BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ADDITIONAL BENCH,                                                                                                         MANGALORE                    

Dated this the 30^th November 2016

PRESENT

       SRI. VISHWESHWARA BHAT D    : HONBLE PRESIDENT

        SRI. T.C. RAJASHEKAR                 : HONBLE MEMBER

ORDER IN

C.C.No.265/2013

(Admitted on 24.09.2013)

Mr. B.L Somashekara Nayak,

S/o B. Laxminarayana Nayak,

Of age 68 years,

Agriculturist, Thannimani Village,

Post: Baghamandala  571 242.

                                                        ….. COMPLAINANT

(Advocate for the Complainant: Sri DS)

VERSUS

1.  Dr. Bhaskar Shetty,

     Proprietor and owner

     Of City Hospital,

     Pound Garden, Mallikatta,

     Kadri, MANGALORE.

2.  The Chief Executive Officer,

     City Hospital,

     Pound Garden, Mallikatta,

     Kadri, MANGALORE.

3.  Authorised Signatory,

     Chief Executive Officer,

     M/s Yashasvini Co operative

     Farmers Health Care Scheme,

     Bagamandala Agricultural Co

     Operative Bank Limited,

     Bagamandala, KODAGU.

                                                      ….........OPPOSITE PARTIES

(Advocate for the Opposite Parties No.1 & No.2: Sri. KN)

(Opposite party No.3: In person)

ORDER DELIVERED BY HON’BLE PRESIDENT

SRI. VISHWESHWARA BHAT D:

I.       1. The above complaint filed under Section 12 of the Consumer Protection Act alleging deficiency in service against claiming certain reliefs. 

The brief facts of the case are as under:

     The complainant alleges the obtained insurance cover under policy obtained Yashasvini scheme for a total sum Rs.1,66,700/ under Yashasvini Health Trust Insurance from opposite party No.3.  Complainant got admitted to the hospital of opposite party No.1 name City Hospital at Mangalore on the advice of one Dr. Jayaram Shenoy for Prolapsed Haemorroids aliment and was inpatient for the period from 1.4.2013 to 5.4.2013.  The City Hospital of opposite party No.1 is a notified hospital under the Yashasvini Health Insurance Scheme a board was also affixed to that effect.  On showing the receipt issued by opposite party No.3 to complainant in the city at hospital an entry was made in the medical register maintained by opposite party No.1.  on scrutiny of green card and records and certified by opposite party that effect stating that complainant got admitted as an impatient in the hospital run by opposite party No.3 under advice by Dr. Jayaram Shenoy.  However opposite party No.1 refused to extend facility of providing medical treatment at a reduced rate and made complainant to pay Rs.35,178/  knowing fully well that the complainant being a bonafide beneficiary under the Health Insurance scheme.  When complainant pointed out to the poster of beneficiary put under the scheme in the hospital of opposite party No.1 it was ordered to be remove by the complainant such seeks order against opposite party for deficiency in service to pay the said amount of Rs.35,178 with 12% interest, a sum of Rs.8000/ towards cost and another Rs.1,50,000/- towards metal harassment.

     II.   Opposite party No.1 & No.2 in the written version admits that the treatment given to complainant in their hospital and also the bill amount paid in the hospital by Dr. Jayaram Shenoy.  They also admit the hospital of opposite party No.1 was one of the beneficiary hospital under Yashasvini scheme introduced by Government of Karnataka till 29.3.2013.  There was outstanding maturity due towards the treatment under the scheme as opposite party No.3 failed to pay an outstanding amount of Rs.4,61,250/ legal steps were initiated for recovery before proper court after the notice u/s 80 of the CPC was issued.  Infact opposite party No. 1 did send letter to opposite party No.3 on 6.4.2013 but there was no reply.  Hence opposite party No.1 constrained to send a notice about withdrawal from 30.3.2013 of Yashasvini scheme with immediate effect from their hospital. 

    2.      It was further contended by opposite parties No.1 & No.2 if and when they recover the amount pertaining to the complainant they will pay the amount to complainant. The complainant at the time of treatment promptly paid the amounts due without protest.   The patient and the Dr. Jayaram Shenoy were fully made to understand that the Yashasvini scheme were not available in the hospital.  Hence seeks dismissal.

