Jharkhand

Bokaro

CC/20/2020

Mahesh Prasad Ram - Complainant(s)

Versus

The Executive Chief/Director Md. India Health Insurance TPA Pvt. Ltd. - Opp.Party(s)

S.K. Jha

04 Jun 2022

ORDER

District Consumer Commission, Bokaro.

Case No. 20/2020

 Date of Filing-18-03-2022

 Date of Order-04-06-2022

Mahesh Prasad Ram, S/o Late Ganga Ram

R/o Qr.No. 3233, St-8, Sector-4/E,

Bokaro Steel City, District- Bokaro, Jharkhand.

                                      Vr.

1. The Executive Chief/Director Md. India Health Insurance TPA Pvt. Ltd. Registered Head Officer At S.NO. 46/1, E-Space, A-2 wing, 3^rd Floor, Pune Nagar Road, Vaduon Sheri, Pune-411014

 2. The Br. Manager/ Chief Branch Manager, Md. India Health Insurance TPA Pvt Ltd. Sector-1, Near B.S.City Thana, Quality Circle, Bokaro Steel City, Bokaro, Jharkhand, 827001

 3. The Divisional Manager, The New India Assurance Co. Ltd. Bokaro Division, Sector-4, City Centre, Bokaro.

4. Director In-charge, B.S.L. Adm. Building, Bokaro Steel City, Bokaro.

Present:-

          Shri Jai Prakash Narayan Pandey, President

             Shri Bhawani Prasad Lal Das, Member

            Smt. Baby Kumari, Member

                                                -Order-

1.   Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 2,00,640/- on account of medical expense incurred during treatment of complainant  and to pay Rs. 50,000/-  as compensation.
2.   Complainant’s case in brief is that he is retired SAIL, BSL employee and as per policy of the company he opted for Mediclaim policy vide MIN No. 4736552 for himself valid from 11.07.2019 to 10.07.2020. During the enforcement of the insurance policy the complainant became ill and he was firstly  admitted  in BGH Bokaro from where he was referred to Mission Hospital, Durgapur for treatment where he was admitted on 02.08.2019 and discharged on 08.08.2019 during that very period Rs. 2,00,640/- was paid to the Hospital. Complainant applied for reimbursement of the said 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.
3.     Inspite of due service of notice O.P. No.1 & 2 have not appeared and have not filed W.S. Hence case has been proceeded against them Ex-parte.
4.    O.P. No.3 appeared and has filed W.S. mentioning therein that the complainant has not provided Bar Code Sticker of the stent and invoice related to its purchase hence claim has been closed for want of those articles. During argument it was submitted by the Learned Counsel for the Insurance Co. that they will consider the claim on receipt of Bar Code Sticker and invoice related to its purchase because claim has not been repudiated rather it has been closed for want of above mentioned articles.
5.    During argument Learned Counsel for the complainant has submitted that original Bar Code Sticker has already been provided to the O.P. TPA M.D. India on 30.05.2022 and invoice related to its purchase is on record which is specific in the combined bill which has already been provided to the O.Ps.  It appears that cost of stent has been mentioned in the bill as Rs. 31,584/- and cost of balloon has been mentioned Rs. 25,000/-.  Since recently complainant has provided the required articles to the O.Ps. on 30.05.2022 hence we are of the opinion that this case is required to be disposed off with certain observations.

6       Accordingly this case of the complainant is being disposed off in the manner indicated here in below:-

O.P. No. 1,2 & 3    (TPA and New India Assurance Co. Ltd.)  are directed to consider the claim of the complainant within 60 days from today and to make payment accordingly because all the required documents/articles have already been provided to them recently. In case the grievance of the complainant is not redressed within 60 days from today then he may approach this Commission on fresh cause of action. Accordingly this case is being disposed off with above observations.