CONSUMER DISPUTES REDRESSAL FORUM – X
GOVERNMENT OF N.C.T. OF DELHI
Udyog Sadan, C – 22 & 23, Institutional Area
(Behind Qutub Hotel)
New Delhi – 110 016
Case No.554/12
Shri Nitin Kumar,
S/o Sh. Sanjeev Kumar,
R/o 467, Laxmi Bai Nagar,
New Delhi-110023. ………. Complainant
Vs.
- National Insurance Company
301-304, sahyog,
Nehru Place,
New Delhi-110019.
- M/s Paramount Health Services (TPA) pvt.Ltd
D-39, Okhla Industrial Area, Phase-1,
New Delhi-110020 …………..Respondents
Date of Order: 21.07.2016
O R D E R
Ritu Garodia-Member
Briefly stated, that the facts of complaint are that a medi claim policy no.NANO1-20330918CLTHE was purchased from OP for a period from 22.01.2011 to 21.01.2012. The complainant suffered some dizziness and congestion and was subsequently, hospitalized in Moolchand Hospital on 09.10.2011. A bill of Rs.34,136/- was raised by the hospital which is annexed at page 16 of complaint. Complainant filed a claim which was subsequently, repudiated by OPs letter dated 1.11.2011. It was stated that patient has undergone extensive investigation and received no active treatment and as such the claim is rejected.
OP2 was proceeded ex-parte on 02.08.13. OP1 was proceeded ex-parte on 10.10.2013. However, OP1 filed an application on 09.03.2015, stating that OP has made the payment Of Rs.32,761/- on 24.09.2014. They have attached the proof of
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payment into complainant’s account. Complainant in his reply has admitted to receiving the sum of Rs.32,761/-. OP refused to pay Rs.125/- as miscellaneous charge and Rs.1,250/- as blood glucose chart was not attached with the bill.
Perusal of bills paid to hospital dated 13.10.2011 reveals that Rs.34,136/- were received by the hospital from the complainant on account of hospitalization. The graphically detailed bills demonstrate different charges levied by the hospital for various medical expenses. The bill shows Rs.1250/- as room procedures charges and Rs.125/- as miscellaneous charges. The contention of OP that the blood glucose chart is not attached is bereft of merit. It is the bounden duty of OP to pay the complete hospitalization expenses of medical policy holders. Therefore, the deductions by OPs are wholly misconceived and untenable. Further the claim was filed on 14.10.2011, the complaint was filed on 26.11.2012 and the claim amount was paid only on 24.09.2014.
OP cannot shun its own liability of paying the complete claim on time. We therefore hold OP guilty of deficiency in service and direct it to pay Rs. 1475/- (Rs.1250/- + Rs.25/-) with 9% interest from date of claim till payment. We also direct OP to pay Rs. 5,000/- as compensation for harassment caused to complainant and Rs.3,000/- for litigation expenses.
Let the order to be complied within one month of the receipt thereof. The complaint stands disposed of accordingly.
(D.R TAMTA) (RITU GARODIA) (A.S YADAV)
MEMBER MEMBER PRESIDENT
