Delhi

East Delhi

CC/146/2016

ASHOK KUMAR - Complainant(s)

Versus

STAR HEALTH - Opp.Party(s)

23 Aug 2016

ORDER

Present : Counsel for the Complainant.

 

Complainant Shri Ashok Kumar Luthra was having a Medi Claim insurance policy bearing no. P/161112/01/2015 with M/s Star Health and Allied Insurance Co. Ltd., Chennai (OP-1) and M/s. Star Health and Allied Insurance Co. Ltd., Vaishali (OP-2).  During the cover of the policy, he got his treatment from M/s. Max Super Specialty Hospital, Patparganj, New Delhi (OP-3), where he paid an amount of Rs. 2,50,000/- for his treatment as cashless treatment was denied by M/s Star Health and Allied Insurance Co. Ltd., Chennai (OP-1) and M/s. Star Health and Allied Insurance Co. Ltd., Vaishali (OP-2), which was informed to M/s. Max Super Specialty Hospital, Patparganj, New Delhi (OP-3). 

Counsel for the complainant has argued that though the complainant was denied cashless treatment in spite of his having not filed the claim with M/s Star Health and Allied Insurance Co. Ltd., Chennai (OP-1) and M/s. Star Health and Allied Insurance Co. Ltd., Vaishali (OP-2), this amounts to repudiation of his claim.  If the whole complaint is perused in para 11 of the complaint, he has stated: “That the cause of action for filing the present complaint arises when the repudiation letter of the claim was sent to Max Hospital and the cause of action is a continuing cause of action as the claim of the complainant has not been settled till date”.    From this, it is noticed that the complainant has not filed the claim with M/s Star Health and Allied Insurance Co. Ltd., Chennai (OP-1) and M/s. Star Health and Allied Insurance Co. Ltd., Vaishali (OP-2).  The claim has not been repudiated but only cashless treatment has been denied which was informed to M/s. Max Super Specialty Hospital, Patparganj, New Delhi (OP-3).  Denial of cashless treatment has informed to M/s. Max Super Specialty Hospital, Patparganj, New Delhi (OP-3) does not amount to repudiation of his claim by M/s Star Health and Allied Insurance Co. Ltd., Chennai (OP-1) and M/s. Star Health and Allied Insurance Co. Ltd., Vaishali (OP-2) as the complainant Shri Ashok Kumar Luthra has not filed any claim with them. 

            The fact that the complainant has not filed any claim with M/s Star Health and Allied Insurance Co. Ltd., Chennai (OP-1) and M/s. Star Health and Allied Insurance Co. Ltd., Vaishali (OP-2).  No cause of action has arisen in his favour to file the complaint. 

In view of the above, we are of the opinion that the complaint of Shri Ashok Kumar Luthra against M/s Star Health and Allied Insurance Co. Ltd., Chennai (OP-1), M/s. Star Health and Allied Insurance Co. Ltd., Vaishali (OP-2) and  M/s. Max Super Specialty Hospital, Patparganj, New Delhi (OP-3)  cannot be admitted as no cause of action has arisen in his favour.  Hence, the complaint is dismissed.  There is no order as to cost.

 File be consigned to Record Room.

 

DR P.N.TIWARI     HARPREET KAUR CHARYA   SUKHDEV SINGH 

    MEMBER                           MEMBER                          PRESIDENT