHAGWAN GAUR,

R/O VILL. AND POST OFFICE

SHAHBAD MOHAMMAD PUR,

NEW DELHI-110061

 

         ……..COMPLAINANT

       

VERSUS

 

1. M/S RELIANCE INSURANCE,

#14, HIMALAYA BUILDING,

BARAKHAMBA ROAD, H.O.,

CONNAUGHT CIRCUS,

NEW DELHI-110001

 

2. MEDI ASSIST INDIA

TPA PVT. LTD.(DELHI),

F-2, KAILASH PLAZA, 2 FLOOR,

H-252, SANT NAGAR, EAST OF KAILASH,

NEW DELHI-110065,

LAND MARK: ISKCON TEMPLE(SANTAGAR)

 

………. OPPOSITE PARTY

 

ORDER

 

President :  C.K. Chaturvedi

        The minor son of complainant was a beneficiary of cashless mediclaim policy no.282510370952 taken by complainant for him and his family members from OP, which was lastly renewed till 24.12.09.  The son of complainant Master Parth fell ill and remained admitted in Ayushman Hospital from 07.12.09 till 16.12.09, when he was discharged.  The complainant, despite cash less policy paid Rs.15,300/- on 11.12.09, Rs.10,000/- on 15.12.09 and Rs.4650/- on 16.12.09.  After discharge he made a mediclaim for reimbursement which was denied by OP on the ground that there was no need to stay in hospital after 11.12.09, when his condition improved.

        We have summarily considered the case of parties and are shocked at the attitude and misbehavior of OP for firstly not providing cash less treatment and questioned the period of stay to claim more amount.  The OP has no locus to question the stay in hospital and to decide on discharge, which in domain of hospital.  The OP has simply harassed the complainant and deserves punitive compensation. 

We have, thoroughly, considered the arrival of OP and complainant and hold OP guilty of deficiency and harassment we directed as under:-

1. direct OP to pay  compensation of Rs.75000/- for this irresponsible behavior and deficiency which would be inclusive of litigation expenses and harassment etc.
2. we also direct OP to sanction the bill of Rs.31,950/- for hospital stay as medicalim, with interest of 9% form date of repudiation till payment.

The order shall be complied with within 30 days of the receipt of the copy of the order; otherwise action can be taken under Section 25 / 27 of the Consumer Protection Act.

Copy of the order be sent to the parties free of cost.

 

        Pronounced in open Court on 02.03.2015.

 

 

 

 

(C.K.CHATURVEDI)

PRESIDENT

 

 

 

 

(S.R. CHAUDHARY)              (RITU GARODIA)

MEMBER                                  MEMBER