Jharkhand

Bokaro

CC/17/86

Puthu Devi - Complainant(s)

Versus

The E- Meditek (TPA) Services Ltd. - Opp.Party(s)

Annu Mishra

28 Dec 2022

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-26-05-2017

Date of final hearing-28-12-2022

 Date of Order-28-12-2022

Case No. 86/2017

Puthu Devi W/O Late Fanindra Mahto

R/o  Vill- Solagidih, P.O.- Jodhadih More, P.S. Chas, District- Bokaro

Vs.

1. The Manger, E-Meditek,

Plot No.- 577, Udyog Vihar, Phase-5, Gurgaon, Haryana,

2. The E- Meditek (TPA), Service Pvt. Ltd.

Plot No.- HD-11, Sector-04, Bokaro Steel City, District- Bokaro

3. The Manager United India Insurance Co. Ltd.

Divisional Office, Sector-04, Bokaro Steel City, District Bokaro

                             Present:-

                             Shri Jai Prakash Narayan Pandey, President

                   Smt. Baby Kumari, Member

 

PER- J.P.N Pandey, President

 

-Judgment-

1. Both parties are absent. None turned up on behalf of any of the parties on repeated call. It reveals from the record that this case is pending at the stage of argument in which complainant is absent since long.  Hence as per provision of Section 38 (3) (c ) Consumer Protection Act. 2019 case has been taken up for decision on merit on the basis of materials available on record.

 

2. Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 38,748/- with 18% per annum interest on account of medical expense incurred during treatment of her husband and to pay Rs. 25,000/-  as compensation and Rs. 10,000/- as litigation cost.
3. Complainant’s case in brief is that her husband was retired SAIL, BSL employee and as per policy of the company he opted for Mediclaim policy and was provided MIN No. 4736432 for himself which was valid at the relevant time. Further case is that due to illness husband of the complainant got himself admitted in Saroj Gupta Cancer Centre & Research Institute, Kolkata on 21.01.2016 and discharged on 24.01.2016 from the hospital  and again he was admitted in said hospital on 04.02.2016 and discharged on 08.02.2016 for which total Rs. 39748/- was paid for treatment by the husband of the complainant. Later on he died on 04.07.2016. Further case is that   complainant applied for reimbursement of the above amount but inspite of repeated requests no action was taken by the O.Ps.  Thereafter legal notice was served having no impact. Hence this case has been filed with above mentioned prayer. 

 

4.   O.P. No. 1 & 2 TPA appeared and filed W.S. mentioning therein that inspite of repeated requests for filing of documents like X-ray film, IPD papers, Treatment papers, detail of treatment etc it was not provided by the complainant. Further reply is that complainant was directed to provide the justification of delay in intimation of claim and also to provide discharge summary with diagnosis but it was not provided hence in absence of papers the claim was closed as no claim.

 

5. On behalf of O.P. No.3 (United India Insurance Co.) W.S. has been filed in which it is mentioned that this O.P. is having no role in processing of the claim rather it is being processed by the TPA to whom required papers have not been submitted by the complainant nor intimation of the hospitalization was made within prescribed period hence claim has been closed.
6. On the basis of above pleadings we have to see whether complainant is entitled to get relief as claimed or not?
7. On careful perusal of the materials available on record it is apparent that complainant has not provided discharge summary related to admission of her husband in the hospital from 21.01.2016 to 24.01.2016. Payment receipts have also not been filed to show actual payment made to the hospital. Details related to payment made to the hospital have also not been provided. It is apparent from reply of O.Ps. that for want of papers claim has been closed as no claim. Here before this Commission also supportive papers related to the claim have not been produced by the complainant. Therefore, in light of above discussion we are of the view that O.Ps. have rightly closed the claim for want of papers which were demanded from the complainant by the O.Ps.  and those papers have also not been filed in this case. In this way complainant has failed to prove the case related to deficiency in service by the O.Ps.
8. Accordingly this case is dismissed with cost.

 

(J.P.N. Pandey)

                                                                                      President

                                                                                               

 

 

                                                                               (Baby Kumari)

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