14-05-2014  :    Today is fixed for hearing of the maintainability petition filed by the OP.  Ld. Lawyers of both the parties are present.  Objection is also filed by the complainant against maintainability petition as filed by the OP on 28-04-2014.  Heard Ld. Lawyers of both the parties considered the maintainability petition including objection and after considering the materials of the complaint including the maintainability petition as filed by the OP one Sunita Daga as a mediclaim policy holder under the OP and that daughter of Sunita Daga, Diksha Daga was also covered by the insurance policy no.53090034120100000064 and said Diksha Daga was treated at Devine Nursing Home under cashless facility and went home after treatment but Sunita Daga and Diksha Daga did not lodged any complaint or claim against the OP but the present complaint is filed by the doctor of the said Nursing Home against insurance company claiming that he treated said patient Diksha Daga and as per cashless benefit he is entitled to get such amount as fee.  So, apparently it is found that the consumer of the OP i.e. Sunita Daga and Diksha Daga who has not availed of any claim for reimbursement of the amount or etc. and doctor of the hospital who is the service provider to the patient filed this complaint against the present insurance company which is no doubt not maintainable in the eye of law because this doctor is not a consumer to the OPs but complainant can claim said amount from the patient who had not paid it or the consumer Sunita Daga or Diksha Daga ought to have filed a complaint before this Forum against OPs for non-disbursement of the cashless benefit so in the above situation we have gathered that the present complainant is not a consumer to the OP but it is found that in the meantime OP issued cheque to the complainant in respect of cashless benefit of Diksha Daga but complainants did not receive it but after proper evaluation of the entire materials it is found that the doctor who is the service provider to the patient Diksha Daga is not at all the consumer under the OP and, in fact, as per provision of the C.P. Act, the present complainant’s status is service provider and if the patient has not paid the fees of the doctor in that case doctor has a scope to appear before Civil Court for realization of his fee  but present complainant is not maintainable against the insurance company when the present complainant’s claim has not on the basis of any insurance policy issued in favour of the complainant.  In view of the above findings and materials present complaint is found not maintainable as complainant is found not a consumer under the OP.

          Accordingly, the maintainability petition as filed by the OP on 28-04-2014 bears merit and succeeds accordingly.

          Hence,

Ordered

That the maintainability petition be and the same is allowed on contest without any cost against the complainant.  Accordingly it is further ordered that the complainant is not a consumer for which the present compliant is not maintainable in the eye of law and the complaint is dismissed on contest.

          However, the OP already issued a cheque for payment to Divine Nursing Home and doctor etc. and considering that fact OPs are directed if the said cheques are refused by the present complainant, to reissue the same to the complainant with same amount and disposed of the matter with the complainant and Divine Nursing Home.