R KUSELAN Vs. ORIENTAL INSURANCE CO LTD

JUDGEMENT

(1.) -THE complainant in O. P. No. 262 of 2003 on the file of the District Forum, Chennai (North) is the appellant herein.

(2.) THE case of the complainant was as follows : He was a member of the Group Insurance Mediclaim of O. P. 1 company as per letter dated 12. 11. 1998. He was under treatment with O. P. 2 from 28. 6. 2000. He got admitted as an in-patient in O. P2's Nursing Home on 4. 7. 2000 and was discharged on 5. 7. 2000. The application for reimbursement of the medical expenses incurred by the complainant was rejected by the first opposite party. Alleging defective and deficient service against the opposite parties, the complaint came to be filed.

(3.) OPPOSITE party Nos. 1 and 3 filed a version to the following effect : The complainant had not submitted any certicicate from the hospital to the effect whether it was registered with the local authorities as prescribed in the claim form itself. Murugan Hospital where the complainant got treated was not a registered one. He had submitted an incomplete certificate issued by O. P. 2. O. P. 3's representative visited Murugan Nursing Home and had confirmed that the said hospital did not admit the complainant for any treatment. The complainant was requested to send a complete certificate giving particulars at a timelimit. As there was no response, the file was closed. There was no deficiency in service.