Information relating to the settlement of mediclaim was denied stating it is not information as per section 2(f) - Appellant alleged that the bill of the hospital was inflated & wanted the copy of hospital bills - CIC: provide the copies of the appellant’16 Mar, 2014
1. The appellant, Shri Sunil K. Mirchandani, has submitted RTI application dated 10 September 2012, before the Central Public Information Officer (CPIO), New India Assurance Co. Ltd., Thane; seeking information relating to the settlement of claim to Cardinal Gracious Hospital, Vasai in policy No.14050034110100008051 without the appellant’s signature.
2. Vide order dated 10 October 2012, CPIO denied the information sought on the ground that the it was under nature of query/clarification which did not fall within provisions of RTI u/s 2(f) “information” means any material in any form, including records, documents, memos, e-mails, opinions, advices, press releases, circulars, orders, logbooks, contracts, reports, papers, samples, models, data material held in any electronic form and information relating to any private body which can be accessed by a public authority under any other law for the time being in force; of the Act. This was also in nature of grievance for which appellant was advised to approach the appropriate forum available at Regional Office as well as head Office. Not satisfied by the CPIO’s reply, the appellant preferred appeal dated 26 October 2012, to the First Appellate Authority (FAA). Vide order dated 15 January 2013, the FAA upheld the CPIO’s decision.
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 Sunil K. Mirchandani, made submissions from Thane. The respondent, Shri S.K. Das, Manager, Central Public Information Cell, made submissions from Mumbai.
5. The appellant submitted that there is collusion between the Hospital, Third Party Administrator and the public authority as his Mediclaim has been settled through a cashless system within three months of his discharge from the hospital even without his signature in the discharge form. He alleged that the bill of the hospital was inflated. He sought copy of the Hospital bills (with his signatures) at the time of discharge, discharge card and claim form.
6. The respondents submitted that the claim has been settled based on the pre authorisation form submitted by the appellant. The appellant was also advised by the CPIO to contact Shri R. Gangadharan, Deputy Manger, Central Office, Mumbai for the redressal of his grievances.
7. The Commission directs the CPIO to provide copies of the appellant’s hospital bills at the time of his discharge, discharge card and claim form as held by the public authority to the appellant within 21 days of the receipt of the order of the Commission.
Citation: Shri Sunil K. Mirchandani v. NIA, Mumbai in Appeal: No. CIC/DS/A/2013/000536/MP