Information regarding the names of persons, names & addresses of hospitals & amount of claims recommended by Dr. Suresh Agarwal for medical reimbursement - CIC: denial upheld as the public authority is not the holder of the information
Information regarding the names of persons, names & addresses of hospitals & amount of claims recommended by Dr. Suresh Agarwal - Respondent: information is about the private practices of Dr. Agarwal who has an agreement with the TPA & not with the Public authority directly - CIC: denial upheld as the public authority is not the holder of the information
1. The appellant, Shri Pradip Banura, has submitted RTI application dated 05 October 2012 before the Central Public Information Officer (CPIO), National Insurance Co. Ltd., Amritsar; seeking information relating to medical report prepared by the doctors in the matter of medical reimbursement claim of Smt. Saroj Banura, having Policy No. 401900/48/09/8500000376 and reimbursement recommended by Dr. Suresh Aggarwal in such cases from the date of his empanelment in the respondent company through a total of 02 points.
2. Vide order dated 17 October 2012, CPIO denied the information by replying that the information sought was related to TPA, therefore the appellant was requested to get requisite information from TPA, whose name and address has been provided by them. Not satisfied by the CPIO’s reply, the appellant preferred appeal dated 07 November 2012, to the First Appellate Authority (FAA). Vide order dated 21 November 2012, the FAA held that the CPIO had not acted in accordance with the provisions of the RTI Act and directed the CPIO to collect the required information from the TPA concerned and provide the same to the appellant within 10 days. Vide order dated 21 November 2012, CPIO furnished the information to the appellant.
3. Being aggrieved and not satisfied by the above response of the public authority, the appellant preferred second appeal before the Commission.
4. The matter was heard today via videoconferencing. The appellant, Shri Pradeep Banura, made submissions from Amritsar. The respondents, Shri Lokesh Saini, CPIO and Shri S K Passi, FAA were present and made submissions from Chandigarh.
5. The appellant submitted that he wanted information regarding the names of persons, names and addresses of hospitals/nursing homes and amount of claims recommended by Dr. Suresh Agarwal. The respondents submitted that the information may not be disclosed under the RTI Act as the said information is not related to the claim settlement case of Smt Saroj Banura, relative of the appellant. The information sought is about the private conduct/practices of Dr. Suresh Agarwal who has an agreement with the TPA (Outsourcing agency private entity) and not with the Public authority directly. Further, it is the responsibility of the TPA to identify any particular professional for a Claim settlement case. He also submitted that the information related to the claim settlement case of Smt Saroj Banura, relative of the appellant has already been provided.
7. In view of the above, the Commission upholds the CPIO’s order as the public authority is not the holder of the information regarding Dr. Suresh Agarwal who is in the panel of TPA (Third Party Administrator).
8. With the above directions, the appeal is dismissed and the case is closed at the Commissions’ end.
Citation: Shri Pradip Banura v. National Insurance Co Ltd, in Appeal: No. CIC/DS/A/2013/000475/MP