Jharkhand

Bokaro

CC/102/2019

Chhutu Mahto - Complainant(s)

Versus

United India Insurance Co. Ltd. - Opp.Party(s)

Ajay Kumar Jha

09 Jun 2023

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-31-05-2019

Date of final hearing-09-06-2023

 Date of Order-09-06-2023

Case No. 102/2019

Chhutu Mahto S/o Late A. Mahto,

 R/o village- Chikitsia, P.O.- Chikitsia, District- Bokaro, Jharkhand

                                      Vrs.

1. M/s United India Insruance Co. Ltd.

at- 24, Whites Road, Chennai, Tamil Nadu-600014

2. Branch Manager, M/s United India Insurance Co.Ltd.

at Plot No. C-27, City Centre, Sector-4, Bokaro Steel City

3. M/s, MD India Health Insruance TPA Pvt. Ltd.

At S.No. 46/1, E-Space, A-2 Wing, 3^rd Floor,

Pune- Nagar Raod, Vadgon Shrei Pune- 411014

Present:-

                             Shri Jai Prakash Narayan Pandey, President

Shri Bhawani Prasad Lal Das, Sr.Member

                  Smt. Baby Kumari, Member

PER- J.P.N Pandey, President

-:Order:-

1. None turned up on behalf of the complainant on repeated call. On the other hand Ld. Counsel for the O.P. No.1 & 2 is present.  It reveals from the record that this case is pending at the stage of argument in which complainant is absent since long, therefore, in the given facts 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 as well as the argument of the O.Ps.

 

2. Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 1,28,720/- as medical expense and to pay Rs. 10,000/-  as compensation for various type of harassment and also to pay Rs. 5000/- as litigation cost with interest thereon @ 18% per annum.

 

3. Complainant’s case in brief is that he is a retired SAIL/BSL employee and as per policy of the company he opted Mediclaim policy for the year 2017-18 and was provided MIN No. 4728291. Further case is that due to eye disease he was treated in the Prudence Hospital, Bye Pass Road, Chas, Bokaro on 08.04.2018 and discharged on same day for which he paid Rs. 36,000/- to the hospital and purchased medicine of Rs. 1582/- thereafter, he submitted claim before the O.Ps. with all relevant documents which was not settled. Further case is that again he was treated at BGH from 05.06.2018 to 09.06.2018 later on doctor at BGH referred him to higher centre hence he was admitted in Abdul Razzaque Ansari Cancer institute, Ranchi on 17.06.2018 and discharged on 23.06.2018 where he was treated for cancer of Gall Bladder in which he paid Rs. 91,044/- to the hospital and submitted claim with the O.Ps. which was not settled hence legal notice dt. 11.03.2019 was served having no impact, hence this case has been filed.

 

4. W.S. has been filed by O.P. No.1 & 2 mentioning therein that these O.Ps. are having no knowledge about claim of the complainant in respect to his treatment as alleged in the complaint petition. Further reply is that if complainant has submitted claim before the O.P. No.3 then definitely it would have not been fulfilling the criteria of the claim hence it would have been denied. Hence complainant is not entitled to get any relief as claimed.

 

5. O.P. No.3 has not appeared inspite of due service of notice hence vide order dt. 20.10.2022 case is being proceeded ex-parte against him.

 

6. Point for adjudication is whether complainant is entitled get any relief as claimed ?

 

7. The fact that at the relevant time complainant was covering with mediclaim policy is not in dispute. From perusal of the papers submitted by the complainant it appears that those papers are photo copy of the papers and only the copy of claim form related to second treatment is annexed with the complaint petition which is not bearing the signature of the complainant. In this way it is very much clear that the reply of the O.P. is being supported with the papers of the complainant itself. In respect to first claim there is no any copy of claim form submitted by the complainant.

 

8. Therefore, in light of above discussion we are of the view that this case may be disposed of with certain observation. Accordingly this case is being disposed off with direction to the complainant to file all relevant papers before the O.Ps. within 3(three) weeks  from today and on filing all relevant papers O.Ps. No. 1 & 2 shall take appropriate decision within further 4 (four) weeks from receipt/production of all documents by the complainant.

 

S/d   

(J.P.N. Pandey)

                                                                                      President

 

S/d   

(B.P.L Das)

   Sr. Member

                                                                            

          S/d   

                                                                               (Baby Kumari)

                                                                                       Member