    3.     Opposite party No.3 in written version ignore as to the treatment provided to the complainant in the hospital but the admission of complainant coming under the Yashasvini health scheme Bhagamandala Agricultural Credit Co Operative Society is only an agent in Yashasvini Co operative Famers Health Care Scheme as provided under the Co Operative Department by the Government of Karnataka the office Yashasvini Co operative Farmers Health Care Trust is at Bangalore and they are insureer which is the Insurance and Medi Assist India TPA Pvt, Ltd .  Hence seek dismissal.

          4.     In support of the above complainant Mr. B.L Somashekara Nayak filed affidavit evidence as CW1 and answered the interrogatories served on him and produced documents got marked Ex C1 to C39 detailed in the annexure here below.  On behalf of the opposite parties Mr. Robert D Souza (Rw1) Manager in op hospital also filed affidavit evidence and answered the interrogatories served on him.

III.     In view of the above said facts, the points for consideration in the case are:

1. Whether the Complainant is a consumer and the dispute between the parties?
2. If so, whether the Complainantis entitled for any of the other reliefs claimed?
3. What order?

      We have considered the notes/oral arguments submitted by the learned counsels and also considered the materials that was placed before this Forum and answer the points are as follows:         

               Point No. (i): Affirmative 

               Point No. (ii): Partly Affirmative

              Point No. (iii): As per the final order.                 

                                                                                                REASONS

IV.      POINTS No. (i):  The complainant were covered under the Yashasvini health insurance scheme of the Government of Karnataka is not in dispute and that the City hospital run by opposite party No.1 is one of the notified hospital for treatment under the said scheme were not in dispute.  Infact the complainant is covered under the policy issued by opposite party No.3 is undisputed by the opponents.  The treatment given to complainant in the hospital of opposite party No.1 City hospital Mangalore as inpatient from 1.4.2013 to 5.4.2013 and the total bill of Rs.35,178/ is also not disputed.  In view of the under scheme the opposite party No.1 have according to complainant received the facility promised by opposite party No.3 under the Scheme Ex.C1 is the card issued to complainant covering the risk of complainant and his family member and it contains the list of hospitals where the treatment can be obtained. The admittedly the hospital run by opposite party No.1 namely City Hospital is included in this list.  However opposite party no.1 claimed that from 30.3.2013 he had withdrawn from the Yashasvini scheme and this was informed both to complainant and Dr. Jayaram Shenoy at whose instance the complainant was admitted in and who treated in the hospital of opposite party No.1 about the withdrawal of the scheme.  But the specific case of complainant in the complaint itself at the time of admission his name was entered in the register maintained under the scheme in the hospital and that he has shown the Insurance Health card to the hospital authorities has not been controverted by opposite party No.1 and No.2.  Infact the register mentioned by complainant is not produced by opposite party No.1 and No.2 before this Forum.  Hence we are of the view that we are justified in drawing and inference that there is no such intimation given to complainant at the time of admission by opposite parties No.1 and No.2.   Hence there is a dispute between the complainant the consumer and the opposite parties the service provider.  Hence we answered point No.1 in the affirmative.

POINTS No. (ii):  The complainant further asserted apart from entering his name in the register in the Hospital he was required to produce certificate and document were sought by the hospital authorities and accordingly they were secured from opposite party No.3 and produced before the hospital.   This mention made in the complaint and about instructions given by opposite parties No.1 and No.2 as mentioned in Ex.C39 the representation of complainant made to the hospital authorities on 3.4.2013 was never controverted by opposite party No.1 and No.2.  

