Punjab

Sangrur

EA/135/2017

Jasvir Kaur - Complainant(s)

Versus

Star Health and Allied Ins.Co.Ltd. - Opp.Party(s)

Sh.S.S.Dhindsa

15 Jan 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

               

                                               

                                                EA  No.             135

                                                Instituted on:      29.09.2017

                                                Decided on:       15.01.2018

 

 

Jasvir Kaur wife of Amar Singh, R/O H.No. 84, Ward No.5, Tehsil Lehra and District Sangrur.

                                                        …Complainant.

                                Versus

1.             Star Health and Allied Insurance Company Limited No.1, New Tank Street, Valluvarkottam High Road, Nungambakkam, Chennai through its Managing Director.

2.             Star Health and Allied Insurance Company Limited, SCO 70, 2^nd Floor, Opp. Tata Indicom, New Leela Bhawan, Patiala 147001 through its Branch Manager. 

                                                        …Opposite parties

 

For the complainant    :       Shri S.S.Dhindsa, Advocate.

For OP/JDs               :       Shri Rohit Jain, Advocate.

 

 

Quorum:    Sukhpal Singh Gill, President

                Sarita Garg,   Member

                Vinod Kumar Gulati, Member

 

 

Order by : Sukhpal Singh Gill, President:

 

1                      Smt. Jasvir Kaur, complainant/DH (referred to as complainant in short) had earlier filed a complaint number 1428 dated 4.11.2015, which was decided by this Forum on 15.7.2016, whereby this Forum directed the Ops to reimburse a sum of Rs.6340/- to the complainant and to provide the complainant cash less authorization for her knee joints as per the policy. Further the OPs were directed to pay a sum of Rs.10,000/- being amount of compensation for mental tension and agony and a sum of Rs.5000/- being litigation expenses.  Further case of the complainant is that the JDs have already complied with the order by paying the amount of Rs.21,340/- and the remaining part of the order has not been complied with and have refused to provide the cashless authorisation for the treatment of her knee joints. As such, the complainant has prayed that the OP/JDs be punished with sentence and fine for not providing the cashless authorisation of the knee joints of the complainant.

 

2.             In reply to the execution application, preliminary objections are taken up on the grounds ground the complainant has no locus standi to file the present application and that the complainant has not come to the Forum with clean hands. On merits, it is admitted that the amount of Rs.21,340/- has already been paid to the DH, but the other allegations levelled in the application have been denied.  It is stated that after passing of the order dated 15.7.2016, the complainant never applied for cashless authorisation nor the OPs received any letter or request from the hospital. The other allegations levelled in the execution application have been denied in toto.

 

3.             We have carefully perused the execution application as well as reply to the application and heard the arguments of the learned counsel for the parties. In our opinion, the execution application merits dismissal, for these reasons.

 

4.             It is an admitted fact between the parties that the OP/JDs have already paid to the complainant/DH an amount of Rs.21,340/- as directed by this Forum in its order dated 15.07.2016. Now, the learned counsel for the complainant/DH has contended vehemently that the OP/JDs have failed to provide the complainant cash less authorisation for her knee joints as per the order of the Forum, but we are unable to accept such a  contention of the learned counsel for the DH, as there is nothing on record to show that when the DH  approached any hospital for treatment or approached the Op/JD for any authorisation.  Further there is nothing on record to support the contention regarding denial of cash less authorisation by the Ops to the complainant/DH.  As such, we feel that the complainant/DH has miserably failed to establish his case by producing cogent, reliable and trustworthy evidence on record.  Accordingly, we are of the considered opinion that the execution application of the complainant deserves dismissal. 

 

5.             Accordingly, we dismiss the execution application of the complainant/DH. However, no order as to costs.  A copy of this order be issued to the parties free of cost. File be consigned to records.

 

                Pronounced.

                January 15, 2018.

 

                                                        (Sukhpal Singh Gill)

                                                                President

                                                                               

                                                                                       

                                                                (Sarita Garg)

                                                                   Member

 

 

 

                                                          (Vinod Kumar Gulati)

                                                                     Member