Jharkhand

Bokaro

CC/17/1

Indu Bala - Complainant(s)

Versus

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

Ram Babu Sharma

26 Dec 2022

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-04-01-2017

Date of final hearing-26-12-2022

 Date of Order-26-12-2022

Case No. 01/2017

Indu Bala W/o Late Rajeshwar Singh

R/o- Qr.No. 2198, Sector-12/D, Bokaro Steel City,

P.O. & P.S.- Sector-12,  Disrict- Bokaro, Jharkhand

Vs.

1. The Director/Manager

    E-Mediteck (TPA) Service Limited

   Plot No. 577, Udyog Vihar, Phase-V, Gurgaon, Haryana-122016

2.  Smt. Nanda Priyadarshi, Manager

    Final Settlement, Deptt.

    Bokaro Steel Plant, Bokaro Steel City.

3. M/s United India Insurance Co. Ltd.

    City Centre, Sector-4, Bokaro Steel City,

   P.O. & P.S.- Sector-4, District- Bokaro, Jharkhand.

                             Present:-

                             Shri Jai Prakash Narayan Pandey, President

        Shri Bhawani Prasad Lal Das, 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. 36,488/- with 18% per annum interest on account of medical expense incurred during treatment of complainant  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. 04728143 for himself which was valid at the relevant time. Further case is that due to illness husband of the complainant got himself admitted in Bokaro General Hospital on 27.10.2015 and discharged on 30.10.2015 from the hospital for which Rs. 6588/- was paid in treatment by the husband of the complainant. Further he was admitted in the same hospital on 18.02.2016 and discharged on 22.04.2016 during which period he paid Rs. 1,29,891.50/-. Later on he died on 14.05.2016. Further case is that   complainant applied for reimbursement of the above amounts Rs. 6588/- and Rs. 1,29,891.50/- separately from which only Rs. 99,991/- of second claim was settled and total Rs. 36488/- has not been paid 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. 2 SAIL/ BSL Bokaro appeared and filed W.S. mentioning therein that this O.P. is having no liability to pay the claim amount.
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. has paid Rs. 99,991/- from Rs. 1,29,891/- as it was admissible in respect to claim related to hospitalization from 18.02.2016 to 22.04.2016 and for the same period the applicant has claimed Rs. 29,900/- for which this O.P. is not liable to pay and so far other claim is concerned it is not related to the complainant.
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 reply of the O.P. Insurance co. it is very much clear that no ground shown in the W.S. regarding rejection of the partial claim related to Rs. 29,900/-. It is admitted fact that for the hospitalization period from 18.02.2016 to 22.04.2016 claim of the complainant was admissible and Rs. 99,991/- has already been paid but claim for Rs. 29,900/- has not been considered. There is no justification given by the O.P. regarding refusal of part of the claim of same period.
8. So far, first claim is concerned photo copy of receipt related to claim No. 100111501624 is annexure-1 and it is related to Rs. 6588/- received in the office of O.P. and its claim form was submitted in time. Photo copy of claim form is annexure-2. On careful perusal of the contents of the W.S. it appears that there is some confusing facts related to claim number etc. which is not in accordance with the papers submitted by the parties. Therefore, we are of the view that complainant is able to prove its case for grant of relief, accordingly there is deficiency in service by the O.Ps.

 

8. Accordingly prayer of the complainant is being allowed in the following manner:-

         O.P. No. 3 M/s United India Insurance Co. Ltd. Is directed to pay Rs. 36,488/- to the complainant within 60 days from receipt/production of the copy of this Judgment, failing which he will pay interest @ 10% per annum  on that very amount from 04.01.2017 (i.e. the date on which case was filed). Further this O.P. No.3 is directed to pay Rs. 5000/- compensation and Rs. 5000/- as litigation cost within above mentioned period.

 

J.P.N. Pandey)

                                                                                      President

                                                                                     

         

    (B.P.L Das)

   Sr. Member