UNIT TRUST OF INDIA Vs. SWARAN LATHA JAIN

JUDGEMENT

(1.) This revision petition has been filed under Section 21 (B) of the CP Act, 1986 by Unit Trust of India (Petitioner in this case) against the impugned orders of the State Consumer Disputes Redressal Commission, Himachal Pradesh and earlier by District Forum Hamirpur, HP in complaint No. 263 of 2001.

(2.) Brief facts of the case according to the Petitioner are that the Petitioner launched a Scheme in 1993 under Senior Citizen's Unit Plan (hereinafter referred to as 'SCUP'). As per the provisions of this Scheme, launched in collaboration with New India Assurance Co. Ltd., those members joining SCUP after completion of 58 years of age alongwith their spouse would be eligible for medical insurance cover of Rs.2,50,000/-, after two years of joining the Scheme and the limit will be increased to Rs.5.00 lakh (after adjusting claims made, if any, earlier) six years after joining the SCUP scheme. However, the above limit is restricted to Rs.1,50,000/- per illness per spouse. Under the said scheme members would also be provided with an Identity Card and log-book to record the amounts claimed. Respondent No.1 joined SCUP as a member on 31.05.1997 and she & her spouse, Respondent No. 2 became eligible for medical cover as provided under the Scheme after two years i.e. from 31.05.1999. A duplicate identity card and log-book was also issued as the Respondent No. 1 stated that the original had not been received by her. On 26.06.1999 Respondent No. 2 was admitted in hospital for heart surgery for which an expenditure of Rs.2,65,500/- was shown as having been incurred and medical bills and claims were submitted on 25.05.2001 for settlement. The request though received late, was settled in terms of Clause 17 of the provisions of the Scheme to the extent of Rs.1,50,000/-. Since the claim for Rs.2,65,500/- was not maintainable under the provisions of the SCUP Scheme.

(3.) The Respondents in their revision while confirming membership under the scheme after payment of Rs.33,000/- have contended that for want of log-book and Identity Card they had to spend Rs.2,56,500/- on Respondent No. 2 surgery and treatment and despite submitting the claims with the required documentary proof, the Petitioner reimbursed only an amount of Rs. 1,50,000/-.