SUBHASH CHANDER VERMA Vs. REGIONAL MANAGER, RAKSHA TPA PVT. LTD. AND ORS.

JUDGEMENT

(1.) THIS appeal is directed against the order dated 20.2.2015, rendered by the District Consumer Disputes Redressal Forum -I, UT, Chandigarh (hereinafter to be called as the District Forum only) vide which, it dismissed the complaint, filed by the complainant (now appellant). The facts, in brief, are that the complainant obtained a Mediclaim Policy (2007) (Hospitalization Benefit Policy) Annexure -1, from the opposite parties, valid for the period from 10.4.2013 to 9.4.2014, for the sum insured of Rs. 2,00,000, on payment of premium, to the tune of Rs. 8,826. It was stated that the complete Policy document and the terms and conditions thereof were not supplied to the complainant, at any point of time. It was further stated that, on 18.2.2014, the complainant suffered brain stroke, as a result whereof, he was taken to the Alchemist Hospital, Sector 21, Panchkula. Initially, the complainant was admitted in emergency ward of the said Hospital, and, thereafter, was shifted to the Intensive Care Unit (ICU). It was further stated that, on the next day, the complainant was shifted to the private room. It was further stated that the complainant was discharged, from the Alchemist Hospital, Sector 21, Panchkula, on 21.2.2014. It was further stated that bill Annexure -2 for Rs. 60,625 was prepared by the said Hospital, in relation to the expenses incurred by the complainant on his treatment. It was further stated that the claim was lodged by the complainant, with the opposite parties. It was further stated that the complainant was shocked to receive letter Annexure -3, from opposite party No. 1, whereby it agreed to pay Rs. 26,926 only, out of the aforesaid amount.

(2.) IT was further stated that, as per the directions of the concerned Doctor of the said Hospital, in the discharge certificate, the complainant continued getting treatment in the OPD. However, the complainant was again hospitalized in the Alchemist Hospital, Sector 21, Panchkula, from 10.3.2014 to 15.3.2014 for treatment. The said Hospital again charged Rs. 59,967, for treatment of the complainant, vide bill Annexure 5. It was further stated that when the complainant submitted claim with the opposite parties, he was again issued letter Annexure R -6, by opposite party No. 1, whereby it agreed to pay Rs. 35,935, against Rs. 59,967. It was further stated that on 15.5.2014, the complainant visited the office of opposite party No. 1 and delivered the supplementary claim bill of Rs. 89,167, but it made payment of Rs. 31,435 against the same (Rs. 89,167).

(3.) NOTICE of the complaint was served upon the opposite parties. Though, Mr. J.P. Nahar, Advocate, put in appearance, on behalf of the opposite parties, yet written version and evidence, were filed, on behalf of opposite party Nos. 2 and 3 only.