Haryana

Yamunanagar

CC/1000/2012

Sanjay malik S/o C.L.Malik - Complainant(s)

Versus

Vipul Medcrop TPA Private Ltd. - Opp.Party(s)

Satish Sangwan

27 May 2016

ORDER

BEFORE THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR AT JAGADHRI.

                                                                                                Complaint No. 1000 of 2012.

                                                                                                Date of institution: 19.9.2012.

                                                                                                Date of decision: 27.05.2016

 

Sanjay Malik son of Shri C.L.Malik, resident of 183-L, Model Town, Yamuna Nagar.

                                                                                                                       …Complainant.

                                    Versus

 

1. Vipul Medcorp TPA Private Limited, 515, Udyog Vihar, Phase V, Gurgaon, Haryana-122016.
2. Oriental Insurance Company Ltd. near Hindu Girls College, Jagadhri, District Yamuna Nagar through its Branch Manager.

 

                                                                                                            …Respondents.

BEFORE:         SH. ASHOK KUMAR GARG, PRESIDENT.

                        SH. S.C.SHARMA, MEMBER.

              

Present: Sh. Satish Sangwan, Advocate, counsel for complainant.

              Respondent No.1 already ex-parte.

              Sh. V.P.S.Trehan, Advocate, counsel for respondent No.2.  

 

ORDER

 

1.                     Complainant  Sanjay Malik has filed the present complaint under section 12 of the Consumer Protection 1986 praying therein that the respondents (hereinafter referred as OPs) be directed to pay an amount of Rs. 8800/- on account of medical expenses and also to pay compensation as well as litigation expenses.  

2,                     Brief facts of the present complaint, as alleged by the complainant, are that the complainant obtained a family medicare insurance policy bearing No. 261701/48/2011/2436 under which the complainant and his entire family was insured for their medical claim issued by Oriental Insurance Company Jagadhri. The daughter of the complainant Sasha Malik was suffering from gastritis and doudentitis and due to that she remained admitted in hospital and complainant spent an amount of Rs. 17290/- on her treatment vide bill bearing No. 10413450 dated 09.05.2011. Out of this amount an amount of Rs. 8800/- was deposited as advance at the time of admission in the hospital. After discharge from the hospital a claim was lodged with the Ops but the Ops did not issue advance amount of Rs. 8800/- which was deposited by the complainant as advance with the hospital and made only part payment to the complainant. Hence, this complaint.  

3.                     Upon notice, OP No.1 remained absent despite service, so, he was proceeded ex-parte vide order dated 04.03.2013. However, Op No.2 appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable and complainant has concealed the true and material facts from this Forum. Complainant has since been duly compensated and an amount of Rs. 40,592/- has been  paid vide cheque No. 596503 dated 22.03.2012 drawn on HDFC Bank Ltd. in full and final settlement of mediclaim file No. 12 RB04OID0121 under policy no. 261701/48/2011/2436. As the entire amount has been paid to the complainant. Hence, the complaint is liable to be dismissed and on merit reiterated the stand taken in the preliminary objections and lastly prayed for dismissal of complaint.

4.                     To prove the case, counsel for the complainant tendered into evidence affidavit of complainant as Annexure CW/A and documents such as photo copy of legal notice dated 07.08.2012 as Annexure C-1, Photo copy of postal receipt as Annexure C-2, Photo copy of legal notice dated 7.8.2012 as Annexure C-3, Photo copy of postal receipt as Annexure C-4, Photo copy of No dues certificate issued by Hospital as Annexure C-5, Photo copy of letter for disbursal of payment of Rs. 40592/- to the complainant as Annexure C-6, Photo copy of discharge voucher as Annexure C-7, Photo copy of PGI bill as Annexure C-8 and closed the evidence on behalf of complainant.

5.                     On the other hand, counsel for OP No.2 tendered into evidence Photo copy of discharge Voucher as Annexure R2/1 and closed the evidence on behalf of OP No.2.

6.                     We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very minutely and carefully. Counsel for the complainant reiterated the averments mentioned in the complaint and prayed for its acceptance whereas counsel for OP No.2 reiterated the averments made in the reply and prayed for dismissal of complaint.

7.                     It is not disputed that the complainant obtained a family insurance policy bearing No. 261701/2011/2436 valid from 21.09.2010 to 20.09.2011 for a sum of Rs. 4,00,000/- and Rs. 50,000/- for hospitalization and paid a premium of Rs. 10647/-. The only plea of the complainant is that an amount of Rs. 8800/- deposited as advance with the hospital at the time of admission has not been reimbursed by the Ops Insurance Company whereas counsel for the OPs draw our attention towards discharge Voucher Annexure R2/1 vide which an amount of Rs. 40592/- has been paid to the complainant including the amount of advance deposited by the complainant as full and final payment on account of hospitalization on 22.4.2011. Learned counsel for the complainant failed to convince this Forum that any discrepancies in the payment made by the OPs Insurance Company. Moreover, when the complainant has received an amount of Rs. 40592/- as full and final settlement on 25.01.2012 including the hospitalization period of 22.04.2011 without any protest. Moreover, the present complaint has been filed after a lapse of considerable time i.e. after a period of 8 months from the receipt of full and final payment on 25.01.2012. Hence, we are of the considered view that there is no deficiency in service or unfair trade practice on the part of Ops.

8.                     In the circumstances noted above, we are of the considered view that there is no deficiency in service on the part of OPs and the present complaint is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced: 27.05.2016

                                                                        (ASHOK KUMAR GARG)

                                                                        PRESIDENT

 

 

                                                                        (S.C.SHARMA    )

                                                                        MEMBER