Delhi

East Delhi

CC/823/2012

HARA RAM PRASD - Complainant(s)

Versus

N.I.C - Opp.Party(s)

07 Mar 2013

ORDER

DISTRICT CONSUMER DISPUTE REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

C.C. NO. 823/12

 

Shri Haridwar Prasad

S/o Hare Ram Prasad

R/o A-55, Gharoli Village

Kumhal Basti, Delhi – 110 096                                                   ….Complainant

 

Vs.

 

The National Insurance Company Ltd.

Registered Office:

106, Ist Floor, Palika Bhawan

Sector-13, Ring Road, R.K. Puram

New Delhi – 110 066

 

East West Assist Pvt. Ltd. (TPA)

97, Manekshaw Road, Near Anupam Garden

Sainik Farm, New Delhi – 110 068                                            ….Opponents

 

 

Date of Institution: 04.01.2013

Judgment Reserved for : 15.07.2016

Judgment Passed on : 18.07.2016

 

CORUM:

Sh. Sukhdev Singh (President)

Dr. P.N. Tiwari  (Member)

Ms. Harpreet Kaur Charya (Member)

 

Order By : Shri Sukhdev Singh (President)

 

 

JUDGEMENT

The complainant Shri Haridwar Prasad has filed a complaint against the National Insurance Company Ltd. (OP-1) and East West Assist Pvt. Ltd. (TPA) (OP-2) praying for reimbursement of insurance claim of Rs. 68,640/- along with interest of 18% from its due date; compensation of Rs. 50,000/- on account of harassment and mental agony and            Rs. 10,000/-  as litigation cost.

2.        The facts in brief are that Shri Haridwar Prasad (complainant) got issued Mediclaim Insurance Policy No. 351800/46/11/8500002964 for a period from 16.08. 2011 to 15.08.2012.   It is stated that on 08.11.2011, he was admitted at Chaturbhuj Hospital, A-5, Deepak Vihar, Khora Colony, Sector-62, Noida-201301 and on examination, he was diagnosed as Meningitis.  He remained in the hospital for 07 days from 08.11.2011 to 14.11.2011.  The hospital raised a bill for an amount of Rs. 68,640/- which were paid in cash, vide receipt No. 24872 dated 08.11.2011 for  Rs. 25,000/- and receipt no. 24921 dated 14.11.2011 for Rs. 43,640/-, making a total amount of Rs. 68,640/-.  He submitted the entire documents for mediclaim in the office of OP-2 at Sainik Farm, New Delhi.  However, they have not sanctioned the amount.  Thus, he has prayed for reimbursement of Rs. 68,640/- as insurance claim; Rs. 50,000/- as compensation on account of mental pain and agony and Rs. 10,000/- on account of litigation charges. 

3.        OPs were served and they have not put the appearance.  Hence, they have been proceeded ex-parte.  During the course of proceedings, it has been noticed that there has been memo of appearance on behalf of National Insurance Company but no written statement has been filed on their behalf.

4.        In support of his case, the complainant has examined himself on affidavit.  He has deposed the facts, which have been stated in the complaint.            From the proceedings, it is noticed that after filing the evidence, the complainant stopped appearing.  Even OP did not put the appearance also.  It seems that the complainant might have received his claim from OP.  If he would not have received the claim, certainly, the complainant would have attended the proceedings.  That being so, there is no point in awarding any compensation to the complainant, except to issue a direction to OP to consider his claim, if not considered earlier. 

            With this, the complaint of the complainant stands disposed off.

Copy of the order be supplied to the parties as per rules.

File be consigned to Record Room.

 

(DR. P.N. TIWARI)                                                  (HARPREET KAUR CHARYA)

Member                                                                                Member                 

 

 

(SUKHDEV SINGH)

President