Punjab

Ludhiana

CC/14/391

Partik Jain - Complainant(s)

Versus

National Ins.Co.Ltd - Opp.Party(s)

29 Dec 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA.

                                                          Complaint No:  391 of 21.05.2014.                                                            Date of Decision: 29.12.2016.

 

Partiek Jain s/o. Shri Lavnish Jain, resident of 105-C, B.R.S. Nagar,  Ludhiana                                                                    ..… Complainant

                                                Versus

1. National Insurance Company Ltd., having its registered office at Middleton Street, Post Box No.9229, Kolkata through its Managing Director
2. National Insurance Company Ltd., having its Branch Office at B.O.-VI, G.T. Road, Miller Ganj, Ludhiana through its Manager.
3. M/s. Park Mediclaim TPA Pvt. Ltd., 702, Vikrant Tower, Rajendra Place, New Delhi-110008 through its Director/Manager.

…..Opposite parties 

                                      Complaint under the Provisions of Consumer Protection Act, 1986

QUORUM:

SH. G.K. DHIR, PRESIDENT

SH. PARAM JIT SINGH BEWLI, MEMBER

COUNSEL FOR THE PARTIES:

For complainant            :         Sh. Dinesh Kumar, Advocate

For OP1 and OP2          :         Sh. Rajeev Abhi, Advocate

For OP3                         :         Exparte.

ORDER

PER G.K. Dhir, PRESIDENT

1.                Complaint under Section 12 of the Consumer Protection Act (hereinafter referred as Act) filed by complainant by pleading that he and Smt. Sangeeta Jain holds mediclaim policy issued by OP1 and OP2 since for the last 20 years continuously. Details of the policy got by the complainant for the last four years are as under:-

(a)               Policy No.404500/48/09/8500000340 effective from 27.02.2010 to 26.02.2011 in the name of Smt. Sangeeta Jain w/o. Shri Lavnish Jain

(b)               Policy No.404500/48/10/8500000778 effective from 27.02.2011 to 26.02.2012 in the name of Smt. Sangeeta Jain w/o. Shri Lavnish Jain

(c)               Policy No.404002/48/11/8500000797 effective from 27.02.2012 to 26.02.2013 in the name of Smt. Sangeeta Jain w/o. Shri Lavnish Jain

(d)               Policy No.401603/48/12/8500000548 effective from 27.02.2013 to 26.02.2014 in the name of Sh. Partiek Jain S/o. Shri Lavnish Jain and Smt. Sangeeta Jain is also covered under the policy.

Status of health of the insurer is in the knowledge of OP1 and OP2 because they have got medical examination done at the time of initial policy and thereafter as per requirement. Complainant obtained policy No.401603/48/12/8500000548  from Ops for the period from 27.02.2013 to 26.02.2014. That policy covers the health risk of complainant and his mother Smt. Sangeeta Jain. Mother of the complainant is suffering from certain neurological disorders for the last many years due to which she had to be hospitalized in 2005 after admission on 28.12.2005 in Satguru Partap Singh Apollo Hospital, Ludhiana. At that time she remained admitted there till 30.12.2005. As per discharge summary issued by said hospital, it was found that she had generalized sinking of the whole body on 3/4  occasions and was  also having numbness of left upper limbs, albeit she was conscious. However, she was having no control over her body during period of such ailment. Medical expenses incurred on her treatment during this hospitalization were reimbursed by OP1 and OP2.

2.                Again Smt. Sangeeta Jain suffered from similar ailment in 2006, due to which she remained admitted in Dayanand Medical College & Hospital, Ludhiana from 08.03.2006 to 09.03.2006. She was treated in neurology department of that hospital for more or less the similar symptoms, which she was earlier having. Even the expenses borne by the complainant on this treatment were reimbursed by the insurance company.

3.                Smt. Sangeeta Jain then again suffered from partial seizures and related problems because she was suffering from progressive headache. Smt. Sangeeta Jain remained admitted in  Satguru Partap Singh Apollo Hospital, Ludhiana  for the period from 11.04.2007 to 12.04.2007 and the medical expenses incurred on this treatment again were reimbursed by insurance company.

