BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT BANGALORE (URBAN)

 23^RD DAY OF APRIL 2016

O R D E R

SMT. M. YASHODHAMMA,   MEMBER

This is a complaint filed by the complainant in person under Section 12 of Consumer Protection Act, 1986 praying for an order against Opposite Party (herein after referred as OP) to pay Rs.2,554/- along with compensation of Rs.90,000/- towards waste of time, work disruption and mental agony on the allegations of deficiency of service. 

2.      The brief averments made in the complaint are as follows:

Complainant is an employee of CISCO.  The said Company has obtained insurance covering for its employees. On 08.09.2015 complainant diagnosed with dengue.  He was treated at C.M.H Hospital Indiranagar, Bangalore and incurred hospitalization expenses of Rs.15,091/- and pre and post hospitalization expenses of Rs.2,868/.  After submitting the claim petition, OP reimbursed hospitalisation expenses, but failed to pay pre and post hospitalisation charges on the ground that dietician charges are not allowed by insurance Company.  Complainant informed OP that the said amount of Rs.200/- was paid towards consultation charge for dietician, but OP rejected his claim.  Complainant contacted OP several times to know the status of his claim.  After few weeks OP informed the complainant that some reports are not submitted by complainant along with the documents.  Insurance Company will accept only original documents.  Hence complainant has sent all the original documents to OP.   Complainant checked the documents submitted to OP and found all the reports are present in the documents sent to OP.  If any documents is lost OP shall be held responsible.  OP though informed the complainant that they will re-check the documents, but never came back with reply, finally OP discarded the claim of the complainant.  Hence, felt deficiency in service against OP.  Under the circumstances, he is advised to file this complaint against OP for appropriate relief.

3.  After service of notice from this Forum, OP entered appearance through his counsel, but failed to contest the matter by filing version or affidavit evidence.  Hence OP is placed exparte and posted the case for filing affidavit of the complainant.

4. In support of the complaint averments, Mr.Vineet Vashishth, who being the complainant filed his affidavit by way of evidence reiterating the complaint averments and also produced documents.

5. In support of his complaint, complainant has produced the following documents. Document No.1 is copy of the ID card issued by OP, claim form, discharge summary issued by Chinmaya Mission Hospital dated 15.09.2015 with diagnosis of Dengue Fever, Receipts, ECG Report, Lab report etc.  On 23.01.2016 complainant filed a memo reporting receipt of Rs.2,120/- from OP to his account on 12.01.2016 and prayed for suitable compensation for mental agony and inconvenience caused.

6.  On perusal of oral and documentary evidence produced by the complainant, the complainant is a beneficiary under the medi-claim insurance obtained by his employer, CISCO systems.  On 08.09.2015 complainant suffered from Dengue Fever.  He was treated at C.M.H Hospital, Indiranagar, Bangalore and incurred expenses for the treatment to the extent of Rs.15,091/-, and pre and post hospitalization expenses of Rs.2,868/-.  It is contended by the complainant that OP has reimbursed Rs.15,091/- hospitalization expenses, but failed to reimburse pre and post hospitalization expenses to the extent of Rs.2,868/-.  Inspite of repeated request and emails OP has failed to reimburse Rs.2,868/- to the complainant on the ground, the said expenses is towards diet charges.  Hence, this complaint. 

7. From the available materials on record, it is crystal clear that complainant has acknowledged receipt of Rs.2,120/- from OP on 12.01.2016 towards pre and post hospitalization expenses as per the memo filed by the complainant himself as per the order sheet dated 23.01.2016.  Complainant has not produced policy terms and conditions, so as to enable this Forum to come to the conclusion whether particular expenses are covered under the policy terms or not.  In the absence of any material, we are unable to come to the conclusion that expenses asked for are covered under the policy terms.  In the absence of any material we are unable to come to conclusion whether there is any deficiency in service on the part of OP, in not allowing some of the expenses incurred by the complainant.  Complainant failed to prove deficiency in service on the part of the OP.  Hence, complainant is not entitled for any compensation from OP. The complaint is liable to be dismissed.   Accordingly, we proceed to pass the following:

ORDER

1. The complaint filed by the complainant is dismissed.  

2. There is no order as to costs.

3. Supply free copy of this order to both the parties.

 (Dictated to the Stenographer and typed in the computer and transcribed by her, verified and corrected, and then pronounced in the Open Court by us on this the 23^rd day of April 2016)

MEMBER                          MEMBER                          PRESIDENT

COMPLAINT NO.2011/2015

Witness examined on behalf of the complainant dated 20.02.2016 Sri.Vineet Vashishth,                     

Witnesses examined on behalf of the OP – Absent

List of documents produced by the OP– Nil

MEMBER                             MEMBER                         PRESIDENT

NRS*