Jharkhand

Bokaro

CC/100/2019

Chitranjan Thakur - Complainant(s)

Versus

Incharge of E- Space, M.D. India Health Insurance TPA Pvt. Ltd. - Opp.Party(s)

12 Dec 2022

ORDER

                                               

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-30-05-2019

Date of final hearing-12-12-2022

 Date of Order-12-12-2022

Case No. 100/2019

Chitranjan Thakur S/o Amulya Thakur

R/o House No. 1231, Sector-12/F, Bokaro Steel City

Vs.

1. Incharge of E- Space, M.D. India Health Insurance TPA Pvt. Ltd.,

     A-2A, 3^rd Floor, Pune Nagar Road, Wadgeneswary, Pune 411014

 2. Divisional Manager, United India Insurance Co. ltd.

     Plot No. D.O. E-85, Himalya House, 8^th Floor, K.G. Marg,

       New Delhi, 110001

 3. SAIL B.S.L., Corporate Office, Lodi Road, New Delhi

4. Divisional Manager, United India Isnurance Co. Ltd.

    Plot No. A/17, City Centre, Sector-4/A, B.S.City, Bokaro

                             Present:-

                             Shri Jai Prakash Narayan Pandey, President

        Shri Bhawani Prasad Lal Das, Member

          Smt. Baby Kumari, Member

 

PER- J.P.N Pandey, President

-Judgment-

1. Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 23,955/- with 18% per annum interest on account of medical expense incurred during treatment of complainant  and to pay Rs. 10,000/-  as compensation and Rs. 3,000/- as litigation cost.
2. Complainant’s case in brief is that he is retired SAIL, BSL employee and as per policy of the company he opted for Mediclaim policy and provided  MIN No. 4743773 for himself which was valid at the relevant time. Further case is that due to illness complainant got himself admitted in CMC Vellore on 11.12.2018 and discharged on 14.12.2018 from the hospital for which Rs. 23,955/- was paid to the hospital by the complainant. Complainant applied for reimbursement of the above amount but inspite of repeated requests no action was taken by the O.Ps.  Thereafter legal notice was served having no impact. Hence this case has been filed with above mentioned prayer.  

 

3.   O.P. No.3 SAIL/ BSL Bokaro appeared but no W.S. has been filed by  this O.P. No.3.
4. On behalf of O.P. No.2 and 4 (United India Insurance Co.) W.S. has been filed in which it is mentioned that this O.P. has rightly repudiated the claim because as per discharge summary of CMC, Vellore it is found that the complainant was admitted there for  surveillance and investigation. He has no other co-morbid illness (history paragraph of discharge summary).
5.  On the basis of above pleadings we have to see whether complainant is entitled to get relief as claimed or not?
6. On careful perusal of the papers annexed with the complaint petition it appears that annexure-4 is photo copy of discharge summary dt. 14.12.2018 issued by CMC, Vellore. It appears that at second page under the heading Discussion  it is mentioned that “the patient wanted surveillance investigation to be done as inpatient. However he decided after admission to have the investigations as an outpatient. Hence he was discharged with advice to do surveillance tests as outpatient”.
7. On careful perusal of above observation of the Doctors of CMC, Vellore it is very much clear that admission in the hospital was only for the purpose of investigation on request of the complainant and it was not for the purpose of treatment of any illness. Therefore, we are of the view that O.P. has rightly repudiated the claim of the complainant and there is no any deficiency in service.

8. Accordingly prayer of the complainant is being dismissed. In the facts of the case parties shall bear their own costs.

 

 

(J.P.N. Pandey)

                                                                                      President

                                                                                               

    (B.P.L Das)

   Sr. Member

 

 

                                                                               (Baby Kumari)

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