4.                During the subsistence of present policy for period from 27.02.2013 to 26.02.2014, Smt. Sangeeta Jain again suffered from above said neurological disorder and as such, she was admitted in Medanta, The Medicity Hospital, Gurgaon on 27.12.2013 for getting treatment in the institute of Neuro Sciences. There she was treated by highly qualified super specialists in the Neuro Department. At the time of admission, complainant duly informed Ops regarding the hospitalization, on which OP3 issued letter dated 28.12.2013 addressed to Medanta Hospital. OP3 guaranteed payment of Rs.20,000/- towards costs of necessary treatment by further mentioning that in case total costs of treatment exceeds Rs.20,000/-, then same will require further authorization. This time an amount of Rs.42,616.50P were spent on treatment, which were paid vide invoice No.GHIPBL/14055434 dated 28.12.2013. Despite getting of cashless policy and issue of letter dated 28.12.2013 referred above, the amount of expenses borne on this treatment were not paid and as such, said denial for such reimbursement alleged to be against terms and conditions of the policy. Repudiation of claim for reimbursement ordered by Ops by claiming that hospitalization for this period was for diagnosis of paroxysmal non epileptic seizure, a psychiatric and psychosomatic illness/disorder, due to which the same covered by exclusionary clause 4.8 of the policy. These observations for repudiation of the claim alleged to be illegal and as such, by pleading deficiency in service on the part of Ops, prayer made for directing Ops to pay Rs.42,616.50P with interest @12% per annum from the date of treatment till full and final payment. Compensation for mental harassment, pain, agony and sufferings of Rs.50,000/- along with costs of litigation expenses claimed. Additionally, it is claimed that Medanta Hospital issued certificate dated 28.12.2013 for mentioning that Smt. Sangeeta Jain had seizures and was suffering from the ailment in the past also, due to  which she needed VEEG and MRI. Further it was mentioned in the certificate that VEEG is possible only after admission in hospital. Nowhere it was mentioned by the said hospital that disease from which Smt. Sangeeta Jain was suffering pertained to Psychiatric disorder and not to the Neurological disorder.

5.                OP1 and OP2 filed joint written statement for claiming that complaint barred in view of Section 26 of the Consumer Protection Act; complainant not entitled to compensation because repudiation of the claim is as per clause 4.8 of the terms and conditions of the policy, which provides that insurer is not liable to reimburse the expenses incurred in connection with or in respect of treatment for psychiatric and psychosomatic disorder/diseases; complicated question of law and facts requiring elaborate evidence are involved due to which Civil Court is alone competent to decide the matter and that the complainant estopped by his act and conduct from filing the complaint, particularly when he has not approached the Forum with clean hands because of suppression of material facts. Admittedly, complainant was admitted in Medanta, The Medicity Global Health Pvt. Ltd. Sector 38, Gurgaon (Haryana). On her admission on 27.12.2013, she was diagnosed as a patient of  Paroxysmal Non Epileptic Seizures . Said hospital sent authorization request for cashless treatment to OP3, but denial of the same took place vide letter dated 31.03.2014 in view of the treatment of being of psychiatric and psychosomatic, which is not covered under terms and conditions of the policy. So earlier grant for Rs.20,000/- was withdrawn. Through that letter of 31.03.2014, it was further intimated that denial of cashless request is not denial of treatment or admissibility of the claim, but mention was made that complainant be informed that his claim will be considered for reimbursement on merits under terms and conditions of the policy. Complainant/insured/patient was requested to submit all the documents to OP3 after discharge from the hospital. Complainant after discharge from hospital of Smt. Sangeeta Jain, lodged claim with OP3 and after scrutinizing the documents placed in the claim file and after applying mind by the doctors, OP3 vide letter dated 11.04.2014 informed National Insurance Company that treatment with diagnose of paroxysmal non epileptic seizure is for psychiatric and psychosomatic illness/disorder, which is not covered under the policy owing to exclusionary clause 4.8 of the policy. After receipt of that letter, insurance company vide letter dated 23.05.2014 repudiated the claim. Wikipedia, the free encyclopedia cited for claiming that non epileptic seizures with paroxysmal events are caused either by psychiatric or psychosomatic conditions. Complainant has not challenged denial of cashless request and repudiation of the claim vide letter dated 23.05.2014 defended as justified by denying each and every other averment of the complaint except that of purchase of the policy in question and lodging of the claim. Prayer made for dismissal of the complaint. Moreover request made for calling upon complainant to supply the particulars of the insurance policies got by him in the past 20 years as alleged. Smt. Sangeeta Jain was never admitted for the treatment of the same disease for which she was admitted on 27.12.2013 in Medanta, The Medicity, Gurgaon. The disease for which earlier claims were settled were totally different than that of the disease for which claim repudiated vide letter dated 23.05.2014. As per record available with OP1 and OP2, Smt. Sangeeta Jain lodged claim under policy No.401603/48/12/8500000548 with diagnose of fibroid uterus for amount of Rs.28,527/-, but Rs.26,770/- were paid in full and final settlement of the claim Smt. Sangeeta Jain was never admitted for treatment of paroxysmal non epileptic seizures earlier.

