- (1.) VAKALATNAMA is being filed on behalf of the respondents in the Court today. Typed copy of the judgment, in terms of the order dated 16.9.2004 is being filed in the Court today. Let the same be kept on the record.
(2.) UNSUCCESSFUL complainant is the appellant before us against the judgment and order dated 16.8.2004 passed in complaint case No. 157/04 on the file of the District Forum, Dhanbad, whereby, his prayer for mediclaim has been rejected. The facts of this case are not very much in serious dispute which may be noticed with utmost brevity. The complainant, who himself is the insured obtained mediclaim policy on 10.12.2001 valid for a period of one year for a sum of Rs. 2,00,000/ -. On 16.5.2002, while he was in Delhi, he felt chest pain, as a result, he was admitted in Raj Nursing Home, Delhi. He was then immediately shifted to Bhatra Hospital and Medical Research Centre at Delhi where space maker was implanted on him on 20.5.2002. Simultaneously, information was sent to the Insurance Company on 28.5.2002. Letter was sent to the Insurance Company informing the details of expenses incurred during the complainant 'sillness. Since the mediclaim policy had expired, which was again renewed on 10.12.2002. The Insurance Company, however, repudiated the claim. A fresh claim was lodged by the insured which was also rejected on 10.4.2003, on the ground, that the claim had already been rejected earlier.
(3.) FROM the materials on record, it appears that though the respondent Insurance Company has been informed regarding the ailments, but the relevant documents sought for by the Insurance Company for finalising the claim, have not been made available to them inspite of repeated requests and sufficient opportunity given to the complainant. The Insurance Company has appointed a Surveyor, namely, Dr. Vinod Gandotra, who sought for relevant documents from the claimant, but even then, no such documents were made available to him, and, accordingly, the Surveyor submitted a report to the Insurance Company denying the claim of the insured in absence of relevant documents.;