Alleging delay in cashless medical facility, information regarding correspondences made by the United India Insurance Company with the TPA w.r.t. appellant’s mediclaim insurance policy was sought - made - CIC: inspection of appellant’s file permitted
1. The appellant, Shri S P Khariwal, submitted RTI application dated 22 The provisions of this Act shall have effect notwithstanding anything inconsistent therewith contained in the Official Secrets Act, 1923 (19 of 1923), and any other law for the time being in force or in any instrument having effect by virtue of any law other than this Act. June 2013 before the Central Public Information Officer (CPIO), United India Insurance Co. Ltd., Abohar; seeking information regarding correspondences made by the United India Insurance Company with the TPA w.r.t. his mediclaim insurance policy no. 200100/48/12/97/00000117 etc., through a total of 6 points.
2. Vide reply dated 25 July 2013, CPIO furnished pointwise reply to the appellant. Not satisfied with the CPIO’s reply, the appellant preferred an appeal dated 31 July 2013 to the first appellate authority (FAA) alleging that he had been provided incorrect and incomplete information by the CPIO concerned. Vide order dated 26 August 2013, the FAA furnished additional information to the appellant.
3. Dissatisfied with the response of the public authority, the appellant preferred appeal before the Commission.
4. The matter was heard by the Commission. The appellant submitted that he sought information regarding correspondences made by the United India Insurance Company with the TPA w.r.t. the mediclaim insurance policy no. 200100/48/12/97/00000117 etc., through a total of 6 points. He submitted that his wife was hospitalized at Fortis Hospital, Mohali on 23.4.2013 and TPA had taken about 72 hours for giving authorization for cashless medical facility against the prescribed time period of 02 hours and the final approval had been given only on 25.4.2013. He submitted that the respondents had replied that no delay had taken place in this matter and alleged that when the patient was suffering from multiple diseases then only one authorization was required.
5. The respondents submitted that it is hospital concerned that sends a preauthorization letter to the TPA and if the TPA finds that everything was in order then they allow the cashless facility. They also submitted that in this case some queries were raised by the TPA from the hospital and after their compliance they allowed the cashless facility to the patient. The TPA allowed the cashless facility within one day, i.e. on 24.4.2013 before the patient was discharged. The respondent also submitted that whatever information they had were already provided to the appellant.
6. Even after the detailed submission made from both the parties, the appellant still not satisfied with the reply given by the respondent; therefore, the Commission allows the inspection of the appellant’s complete file for which the appellant and respondent both agreed. In view of this, the Commission allows the inspection of appellant’s file at UIICL’s Regional Office, Ludhiana on 29 December 2014 in between 2 to 4 PM to the appellant. The appeal is disposed of.
Citation: Shri S P Khariwal v. United India Insurance Co. Ltd., in Appeal No. CIC/MP/A/2014/000451