6.                OP3 is exparte in this case.

7.                The complainant to prove his case, tendered in evidence his affidavit Ex. CW1/A along with documents Ex.C1 to Ex. C24 and thereafter, counsel for complainant closed evidence.

8.                On the other hand, counsel for OP1 and OP2 tendered in evidence affidavit Ex. RA of Sh. Ravinder K. Wadhavan, Senior Branch Manager of insurer; affidavit Ex. RB of Dr. A.K. Batra, Medical Director of OP3 along with documents Ex. R1 to Ex. R19 and Ex. R13/A and thereafter closed evidence.

9.                Written arguments submitted by OP1 and OP2, but not by complainant. Oral arguments also heard and record gone through minutely.

10.              An application for directing complainant to supply the mediclaim insurance policies purchased for the last 20 years even was filed and thereafter, another application for supply of the documents was filed. However that second application was disposed of vide order dated 04.02.2015 because counsel for OP1 and OP2 stated at bar that they have received the required documents from the complainant, so virtually so much of the documents as available with complainant qua the past 20 years of policy have been produced on record.  Ex. C1=Ex. R14 is the insurance cover note showing that hospitalization benefit policy was purchased by complainant for self and his mother Smt. Sangeeta Jain for period from 27.02.2013 to 26.02.2014. Admittedly, the request for cashless treatment under this policy was submitted and the same was disposed of vide letter Ex. R18 dated 31.03.2014 by OP3 by holding that earlier grant of Rs.20,000/- for treatment of Smt. Sangeeta Jain for period from 27.12.2013 to 28.12.2013 in Medanta, The Medicity Global Health Pvt. Ltd., Gurgaon stands withdrawn, but denial of cashless request be not treated as denial of treatment or admissibility of claim. Rather through Ex. R18, it was recommended that claim of insured for reimbursement will be decided on merits subsequently as per terms and conditions of the policy, but on submission of the documents by the insured after discharge from the hospital. It was in pursuance of this letter Ex.R18 that mediclaim was lodged by submitting the requisite documents as revealed by contents of Ex. C19 to Ex.C21 and Ex. R5, Ex.R6, but that claim was repudiated vide letter Ex. R1=Ex. C24, on the basis of recommendations of TPA submitted through documents Ex.R2, Ex. R3 or Ex. C24 and Ex. C23. Even cancelled cheque Ex. C22 along with other documents of treatment and expenses Ex. C12 to Ex. C18 or Ex. R3 and Ex. R7 to Ex. R13, Ex. R13/A; Ex. R16 and Ex. R17 were submitted.

11.              Denial of the submitted claim took place through Ex. R1=Ex. C24 on ground that treatment of Smt. Sangeeta Jain in Medanta, The Medicity Hospital, Gurgaon for period from 27.12.2013 to 28.12.2013 was for diagnose of paroxysmal non epileptic seizure, which is psychiatric and psychosomatic illness/disorder not covered by the terms of the policy in view of exclusionary clause 4.8 of the policy. Bone of contention remains as to whether treatment for this diagnose of paroxysmal non epileptic seizure is a psychiatric and psychosomatic illness/disorder or it is a neurological disorder.

12.              Certainly plethora of precedents cited at bar through written and oral arguments by counsel for OP1 and OP2, lays that terms of the policy of  insurance to be construed strictly because nothing can be added or subtracted thereto by giving different meaning to the words mentioned therein owing to contract of insurance binding on the parties. There is no dispute regarding this proposition of law laid down in cases Ind Swift Limited Vs New India Assurance Co. Ltd. and others  2012 (IV) CPJ 148 (NC); United India Insurance Co. Ltd. Vs Harchand Rai Chandan Lal  IV (2004) CPJ 15 (SC); New India Assurance Co. Ltd. & others Vs Deepak Anand III (2014) CPJ 373 (NC); National Insurance Co. Ltd. Vs Vinod Puri and another I (2014) CPJ 341 (NC). So certainly in deciding the controversy in question, we are to go by the terms and conditions of the contract of insurance arrived at between parties.

