Haryana

Sonipat

CC/294/2016

Pardeep - Complainant(s)

Versus

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

Narender Bhardwaj

19 Jan 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

SONEPAT.

               

 

                                Complaint No.294 of 2016                                             Instituted on:03.08.2016

                                Date of order:19.01.2017

 

Pardeep son of Jai Bhagwan, resident of H.No.857-A/29, Vikas Nagar, Kakroi road, Gali no.3, Sonepat.

…Complainant.         

Versus

 

1.United India Insurance Co. Ltd., near Tulip Hospital, Bahalgarh Delhi road, Sonepat through its Branch Manager.

2.United India Insurance Co. Ltd., 24, Whites road, Chennai-600014 through its Manager.

                                                …Respondents.

 

 

COMPLAINT UNDER SECTION 12 OF

THE CONSUMER PROTECTION ACT,1986

 

Argued by: Sh.Narender Balhara  Advocate for complainant.

           Sh.KS Solanki, Advocate for respondent no.1 and 2.

          

 

Before-    Nagender Singh-President.

Prabha Wati-Member.

J.L. Gupta-Member.

 

O R D E R

 

          Complainant has filed the present complaint against the respondents alleging therein that he has purchased a family medicare policy from the respondents covering the complainant, his wife and two sons namely Deepanshu and Himanshu for the period of 9.7.2015 to 8.7.2016 with cashless facility for hospitalization upto Rs.2,50,000/-.  The complainant has met with an accident on 14.7.2015 and received serious & multiple injuries and was shifted to Sir Ganga Ram Hospital, Delhi and the complainant remained admitted there for 18.9.2015 and 19.9.2015 and his operation of leg was conducted due to fracture.  The complainant has spent Rs.1,39,734/- for medicines, tests, physiotherapy and transportation etc. The above said hospital has informed the respondent about the treatment, upon which, the respondents deposited only Rs.56844/- instead of Rs.139734/- and now Rs.102890/- is outstanding against the respondents.  The complainant has requested the respondents to make the payment of Rs.102890/- to the complainant, but of no use and that amounts to a grave deficiency in service on the part of the respondents. So, he has come to this Forum  and has filed the present complaint.

2.        In reply, the respondents have submitted that the respondents have already released the amount regarding the treatment as per the terms and conditions of the treatment.  The complainant has raised wrong and illegal demands which are not covered under the policy.  The complainant has not suffered any mental agony and harassment at the hands of the respondents and thus, he is not entitled for any relief & compensation and has prayed for the dismissal of the present complaint.

3.        We have heard the arguments advanced by the learned counsel for both the parties at length.  All the documents have been perused very carefully and minutely.

          Ld. Counsel for the complainant has submitted that the complainant has purchased a family medicare policy from the respondents covering the complainant, his wife and two sons namely Deepanshu and Himanshu for the period of 9.7.2015 to 8.7.2016 with cashless facility for hospitalization upto Rs.2,50,000/-.  The complainant has met with an accident on 14.7.2015 and received serious & multiple injuries and was shifted to Sir Ganga Ram Hospital, Delhi and the complainant remained admitted there for 18.9.2015 and 19.9.2015 and his operation of leg was conducted due to fracture.  The complainant has spent Rs.1,39,734/- for medicines, tests, physiotherapy and transportation etc. The above said hospital has informed the respondent about the treatment, upon which, the respondents deposited only Rs.56844/- instead of Rs.139734/- and now Rs.102890/- is outstanding against the respondents.  The complainant has requested the respondents to make the payment of Rs.102890/- to the complainant, but of no use and that amounts to a grave deficiency in service on the part of the respondents.

          Ld. Counsel for the respondents has submitted that the respondents have already released the amount regarding the treatment as per the terms and conditions of the treatment.  The complainant has raised wrong and illegal demands which are not covered under the policy.  The complainant has not suffered any mental agony and harassment at the hands of the respondents and thus, he is not entitled for any relief & compensation.

          After hearing both the ld.counsel for the parties at length and after going through the entire relevant records available on the case file very carefully, we are of the view that there is deficiency in service on the part of the respondents.  The respondents have not placed on record any calculation sheet.  The complainant has remained admitted in Sir Ganga Ram Hospital, Delhi for two days i.e. 18.9.2015 to 19.9.2015 and the said hospital has issued the bill of Rs.92139/- to the complainant.  As per the complainant, the respondents has paid an amount of Rs.56844/- to the complainant.  Regarding the remaining amount of Rs.35295/-, no description has been placed on record by the respondents or its TPA.  Further regarding this fact, nothing has been mentioned by the respondents either in the written statement or in the affidavit.  So, in our view, non-payment of Rs.35295/- to the complainant by the respondent is wrong, illegal and unjustified and the complainant is entitled to get the same from the respondents.  Accordingly, we hereby direct the respondents to make the payment of Rs.35295/- (Rs.thirty five thousand two hundred ninety five only) to the complainant and further to pay Rs.10,000/- towards the other medical bills placed on record by the complainant and this amount is directed to be paid to the complainant within a period of 60 days from the date of passing of this order, failing which, the above said amount shall fetch interest at the rate of 09% per annum from the date of passing of this order.

          Since the complainant has been able to prove the deficiency in service on the part of the respondents, the respondents are further directed to compensate the complainant to the tune of Rs.2000/- (Rs.two thousand) for rendering deficient services, for harassment and under the head of litigation expenses.

           With these observations, findings and directions, the present complaint stands allowed.

          Certified copy of this order be provided to both the parties free of cost.

File be consigned to the record-room.

 

 

(Prabha Wati)(J.L.Gupta)                   (Nagender Singh-President)

Member DCDRF  Member DCDRF                   DCDRF, Sonepat.

 

Announced: 19.01.2017