Delhi

New Delhi

CC/263/2010

Rajesh Mittal - Complainant(s)

Versus

M/S. United India Insurance Company Ltd. - Opp.Party(s)

25 Aug 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/263/10                                                                                                                                                                                Dated:

In the matter of:

Sh. Rajesh Mittal,

R/o 33/19, H.No.23, Dharam Colony,

Main Rohtak Road, Nangloi, Delhi-41

……..COMPLAINANT

       

VERSUS

1. United India Insurance Co. Lyd.,

DMA House, Delhi Medical Association Road, Daarya Ganj, New Delhi-110002

Also at:

United India Insurance Co. Ltd.,

501, 502, Kailash Building,

K.G Marg, Connaught Place, Delhi-01

 

2. Vipul Med Corp T.P.A Ltd.,

515, Udyog Vihar, Phase-V,

Gurgaon, Haryana-122016

                        ……..OPPOSITE PARTIES

 

ORDER

President:  C.K Chaturvedi

The complaint of deficiency is regarding deduction of Rs.6,319/- for the treatment bill of Rs.21,332/- incurred by complainant for his wife in hospital, under medi claim policy. The Complainant was insured for medical insurance of Rs.2 lakhs for period 25.03.09 to 26.03.10. The TPA allowed the hospital only Rs.15,000/- and complainant had to pay Rs.6,315/- from his pocket for treatment of his wife in Maharaja Agrasen Hospital.

The OP in its reply has drawn attention to clause 1.2, ABCD of the policy and has explained that she was entitled to a room of Rs.2,000/- per day that she had admitted her in a different tariff room and explained some other small deduction totally Rs.6,315/-. The deduction towards nebulizer procedure, admin charges of Rs.50/- and small charges of consultation are not excluded in policy clause. Thus, we find OP has wrongly deducted Rs.320 + Rs.50/- total to about Rs.3,70/-. We directed OP to pay Rs.3,70/- for wrong deductions and pay Rs.2,000/- for litigation expenses.

        The order shall be complied 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.

File be consigned to record room.

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

 

 

Pronounced in open Court on 25.08.2015.

 

  (C.K.CHATURVEDI)

PRESIDENT

 

 

(Ritu Garodia)

MEMBER