13.              Those terms and conditions of the insurance policy in question are produced on record as Ex. R15. After going through clause 4.8 of Ex.R15, it is made out that insurer not liable to reimburse the expenses incurred on any person in connection with or in respect of all psychiatric and psychosomatic disorder/disease. Smt. Sangeeta Jain got treatment for diagnosis of paroxysmal non epileptic seizures from Medanta Hospital is a fact borne from contents of Ex. R3 and Ex. R8. However that treatment was got from Neurologist is a fact borne from contents of Ex. R12, Ex. C13, Ex. C14 by paying amount of Rs.42,616.50P as revealed by the contents of Ex. C15 to Ex. C18 or Ex. R8 and Ex. R12. TPA obtained report Ex. R16 to the affect that treatment of diagnose of paroxysmal non epileptic seizures is a psychiatric and psychosomatic illness/disorder and it was on the basis of this report that claim of Rs.42,617/- was repudiated.

14.              Counsel for OP1 and OP2 relied upon affidavit Ex. RB of Dr. A.K. Batra, Medical Director of OP3 as well as on Ex. R4, Wikipedia (the free encyclopedia) for arguing that paroxysmal events with non epileptic seizure are caused by either psychiatric and psychosomatic conditions and as such, it is contended that exclusionary clause 4.8 contained in Ex. R15 is fully applicable. In report Ex. R16 of the TPA reason for arriving at the conclusion as to why the paroxysmal non epileptic seizure treated as psychiatric and psychosomatic illness/disorder is not at all mentioned. When this Ex. R16 does not mention the reasons for arriving at such conclusion, then certainly reliance on same cannot be placed, particularly when contents of Ex. R4 even are not true in view of the material gathered on search of Google internet  by this Forum. Hard copy of that Google internet search made as part of this file.

15.              As per search of Google internet in the opinion of authors Donald Olson, MD, “Early differentiation of epileptic from nonepileptic seizures is important. Clues that suggest epilepsy are a history of febrile seizure (particularly if prolonged), past brain injury from trauma or infection, and epilepsy in first-degree relatives. Nonepileptic events that can resemble epileptic seizures include night terror, benign sleep movements, breath holding spells, gastroesophageal reflux symptoms, syncope, and migraine. In addition, conversion disorders can manifest as psychogenic nonepileptic seizures. If the seizure events are reasonably frequent, a long-term electroencephalogram that records the habitual attacks helps provide diagnostic certainly.       It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with sudden flailing movements or unresponsive staring may, in fact, be experiencing psychogenic events. Other types of pathological spells, such as syncope and migraine, can also be mistaken for epileptic seizures. When epilepsy is incorrectly diagnosed in these patients, unnecessary seizure medications is likely to be prescribed, and correct diagnosis and treatment is delayed. It is also the case that epileptic seizures  can be subtle and difficult to recognize. Inattentive staring may be attributed to attention deficit disorder but may, in fact be due to either absence or complex partial seizures. An orderly approach to the differential diagnosis or paroxysmal events is the best way to avoid misdiagnosis. A careful, detailed history and physical examination supplemented by an electroencephalogram (EEG) will, in most cases, result in a correct diagnosis.”

16.              Further in this search of Google internet, it is found under head Nonepileptic events as under:-

                   “Nonepileptic seizures are behavioral events that resemble epileptic seizures but are not caused by abnormal, hypersynchronous neuronal discharges in the brain. The term “pseudoseizure” is discouraged, since the events themselves are real and disabling. Nonepileptic events can be caused by psychological disorders, or they can be manifestations of other pathological or physiological neurological conditions.”

