BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD.

FA.NO.672 OF 2021 AGAINST ORDERS IN CC.NO.387 OF 2015, DISTRICT CONSUMER COMMISSION, KARIMNAGAR Between:

1. Kandula Arun Kumar, S/o.Surya Rao, Age: 37, Occ: Advocate.

2. Kandula Sridevi, W/o.Arun Kumar, Age: 34 years, Occ: Housewife.

Both R/o.H.No.10-4-64/1, Bank Colony, Karimnagar.

……Appellants/Complainants And

1. National Insurance Company Ltd., 3, Middleton Street, Postbox No.9229, Kolkata – 700 071, Through its branch office at Karimnagar, H.No.2-3-184, 184/A, Second Floor, Kaman to Bus Stand Road, Karimnagar Represented by its Divisional Manager.

2. Heritage Health TPA Pvt.Ltd., Nicco House, 5th Floor, 2 hare Street, Kolkata, through its Regional Office, R.No.1007, 10th Floor, Babukhan Estate, Basheerbagh, Hyderabad R/by its Manager.

3. Appollo Nursing Home, 3-3-96, Civil Hospital Road, Sawaran Street, Karimnagar/by its Managing Director. (R-3 is formal party)

……Respondents/Opposite Parties Counsel for the Appellants/Complainants: Party-in-person Counsel for the Respondent No.1/Opp.Party No.1: Sri G. Koteswara Rao Counsel for the Respondent No.2/Opp.Party No.2: Notice served QUORAM:

HON’BLE SMT.JUSTICE DR.G.RADHA RANI ……PRESIDENT HON’BLE SMT.MEENA RAMANATHAN ……MEMBER (NON-JUDICIAL)

HON’BLE SMT.R.S.RAJESHREE ……MEMBER (NON-JUDICIAL)

WEDNESDAY, THE 8^th OF APRIL TWO THOUSAND TWENTY SIX ******

Order: (Per Smt.Dr.G.Radha Rani, Hon’ble President)

1. This appeal is filed by the Complainants aggrieved by the order of District Consumer Disputes Redressal Commission, Karimnagar in CC.No.387/2015 dated 07.07.2021 directing the Complainant to submit the relevant bills and case records pertaining to the Complainant No.2 in Opposite Party No.3 Hospital from 05.03.2015 to 07.03.2015 and on receipt of the said documents directed the Opposite Party No.2 to settle the claim within one month as per the terms and conditions of the Mediclaim Insurance Policy and directing both the parties to bear their own costs.

2. (a) The case of the Complainants was that, the Complainant No.1 was BOI National Swasthya BIMA policy holder bearing No.551300/48/14/85000001810 having validity for the period from 09.04.2014 to 09.04.2015 issued by Opposite Party No.1 and Opposite Party No.2 is the authorized third party administrator of Opposite Party No.1. Initially, the Complainant No.1 took the above policy in the year 2012 bearing policy No.551300/48/12/8500001810 and got renewed the policy by paying Rs.3,393/- for the consecutive second year covering the above mentioned period. Subsequently, on 02.04.2015, the said policy was renewed for the third consecutive year bearing policy No.55130050510000011 for the period from 09.04.2015 to 08.04.2016. The said health insurance policy provides cashless medical treatment to the policy holder, spouse and children in any of the empanelled hospitals listed in the guide book issued by the Opposite Party No.2. That after renewal of the policy for the second year, the Opposite Party No.2 also issued computer generated letter dated 26.08.2014 to the policy holder i.e., the Complainant No.1 undertaking responsibility of providing health services to the Complainants under the above renewed policy on behalf of the insurer, Opposite Party No.1 and issued guide book and photo identity cards through post.

(b) It is further submitted that in the month of September, 2014, the Complainant No.2 suffered abdominal pain and pain in chest region. On that, they approached the doctors at Chalimeda Ananda Rao Institute of Medical Sciences. In diagnosis they performed 2D Echo Test, Colour Doppler Test and USG Abdominal Scan and found multiple calculi in gall bladder and opined that it could be the reason for the pain and provided medication. Later, the Complainant No.2 got treated by Dr.S.V.Rama Chandra Murthy who advised necessary surgery for removal of gall bladder. The Complainant for a second opinion, approached Dr.Sabbani Krishna Murthy. The said doctor after performing al