Delhi

New Delhi

CC/1277/2010

Miss C. Pramela - Complainant(s)

Versus

M/S. Royal Sundaram Alliance Insurance Company Ltd. - Opp.Party(s)

05 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/1277/10                                                                                                                                                                              Dated:

In the matter of:

Miss. C. Pramela,

A-122, Freedom Fighter Enclave,

Neb Sarai, New Delhi-110068

……..COMPLAINANT

       

VERSUS

1. M/s. Royal Sundaram Alliance Insurance Co. Ltd., 1505-1506, 15^th FL, Ambadeep Building, 14 K.G Marg, Connaught Place, New Delhi-110001

 

2. The Max Super Specialty Hospital,

          1-Press Enclave Road, Saket,

           New Delhi-110017

                              ………. OPPOSITE PARTIES

 

ORDER

Member: S.R Chaudhary

The Complainant had taken a medical insurance coverage vide policy bearing no.H000000446000107-W101-2009-2010 from OP1. Suddenly complainant met with an accident on 21.08.09 and processed prior approval claim to OP2 for Rs.70,000/- for cashless. The complainant was discharged on 26.08.09 & a bill for Rs.59,856.39/- was paid out of Rs.70,000/- i.e. shortfall of Rs.10,143.61/-. Thus complaint was filed.

OP filed its reply stating that the complainant after being discharged from the hospital made a reimbursement claim for a sum of Rs.70,000/- out of which Rs.59,856.39/- was paid to complainant, after perusing the bills and receipts. It is also stated that full explanation with detailed list was given to complainant for deduction of Rs.10,144/-. OP has also explained pre and post hospitalization bill amount deduction of Rs.2,292/- out of Rs.6,942/-. Details of deductions are reproduced below as per letter dated 05.03.10.

Details of Deductions:

 

• Top with net 3 inch Rs.70.
• Artiflex gloves, top with net Rs.199.
• Artiflex Stockinet Rs.249.
• Reports not present Rs.600.
• Cast charges Rs.1875.
• Artiflex gauge, gloves, plasters of paris, scotchcase Rs.1657.

 

We have considered the reply, evidence and submissions made. We find that deductions made by OP for a sum of Rs.10,144/- towards non medical items and room capping charges and deduction for a sum of Rs.4,650/- for non medical items and no supporting bills are purely justified Para wisely  in detail supported by annexures. We see no merit in the case. There is no deficiency on the part of OP.

Therefore complaint is dismissed.

File be consigned to record room.

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

 

        Pronounced in open Court on 05.03.2015.

 

                   

(C.K.CHATURVEDI)

PRESIDENT

 

 

(S.R. CHAUDHARY)                 (Ritu Garodia)

MEMBER                                  MEMBER