17.              So a reading of the gathered material of Google internet search leads to the inference that detailed history and physical examination supplemented by EEG alone will result in correct diagnosis in most cases besides the above collected material of Google internet search leans in favour of holding that nonepileptic seizures are behavioral events, which may be caused by psychological disorders or they can be manifestations of other pathological or physiological neurological conditions. As Smt. Sangeeta Jain continued to be treated in neurology department of Medanta Hospital and no report of Medanta Hospital there to show that said Smt. Sangeeta Jain was treated for paroxysmal nonepileptic seizures on account of psychiatric and psychosomatic illness/disorder and as such, it was duty of TPA to exclude the possibility of sufferance of above said illness/disorder by Smt. Sangeeta Jain from the causes of physiological neurological or pathological conditions. Report Ex. R16 nowhere lays that EEG reports or the detailed history records  or earlier treatment of Smt. Sangeeta Jain were also considered for arriving at the conclusion that the ailment in question was psychiatric and psychosomatic illness/disorder and as such, this report Ex. R16 virtually has not taken into consideration all the factors which are required to be taken into consideration for finding as to whether the illness/disorder in question is psychiatric or it is manifestation of pathological  or physiological neurological conditions. Mention in EX. R16 even not made qua records/reports pertaining to VEEG and MRI, despite the fact that through certificate Ex. C12, it was made clear by the doctors of Medanta Hospital that for better management of situation Smt. Sangeeta Jain needed VEEG and MRI tests, which are possible only after admission in hospital. Discharge summary Ex.C13 makes mention as if Smt. Sangeeta Jain treated by consultant Dr. Sumit Singh, Neurology Consultant and even in Ex. C14 mention made that patient was admitted with history of past ailment under Neurology team, on account of the complaints of inability to move both hands or of inability to speak etc. as referred in Ex. R9.

18.              Contents of Ex. C14 establishes that MRI brain plain and MR  angio brain and neck was done  during treatment of Smt. Sangeeta Jain in Medanta Hospital from 27.12.2013 to 28.12.2013 and the study of test was normal one. Even overnight video EEG was done, which too revealed normal study. During hospital stay patient was treated conservatively and thereafter, was discharged with advise to obtain urgent care in case the problem like that of sudden numbness or weakness of the face etc. felt. All this is recorded in Ex. C14. Through Ex. C14 advise was given to contact neurology department again on contact number mentioned in Ex. C14. So entire record of this Ex. C14 shows that studies of EEG or of MRIs referred above were normal and if that be the position, then it was obligatory for doctors of TPA to mention the reasons in Ex. R16 as to why they arrived at conclusion that diagnosed symptoms were of psychiatric and psychosomatic illness/disorder. If Medanta Hospital through letter enclosed as Ex. R8 advised for follow up  review treatment in Psychiatric OPD after three weeks with prior appointment, then same does not establish that actually the treatment got during period from 27.12.2013 to 28.12.2013 was for psychiatric and psychosomatic illness/disorder. Rather contents of Annexure attached with Ex. R8 even establishes that treatment was got from Dr. Sumit Singh, a Neurologist. Psychiatric treatment is a treatment for mental disease, but neurology treatment is the treatment pertaining to nervous system of the body. Records of Medanta Hospital shows that owing to treatment of Smt. Sangeeta Jain in neurology department, she was treated for ailment of nervous system and not for treatment of any mental disease. It is well settled that as and when two views are possible, then one favouring the consumer to be followed because Consumer Protection Act is a consumer welfare legislation meant for protecting the interest of genuine consumers. In view of continuous neurological treatment got by Smt. Sangeeta Jain from Medanta Hospital and in absence of any report of mental ailment of Smt. Sangeeta Jain, it has to be held that repudiation of the claim owing to sufferance for psychiatric and psychosomatic illness/disorder is quite improper, particularly when Ex. R16 does not disclose the reason for arriving at the conclusion of psychiatric and psychosomatic illness/disorder and same does not exclude possibility of nonepileptic event as manifestations of pathological or physiological neurological conditions.

