DIST.CONSUMER DISPUTES REDRESSAL COMMISSION, KHURDA, BHUBANESWAR:
-ooOoo-
C.D.CASE NO. 351/ 2019
Dr. Dev Prasad Rath, aged about 68 years,
S/o- Late Biswanath Rath, Plot No.26/C, Bihang Residency,
Bhubaneswar -751014, Dist – Khurda
…. Complainant
-Vrs.-
- M/s United India Insurance Company Ltd.,
Divisional Office- 3, T.K.N. Mansion, No.93,
K.H. Road, Shantinagar, Bangalore – 560027,
Represented through its Sr. Divisional Manager.
- M/s Medi Assist Insurance T.P.A. Pvt. Ltd., Tower-D,
-
Bangalore – 560029.
- M/s United India Insurance Company Ltd., I.D.C.O. Tower,
-
- M/s Hindustan Aeronautics Ltd., Corporate office, Cubbon Rod,
Bangalore – 560 001, represented through its Director (H.R.)
… Opp. Parties
For the complainant : Mr.U.N.Sahoo (Adv.)
For the OPs 1 & 3 : Mr. B.B. Pattnaik & Associates (Adv.)
For the OP.4 : Mr. A.R.Dash & Associates (Adv.)
For the OP.2 : Exparte
DATE OF FILING : 30/11/2019
DATE OF ORDER : 05/06/2023
ORDER
K.C.RATH, PRESIDENT
1. This is an application U/s 12 of the C.P.Act, 1986.
2. The complainant’s case in brief is that, the complainant was an employee of Hindustan Aeronautics Limited, Bangalore (HAL in short) . After his retirement, he was enrolled as a member under “Post Superannuation Group Insurance Scheme” of M/s United India Insurance Company Ltd. (OP.1). Under that scheme, the sum assured was Rs.4,00,000/- for each beneficiary. It so happened, the complainant suffered from Psoriatic Arthopathy and was admitted to the hospital for treatment. On first two occasions, he was given the cashless benefit for his treatment for the said disease. But on subsequent two occasions, i.e. on 05/02/2018 to 06/02/2018 and 05/04/2018 to 06/04/2018, he was denied the cashless benefit for his treatment. When he submitted the medical bills of his treatment to the OP.1, the OP.1 refused to reimburse the amount on the ground that no hospitalization was necessary for the said treatment. Hence this complaint.
3. On the other hand, the OP.2 was set exparte. OP.3 was deleted from the cause title. As the OP.1 did not file written version within the statutory period, further opportunity was not given to him for filing of written version. OP.4 files written version challenging the maintainability of the complaint against him. According to the OP.4, the complainant has no relief against it. Besides it is submitted by the OP.4 that, as per the terms of the insurance contract, the jurisdiction is related to Bangalore court and instead of filing complaint before Bangalore court, the complainant has filed this complaint before this Commission at Bhubaneswar. Therefore, the complaint is not maintainable and as such it is liable to be dismissed with cost.
4. Perused the materials on record. The complainant had undergone the treatment for the aforesaid disease from 5/2/2018 to 6/2/2018 and from 5/4/2018 to 6/4/2018 and for same disease, he had undergone treatment prior to this period and he was given cashless benefit for his treatment. But subsequently, the benefit was denied on the plea that hospitalization was not necessary. But the treating physician has categorically written that the treatment for the said disease requires infusion of injection which in turn requires close monitoring for more than 24 hours. The complainant (patient) was admitted to the hospital as an indoor patient on 05/02/2018 and was discharged on 06/02/2018 and again was admitted on 05/04/2018 and discharged on 06/04/2018. Considering all the documents on record, I find that, the patient was properly hospitalized for the treatment and the OP.1 should reimburse the medical expenditure which is permissible. So far as the point of jurisdiction is concerned, the OP.4 raised question that as per the terms & conditions of the Insurance Contract, any dispute is to be resolved within the Bangalore jurisdiction. But the complainant at the material time, was residing at Bhubaneswar. It is highly inequitable to think that the complainant who is undergoing the treatment at Bhubaneswar will go to Bangalore to settle the dispute. The justice requires that the aggrieved party should get the benefit if permissible under law. Besides, the place of adjudication is a matter of procedure which is the handmade of justice. For the sake of procedural law, substantive right should not be defeated. Hence the Consumer Commission at Bhubaneswar has the jurisdiction to entertain the dispute. Therefore, the complaint bears merit. Hence it is ordered.
ORDER
The complaint is allowed exparte against the OP.2 and dismissed on contest against the OP. 4 and allowed on contest against the OP.1. The OP No.1 is directed to reimburse Rs.2,02,385/- towards the medical expenses incurred by the complainant for the treatment of his disease. In addition to that, the OPs 1 & 2 are further jointly & severally liable to pay an amount of Rs.5,000/- (Rupees five thousand) only to the complainant towards compensation for mental agony suffered by him and a further sum of Rs.1000/- (Rupees one thousand) only towards litigation expenses. The order be complied with by the OP Nos. 1 & 2 within a period of one month from the date of communication of this order, failing which the complainant will be at liberty to execute the order against the OPs 1 & 2 in accordance with law.
The order is pronounced on this day the 5th June, 2023 under the seal & signature of the President and Member (W) of the Commission.
(K.C.RATH)
PRESIDENT
Dictated & corrected by me
President
I agree
(S.Tripathy)
Member (W)
Transcribed by Smt. M.Kanungo, Sr.Steno