2.      The contention taken by opposite party No.1 to avoid liability is he had withdrawn from the Yeshasvini Scheme with effect from 30.3.2013. But even as spoken by RW1 the manager of opposite party No.1’s hospital no notification of such withdrawal from the scheme is produced nor an intimation of such withdrawal brought to notice by public by taking up paper publication in and around Bagamandala and in South Canra.  Hence we are of the view opposite party No.1 cannot escape from liability to pay the amount back to complainant. 
3.        The contention of opposite party No.3 that the complainant ought have made Yashasvini Co-operative Famers Health Care Scheme trust and the insurer Medi Assist India TPA Pvt, Ltd Bangalore as parties to this compliant.  However whether the complainant had withdrawn his hospital from the scheme or not with effect from 30.3.2013 is a matter to be established by opposite party No.1 as opposite party No.1 and No.2 admit the hospital run by opposite party No.1 is included in the said scheme. Even now it is not the case of opposite party No.1 and No.2 that any notice of such withdrawal of the scheme given to the concerned authorities and to the general public who would be affected by such withdrawal.  Infact the attitude of opposite Opposite party No.1’s hospital when the complainant appeared for admission for treatment on 1.4.2013 in entering the details of the complainant under register maintained by the hospital under the Yashasvini scheme belies the claim made by opposite party No.1 before this Forum.  Not only that the contention of opposite party No.1 throughout is already taken legal steps for recovery against opposite party No.3 and as and when the amount is recovered he will pay the amount back to complainant.  But the complainant a beneficiary under scheme cannot be made to wait by opposite party No.1 till the conclusion of the litigation if any for the amount.   In our view opposite party No.1 and no.2 wrongfully collected the amount from complainant.  Hence the contention of opposite party No.3 that the Yashasvini Co operative Famers Health Care Scheme and Medi Assist India TPA Pvt, Ltd Bangalore are necessary parties can to be accepted.  Thus we are of the view there is deficiency in service on the part of opposite party No.1 to complainant is established by complainant.
4.      As to the amount to which complainant is entitled is the complainant had contended that he had paid the entire bill of 35,185/ to complainant with interest 9% per annum from the date of 3.4.2013 till the date of payment which is admitted by opposite party No.1 and No.2.  Hence in our view an amount of Rs.20,000/ towards mental agony and harassment and Rs.5,000 towards cost would meet the ends of justice. Hence we answer point No.2 partly in the affirmative.

        POINTS No. (iii):   wherefore the following Order:

ORDER

     The complaint is partly allowed. The opposite parties No.1 and No.2 are directed to pay Rs.35,178/- (Rupees Thirty Five thousand one hundred Seventy Eight only) with the interest 9% per annum from 3.4.2013 to complainant till the date of payment.

     Opposite parties shall also pay Rs. 20,000/- (Rupees Twenty thousand only) towards compensation and another Rs.5,000/- (Rupees Five thousand only) towards cost.  Payment shall be made within 30 days from the date of receipt of copy of this order.

Copy of this order as per statutory requirements, be forward to the parties free of costs and file shall be consigned to record room.

(Page No.1 to 10 Dictated directly to the computer system to the Stenographer typed by her, revised and pronounced in the open court on this the 30^th November 2016)

ANNEXURE

Witnesses examined on behalf of the Complainant:

CW1  Mr. B.L. Somashekara Nayak

Documents marked on behalf of the Complainant:

Ex C1: 30.04.2011    : Identity Card

                               : list of the hospital under the Yashasvini Co operative Health care scheme

ExC2:                      : Document revealing thereon the eligibility  Of the members

ExC3:                       : Receipt for a sum of Rs.22,178/

Ex.C4: 31.03.2013      : Echo cardiography Report

Ex.C5:                        : Certificate

Ex.C6: 09.04.2012       : Receipt issued by Bhagamandala Vyavasaya  Seva Sahakari Bank ltd

Ex.C7: 09.04.2012       : Receipt issued by Bhagamandala Vyavasaya Seva Sahakari Bank ltd

Ex.C8:                        : Prescription issued by Dr.Jayaram Shetty

Ex.C9:                        : Prescription issued by Dr.Jayaram Shetty  

Ex.C10.C19                   : Bills issued by the opp No.1

Ex.C20:                       :  Prescription issued by Dr.U.R. Shenoy

Ex.C21:                       :  laboratory investigation report form

Ex.C22.C30:                 :  Bills issued by the opp No.1

Ex.C31:                        : laboratory investigation report form

Ex.C32:                      : Blood investigation Report

Ex.C33:                       :  Rapid Serology Tests Report

Ex.C34:                       : Laboratory investigation Report Form

Ex.C35:                       : Electrocardiogram issued by Dr. Jayaram  Shenoy

Ex.C36:                       : Report of the Sigmoidoscopy

Ex.C37:                        : X. Rayed report issued by Dr Jayaram Shenoy

Ex.C38:                        : Final Bill

Ex.C39:                         : Complaint letter to op.                 

Witnesses examined on behalf of the Opposite Parties:

RW1: Mr. Robert D Souza, Manager, City Hospital

Documents producedon behalf of the Opposite Parties:

 Nil 

Dated:  30.11.2016                             PRESIDENT