Date of Filing:18.03.2008<br /> Date of Order:30.05.2008<br /> <br /> <br /> <br /> BEFORE THE II ADDITIONAL DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SESHADRIPURAM BANGALORE-20<br /> Dated: 30TH DAY OF MAY 2008<br /> PRESENT<br /> <br /> <br /> <br /> Sri. S.S. NAGARALE, B.A, LL.B. (SPL.), President.<br /> Smt. D. LEELAVATHI, M.A.LL.B, Member.<br /> Sri. BALAKRISHNA. V. MASALI, B.A, LL.B. (SPL.), Member.<br /> <br /> <br /> <br /> COMPLAINT NO: 727 OF 2008<br /> <br /> S. Eshwaran,<br /> S/o Submramani,<br /> No.198, Shivaganga Building,<br /> 11th Cross, 4th Block,<br /> Peenya, Bangalore-58. Complainant<br /> <br /> <br /> V/S<br /> The Branch Manager,<br /> Genins India Ltd.,<br /> 898, I Floor, A.T & T Complex,<br /> 80 feet road, Koramangala,<br /> Bangalore-560 095. Opposite Party<br /> <br /> <br /> ORDER<br /> By the President Sri. S.S. Nagarale<br /> <br /> This is a complaint filed by the complainant to reimburse amount of Rs.34,876/-.<br /> The facts of the case are that, the complainant is the Insurance Card Holder. He has received the above said cards for himself and his family members from the company where he was employed, which are valid up to 22/12/2007. His daughter Pushpalatha was admitted to Sarojini Hospital, Bangalore for delivery. He submitted the bills amounting to Rs. 11,628/- to his company but they have refused to entertain the bills submitted by him on the ground that no reimbursement will be made for delivery cases, as per the rules of the company. The company asked him to get the treatment, submit the bills and obtain reimbursement of the same. He was also admitted to the same Hospital for treatment of left Hydrosols for Surgical treatment. The complainant obtained doctor’s report and also the medical bills for having taken the treatment, amounting to Rs.13,457/-. Since he has not presented the bills for reimbursement within the stipulated period, he told by the opposite party that he has not eligible for the same. On 8/12/2007 the complainant has taken treatment for himself and obtained the medical bills and the doctor’s report the amount incurred by him for purchase of medicines comes to Rs. 6,555/- for treatment of Right Renal Cal cull at Premier Sanjeevini Hospital, Bangalore, but he has not received the said amount due to negligence and defective service on the part of the opposite party. The wife of complainant Smt. K. Gowri was treated at Ravi Kirloskar Hospital, Bangalore for treatment of her eyes. But the medicals incurred by him amounting to Rs.3,236/-, but so far no amount has been received by him in this behalf. Hence, the complaint.<br /> <br /> 2. Notice was issued to opposite party. In spite of service of notice opposite party has not appeared and contested the matter and placed exparte. <br /> 3. Affidavit evidence of complainant filed. Arguments heard. <br /> <br /> REASONS<br /> <br /> 4. The complainant has filed affidavit evidence. Perused the affidavit and documents. Heard the complainant in person. It is the case of the complainant that he and his family members are insurance card holders. He had received the insurance cards when he was working in a private company. As per the case of the complainant the insurance cards were valid up to 22/11/2007. His daughter Puspalatha was admitted to hospital and he has submitted bills amounting to Rs.11,628/- and the complainant was also admitted to hospital for treatment. He had medical bills for having taken treatment and got bills of Rs.13,457/-. He submitted that, he could not get the reimbursement because he has not submitted the bills within stipulated period. His wife Smt. Gowri also taken treatment at Ravi Kirloskar Memorial Hospital and he had incurred expenses of Rs.3,236/-. This amount was also not received from the opposite party. The case made out by the complainant has gone unchallenged. The opposite party has not appeared and contested the matter though served with notice. Therefore, the complainant case has to be accepted as true. The opposite party must be directed to allow the medical claim of complainant and his family members as per the bills submitted by him. Since the complainant and his family members are insurance card holders the complainant is entitled for reimbursement of the amount spent for the treatment of himself, his wife and daughter. The direction requires to be issued to the opposite party to look into the matter and if there is any delay in submitting the medical claim the delay shall be condoned and the admissible claim should be allowed and amount be paid to the complainant. Since the Consumer Protection Act is enacted to safeguard the better interest of the consumers. In this case the complainant who has approached this Forum with his grievances and he has produced supporting documents and bills and other medical papers and hospital records. The complainant has to submit all the bills and hospital records and documents before the opposite party and the opposite party shall reimburse the amount spent by the complainant towards the medical treatment. In the result, I proceed to pass the following:-<br /> ORDER<br /> <br /> 5. The complaint is allowed. The opposite party is directed to allow the medical claim and reimburse the admissible claim to the complainant in respect of the medical expenses of complainant, his wife and daughter. The complainant is directed to submit claim form for reimbursement along with the necessary documents and bills to the opposite party. The opposite party is directed to settle the claim within 30 days from the date of communication of this order. <br /> 6. Office is directed to return all the documents and bills to the complainant, produced by him in this file. <br /> 7. Send the copy of this Order to both the parties free of costs immediately. <br /> <br /> 8. Pronounced in the Open Forum on this 30TH DAY OF MAY 2008.<br /> <br /> Order accordingly,<br /> <br /> PRESIDENT<br /> We concur the above findings. <br /> <br /> MEMBER MEMBER <br /> <br /> <br /> <br /> <br />