Gujarat High Court
Kusumben vs United on 19 October, 2010
Author: H.K.Rathod
Bench: H.K.Rathod
Gujarat High Court Case Information System
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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
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KUSUMBEN
JASVANTRAY TRIVEDI - Petitioner(s)
Versus
UNITED
INDIA INSURANCE CO LTD & 2 - Respondent(s)
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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,
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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 Top