19.              Ex. R8 the discharge summary of Smt. Sangeeta Jain prepared by Medanta Hospital even shows that patient presented with history of sudden onset of numbness of both arms with clenching of teeth on 21.12.2013. Further in Ex. R8 in column of medical history itself it is mentioned that similar history existed on 19.12.2013. It is also mentioned in Ex. R8 itself that there was no history of the loss of consciousness, tongue bite and incontinence. Besides this history, study of MRI brain plain and MR angio brain and neck was found normal. In view of this normalcy of MRI and EEG study, it was obligatory on the part of TPA to find that the alleged manifestations not caused by pathological or physiological neurological conditions. That possibility not got excluded by making reference of the same in Ex. R16 and as such, repudiation of the claim is unjustified, owing to which ends of justice warrants that reconsideration of the claim should be done by Ops for finding from the records available with it as to whether treatment of Smt. Sangeeta Jain in Medanta Hospital during period from 27.12.2013 to 28.12.2013 was for the disorders/ailments manifested by pathological or physiological neurological condition or the same was exclusionary on account of psychiatric and psychosomatic illness/disorder. This is necessary because earlier too Smt. Sangeeta Jain got claim of Rs.6887/- for treatment of disease of right partial seizure, SEL LFT parietal lobe old papillary CA thyroid  (as revealed by the contents of Ex. C6 and Ex. C7), but of Rs.4723/- in 2006 for treatment of disease of K/C/O Thyroid (Post operated) with M/C/O Neurocy & Ticirosis left side with focal seizures with numbriess right side body (as revealed by contents of Ex. C8 and Ex. C9). Moreover contents of Ex. C10 shows that earlier Smt. Sangeeta Jain got treatment from Satguru Partap Singh Apollo Hospital during period from 11.04.2007 to 12.04.2007 because of her case being an old case of seizures with NCC & papillary carcinoma thyroid.  For this treatment of 11.04.2007 to 12.04.2007, Smt. Sangeeta Jain got medical claim of Rs.12,945/- as revealed by contents of Ex. C11. So this past record of ailments produced as Ex. C5 to Ex.C11 also shows that earlier too Smt. Sangeeta Jain suffered from neurological problems and that is why she has been getting treatment since from 2005. The earlier hospitalization benefit policies of period 27.02.2012 to 26.02.2013; 27.02.2011 to 26.02.2012; 27.02.2010 to 26.02.2011 are produced on record as Ex. C2 to Ex. C4 and as such, certainly the submissions advanced by counsel for complainant has force that neurological disease of Smt. Sangeeta Jain was known to Ops, but despite that the policy in question Ex. C1 was issued by them. Non production of past 20 years policies is not fatal to the case of the complainant because these old policies sometimes are not retained by the policy holder for lifetime after issue of new policy through cover note like Ex. C1 to Ex. C4. Even non production of copy of the earlier received claims immaterial, particularly when documents Ex. C5 to Ex. C11 are produced on the record to show the kind of the treatment earlier got by Smt. Sangeeta Jain and the amounts of the reimbursements received by her of treatment during period from 2005 to 2007. If medicine for one year stopped by Smt. Sangeeta Jain as revealed by contents of Ex. R7, then it does not mean that her ailment became incurable. Rather for better management of the situation VEEG and MRI tests were prescribed and those were got conducted as revealed by contents of Ex. R8. Question involved is not qua proliferation of the ailment from which Smt. Sangeeta Jain suffered, rather the question involved is as to whether illness/disorder is psychiatric and psychosomatic or on account of pathological or physiological neurological conditions. That question has not been determined by TPA properly as discussed above and as such, complainant suffered mental harassment and agony due to repudiation of his claim.

20.              As a sequel of above discussion, complaint allowed in terms that OP3 will constitute a board of doctors consisting of three doctors at least including neurologist, psychiatrist  and pathologist for reexamining the matter as to whether treatment of ailment in question got by Smt. Sangeeta Jain from Medanta Hospital during period from 27.12.2013 to 28.12.2013 was a treatment for the ailment of psychiatric and psychosomatic illness/disorder or the paroxysmal nonepileptic event was manifestation of pathological or physiological neurological conditions alone. In case the board of doctors by majority finds that the said ailment was on account of manifestation of pathological or physiological neurological conditions, then OP1 and OP2 will not repudiate the claim, but will pay the amount within 30 days from the date of receipt of report of board of doctors. However, in case said board of doctors by majority decision opines that the said ailment was for treatment of psychiatric and psychosomatic disorder/disease, then claim may be repudiated by OP1 and OP2 again. OP3 will constitute the board of doctors referred above at the earliest, so that the opinion of this board of doctors is obtained within 30 days from the date of receipt of copy of order by OP3. Said board of doctors will reexamine the entire available records of treatment of Smt. Sangeeta Jain in Medanta Hospital and thereafter will give reasons for arriving at its conclusions. Copy of that report by the board of doctors will be made available by OP3 to complainant within 30 days from the date of receipt of same by it and this report will be forwarded by OP3 to OP1 and OP2 or any of them within 7 days from the date of receipt of the same, so that OP1 and OP2 may give final verdict regarding repudiation or reimbursement of the submitted claim within 60 days from the date of receipt of copy of this report. Compensation for mental harassment of Rs.5,000/- (Rupees Five Thousand only) and litigation expenses of Rs.2,000/- (Rupees Two Thousand only) more allowed in favour of complainant and against Ops, whose liability for paying these amounts held as joint and several. Payment of these amounts of compensation and litigation expenses be made within 30 days from the date of receipt of copy of order. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

                                       (Param Jit Singh Bewli)                    (G.K. Dhir)

                                       Member                                            President

Announced in Open Forum.

Dated:29.12.2016.

Gobind Ram.