Jharkhand

Bokaro

CC/18/123

Ram Sawari Devi - Complainant(s)

Versus

The Executive Incharge, Raksha TPA Pvt. Ltd. - Opp.Party(s)

P.P. Singh

11 May 2023

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-03-10-2018

Date of final hearing-11-05-2023

 Date of Order-11-05-2023

Case No. 123/2018

Ram Sawari Devi, W/o Pradumn Choudhary,

R/o Qr.No. 803, A Road, Sector-9/A,

 Bokaro Steel City Jharkhand

                                      Vrs.

1. The Executive Incharge Raksha TPA Pvt. Ltd.

    At Plot No. H.F.12, City Centre, Sector-4, Bokaro Steel City

2. The Chief Executive Officer

     IFFCO TOKIO General Insurance Co. Ltd.

     Unit No. 52-63, Mazzanine Floor, AMSal

     Fortune Arcade Sector-18, Noida, Uttar Pradesh 201301

 3. Pawan Kumar Bhalla C.E.O. Escorts Corporate Centre,

     15/5 Mathura Road Faridabad, Haryana 121003

 

Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

PER- J.P.N Pandey, President

-:Order:-

1. Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 70,998/- as medical expense and to pay Rs. 25,000/-  as compensation and litigation cost for various type of harassment and also for payment of Rs. 200/- as Court fee etc.
2. It is important to note here that originally this case was filed by Ram Sawari Devi w/o Pradumn Choudhary but during pendency of the case Ram Sawari Devi died hence vide order dt. 24.06.2022 case is being conducted by her husband.
3. Complainant’s case in brief is that her husband being ex-employee of the SAIL/BSL opted for Mediclaim policy for himself and the complainant. The MIN Number of the complainant was 4706612 which was valid at the relevant time. Further case is that she became ill for which she was treated at BGH on different dates and paid total amount Rs. 1,42,015/- for purchase of medicines etc. for which she submitted claim papers before the O.Ps. for its re-imbursement  but only Rs. 71,017/- was paid to her and  Rs. 70,998/- was never paid inspite of repeated requests O.Ps. have not paid  the rest amount of claim. Hence this case has been filed with above mentioned prayer.
4. Inspite of due service of notice O.P. No.1 & 3 have not appeared hence vide order dt. 21.06.2019 case is being proceeded ex-parte against them. However, O.P. No.2 appeared and has filed W.S. denying most of the facts of the case. As per O.P. No.2 total 21 claims have been raised by the complainant amongst which 17 claims have been dully approved and payment has already been made after deduction of inadmissible amount.  Further reply is that so far rest of the claims are concerned about it complainant has not provided papers related to bills etc. for which she was reminded to submit original documents within 15 days but it was not submitted hence this case is pre-matured hence liable to be dismissed.
5.  Point for consideration is whether complainant is entitled to get relief as claimed ?
6. To prove its case complainant has filed photo copy of the legal notice (Annexure-1), photo copy of the Bank statement  (Annexure-2), photo copy of the doctor’s certificate (Annexure-3), photo copy of the health card (Annexure-4), photo copy of the postal receipt (Annexure-5) and photo copy of the application dt. 24.05.2017 (Annexure-6). Except above noted papers no any other paper has been filed by the complainant to prove that she was treated by the doctor, she has submitted claims before the O.Ps. and she has paid amount of the claim towards purchase of medicines etc. for her treatment. Therefore, in absence of above noted papers  we are of the view that what to talk about submission of papers before O.Ps. here before this Commission also complainant has not produced the documents on which her claim has been based. Therefore, we are of the opinion that complainant has failed to prove her case for grant of relief as claimed.
7. In light of above discussion this case is being dismissed on merit and in the facts of this case parties shall bear their own costs.

 

 

(J.P.N. Pandey)

                                                                                      President

 

                                                         

                                                                               (Baby Kumari)

                                                                                       Member