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2018 Supreme(P&H) 911

RAKESH KUMAR JAIN
Jangeer Chand – Appellant
Versus
State of Punjab – Respondent


Advocates Appeared:
For the Petitioner:Mr. Ravi Gakhar, Advocate
For the Respondent:Ms. Bhawna Gupta, DAG, Mr. Neeraj Madan, Advocate, Mr. Harsh Aggarwal, Advocate

JUDGMENT :

RAKESH KUMAR JAIN, J.

1. The petitioner is aggrieved against the decision of respondent No.5 by which his medical claim has been negated on the ground that his claim documents have been received after 60 days from the date of discharge.

2. In brief, the Government of Punjab has issued a scheme called Bhai Ghanhya Sehat Sewa Scheme 2014-15. Under the said scheme, a tripartite agreement was executed on 13.11.2013 amongst United India Insurance Company Ltd. [UIIC], M.D. India Health Care Services (TPA) Pvt. Ltd. [TPA] and Bhai Ghanhya Trust [Trust] for the benefit of its members. A number of government and private hospitals were approved by UIIC or TPA by executing MOUs wherein the members of the Trust can have their cashless medical treatment or can get reimbursement after verification of documents through TPA. As per Clause 6.1.6 of the Agreement, TPA or UIIC is to settle the package rates with network hospitals as per Trust Schedule of rates and as per package code No.990, Fortis Hospital is to conduct cashless bye-pass surgery at a prescribed rate. Respondent No.4 to 6, in their reply, have reproduced Clause 6.1.6 of the agreement, which read as under:-

“6.1.6 The TPA/insur











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