Orissa

Cuttak

CC/112/2022

Atma Ranjan Dash - Complainant(s)

Versus

Propriertor,Niva Bupa Health Insurance Co Ltd - Opp.Party(s)

J R Dash & associates

29 Aug 2023

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL COMMISSION,CUTTACK.

C.C.No.112/2022

          Atma Ranjan Dash,

           S/o: Jiban Ranjan Dash,

           At:Chahata Nagar,Lane-4,

           P.O:Markat Nagar(Avinaba Bidanasi),

           Dist:Cuttack.                                                             ... Complainant.

 

          Vrs.

 

1.      Niva Bupa Health Insurance Company Limited,

(Formerly known Max Bupa Health Insurance Company Limited),

(IRDA Registration 145,

Regd. Office-C-98,First Floor,

Lajpat Nagar,Part-1,New Delhi-110024,

Represented through Proprietor.

 

2.     Assistant Manager,

Grievance Redressal Team,

Niva Bupa Health Insurance Company Limited,

Formerly known Max Bupa Health Insurance Company Limited),

2^nd Floor,Logix Infotech Park, Plot No.D-5,

Sector-59,Noida-201309.                                               ....Opp. Parties.                                   

 

 

Present:         Sri Debasish Nayak,President.

                      Sri Sibananda Mohanty,Member.

 

Date of filing:   10.06.2022

Date of Order:  29.08.2023

 

For the complainant:           Mr. J.R.Dash,Adv. & Associates.

For the O.Ps              :                     None.              

           

Sri Debasish Nayak,President.                              

Case of the complainant as made out from the complaint petition in short is that he had obtained one Health Insurance Policy bearing no.31281369202101 from the O.Ps which had cashless provision.  He was hospitalised on 21.12.2021 and was discharged on 26.12.2021.  The total medical expenses were of Rs.1,64,038/-.  The complainant had made his claim bearing no.83075 but surprisingly, only a sum of Rs.81,737/- was approved by the O.Ps and the rest of the amount was not paid.  The complainant after trying to contact the O.Ps had sent pleader’s notice to them and ultimately had to approach before this Commission seeking the balance amount of his medical expenses of Rs.75,000- together with a sum of Rs.10,00,000/- towards his mental agony, another sum of Rs.2,00,000/- towards deficiency in service and further a sum of Rs.25,000/- towards his litigation expenses from the O.Ps.  He has also prayed for any other relief as deemed fit and proper.

          Alongwith his complaint petition, the complainant has filed copies of several documents in order to prove his case.

2.       Having not preferred to contest this case, the O.Ps were set exparte vide order dtd.21.9.2022.

3.       The points for determination in this case are as follows:

i.          Whether the case of the complainant is maintainable?

ii.         Whether there was any deficiency in service on the part of the O.Ps?

iii.        Whether the complainant is entitled to the reliefs as claimed by him?

Point no.ii.

Out of the three points, point no.ii  being the pertinent one, is taken up  first for consideration here in this case.

After perusing the contents of the complaint petition as filed by the complainant and copies of documents as annexed to the complaint petition, it is noticed that as per the complaint petition, the complainant was hospitalised with effect from 21.12.2021 and he was discharged on 26.12.2021 but the reason of such hospitalisation is not mentioned clearly.  After perusing the copies of correspondences alongwith the complaint petition, it is noticed that it seems that the complainant was suffering from Covid-19 positive.  He has mentioned that the total expenses towards his treatment was of Rs.1,64,038/- but his complaint petition lacks any such cogent evidence to that effect.  It is because no money receipt, medicine bill, admission into Hospital and discharge certificate, hospitalisation charges etc are categorically mentioned nor there are any proper documents to that effect.  The complainant alleges that only a sum of Rs.81,737/- was approved in his favour but there is no document to that effect also.  Thus, this Commission is unable to arrive at any finding in absence of any complete documentary evidences in order to conclude that infact there was deficiency in service on the part of the O.Ps of this case.  Accordingly, this issue is answered.

 

Points No.i & iii.

          From the discussions as made above, the case of the complainant is not maintainable and the complainant is not entitled to any of the reliefs as claimed by him.

                                                          ORDER

          Case is dismissed on contest against the O.Ps and as regards to the facts and circumstances of the case without any cost.

Order pronounced in the open court on the 29^th day of August,2023 under the seal and signature of this Commission.         

                                                                                                                                                                                            

                                                                                  Sri Debasish Nayak

                                                                                             President

 

                                                                                        Sri Sibananda Mohanty

                                                                                                  Member