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SCA/1694/2010 4/ 4 ORDER
IN
THE HIGH COURT OF GUJARAT AT AHMEDABAD
SPECIAL
CIVIL APPLICATION No. 1694 of 2010
=========================================================
KUSUMBEN
JASVANTRAY TRIVEDI - Petitioner(s)
Versus
UNITED
INDIA INSURANCE CO LTD & 2 - Respondent(s)
=========================================================
Appearance
:
MR
BJ TRIVEDI for
Petitioner(s) : 1,MR JT TRIVEDI for Petitioner(s) : 1,MS JIGNASA B
TRIVEDI for Petitioner(s) : 1,
RULE SERVED for Respondent(s) : 1 -
2.
MR PALAK H THAKKAR for Respondent(s) : 1,
SERVED BY
AFFIX.-(R) for Respondent(s) :
3,
=========================================================
CORAM
:
HONOURABLE
MR.JUSTICE H.K.RATHOD
Date
: 19/10/2010
ORAL
ORDER
Heard
learned advocate Mr. JT Trivedi on behalf of petitioner, learned
advocate Mr. HM Thakkar appearing for respondent no. 1. Though Rule
is served to respondent no. 2, no appearance is filed by him. On
behalf of respondent no. 3, one Mr. Pathik Bharat Patel for JMSL,
Web Solutions Ltd has filed affidavit, which is at page 36. The
averment made by respondent no. 3 in para 2 and 3 are quoted as
under:
2. I further
say that the letter, dated 12/10/2009 was written by me as an agent
of the respondent No. 3, to the petitioner. I say that when I had a
talk with Mr. Prasad, an officer of the respondent no. 1, he had
told me telephonically on 09/10/2009 that the claim has been
sanctioned. I further say that the TPA i.e. the respondent no. 2
was merely waiting for the float from the respondent no. 1.
Therefore, as the petitioner and her spouse were frequently asking
me as to the fate of the claim, I wrote the letter at Annexure ‘B’
to the petition. I reiterate that the contents thereof are true and
correct.
3. I further say
that I was subsequently told that the file relating to the claim is
under process. As the claim relates to a cataract operation, which
was performed on 25/07/2009, it is difficult to comprehend as to the
modalities of processing and the inordinate delay therein. The non
passing of a number of such claims has caused wide spread
dissatisfaction amongst my clientele. I, therefore, wrote a letter
on 07/04/2010 (copy at Ann. R-1 ), to the respondent no. 3 and
also gave a copy to the petitioner. The said letter has been
written, after I was served with the notice, issued by this Hon’ble
Court.
In
view of aforesaid averment made by respondent no. 3, it is clear
that claim file of petitioner is under process, which relates to
cataract operation, which was performed on 25/7/2009. The letter
annexed to affidavit dated 7/4/2010 addressed to Manager, JMSL Web
Solution Pvt. Ltd page 39 annexure R1. Copy of this letter is sent
to Mrs. Kusumben J. Trivedi. The averment made in aforesaid letter,
page 39 dated 7/4/2010 of respondent no. 3 is quoted as under:
Reg:
Claim under policy no: 021600/48/09/41/00000589
Certificate
no: JSW/U/M/0000000672, Claim no: UN 32218
Please
refer to the claim as detailed above for Smt. Kusumben J. Trivedi
lodged to you on 27/07/2009 and subsequent submission of all
required claim papers to your TPA Alankit Healthcare TPA
Limited.
I
am sorry to say that till date no any kind of fruitful solution has
come out pertaining to the particular claim in spite of my
continuous follow up with the authorities concerned.
Now
the matter has been so serious that my client Smt. Kusumben J.
Trivedi has referred the matter to court of law (Honourable Justice,
High Court of Gujarat at Ahmedabad) for natural justice in the
matter vide special civil application no: 1694 of 2010 & have
served a notice to United India Insurance Co. Ltd., Alankit
Healthcare TPA Pvt. Ltd and to me also.
I
am sending herewith a copy of summon which indicates my presence to
the court being a opponent party no. 3 as per notice of the
Honourable Court.
Please
note that I am a salesman of your designed product in market and no
where attached, authorized or responsible to dispose off the claim
redressal. The claim formalities/decisions to be made good either
by your TPA/insurance company or by you in this kind of special
case.
Therefore
I request you to intervene seriously in the matter as early as
possible to resolve the high attitude grievance of the loyal client
as it is now on serious stage.
Hence,
this is sufficient to move further in the matter. Ignorance of this
request may be sufficient for some indecent steps against your
organization if I will be considered liable for the same in any
manner either monitory/morally or emotionally.
From
perusing aforesaid record, it has been found that till date
Medi-claim application made by petitioner is still not decided by
respondent no. 1. Therefore, it is directed to respondent no. 1 and
2 to decide Medi-claim application made by petitioner in respect to
cataract operation, which was performed on 25/7/2009, on or before
30/11/2010 if so far not decided by respondent no. 1 and 2.
It
is further directed to respondent no. 1 and 2 to place on record
decision on next date of hearing i.e. on 30/11/2010. Therefore,
matter is adjourned to 30/11/2010. Direct service is permitted.
(H.K.RATHOD,
J)
asma
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