DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BARNALA, PUNJAB.

Complaint Case No : CC/272/2021

Date of Institution   : 17.11.2021

Date of Decision    : 05.06.2024

1.Sukhmani aged 23 years wife of Sh. Gagandeep Singh, resident of Suja Patti Village Sanghera, Tehsil and District Barnala.

2.Karamjit Kaur aged 47 years wife of Late S. Kaka Singh mother of Late S. Gagandeep Singh, resident of Suja Patti Village Sanghera, Tehsil and District Barnala.      

                         …Complainants Versus

1.Adesh Advanced Imagine Institute, NH-7, Barnala Road, Bathinda, through its Director/MD/Incharge.

2.State Health Agency Punjab, BSNL Circle Office, Sector 34A, Sector 34, Chandigarh-160022, through its Secretary/Chief Executive Officer.       

                           …Opposite Parties

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

Present: Ms. Simaranjeet Kaur Purba counsel for complainants.

Opposite party No. 1 exparte.

Sh. Lokeshwar Sewak counsel for opposite party No. 2.

Quorum:-

1. Sh. Jot Naranjan Singh Gill : President

2.Smt. Urmila Kumari : Member

3.Sh. Navdeep Kumar Garg : Member

ORDER

JOT NARANJAN SINGH GILL, PRESIDENT

1. The complainants namely Sukhmani and Karamjit Kaur have filed the present complaint under Section 35 of the Consumer Protection Act 2019, (amended upto date) against Adesh Advanced Imagine Institute and others (hereinafter referred as opposite parties).   

2. The facts leading to the present complaint are that the complainants are the legal heirs of Sh. Gagandeep Singh being his wife and mother respectively. It is alleged that Sh. Gagandeep Singh was holder/beneficiary of Ayushman Bhart-Sarbat Sehat Bima Yojna vide Card No. PRVYMN07R. It is further alleged that Sh. Gagandeep Singh suffered from COVID-19 Pnemonia and after making the enquiry that Adesh Advanced Imagine Institute is registered with Ayushman Bhart-Sarbat Sehat Bima Yojna and online checking the empannelment of Adesh Advanced Imagine Institute with Ayushman Bhart-Sarbat Sehat Bima Yojna, Sh. Gagandeep Singh was admitted in Adesh Advanced Imagine Institute on 14.5.2021 for the diagnose of COVID-19. Since Sh. Gagandeep Singh was the holder of  Ayushman Bhart-Sarbat Sehat Bima Yojna Card, as such Sh. Gagandeep Singh was required to be provided cashless treatment in the hospital, but the hospital authorities flatly refused to extend the benefit of cashless facility to Sh. Gagandeep Singh though the hospital authorities are under the legal and contractual obligation to extend cashless facility to the holders of Ayushman Bhart-Sarbat Sehat Bima Yojna Card as per their empanelment with Ayushman Bhart-Sarbat Sehat Bima Yojna. Since the condition of Sh. Gagandeep Singh was critical being infected from COVID-19, as such there was no other option but to admit him in Adesh Advanced Imagine Institute due to his critical condition. Sh. Gagandeep Singh remained under treatment of Adesh Advanced Imagine Institute for the period 14.5.2021 to 22.5.2021. However, unfortunately Sh. Gagandeep Singh could not recover and he expired on 22.5.2021. The hospital authorities have charged a handsome amount of more than Rs. 3,04,771/- from the complainants towards treatment of Sh. Gagandeep Singh. The charging of the above said amount by the opposite party No. 1 from the complainants is totally illegal and arbitrary and by doing these acts they have committed deficiency in service and unfair trade practice. The complainants have suffered utmost physical as well as mental pain, agony, harassment,humilation, anguish and remained tensed and under depression for a number of days due to the deficiency in service and unfair trade practice committed by the opposite parties. The complainants got served one registered legal notice dated 16.9.2021 upon the opposite parties through counsel and calling upon the opposite parties to reimburse the claim amount of Rs. 3,04,771/- to the complainants and to compensate the complainants to the tune of Rs. 5,00,000/-for the physical as well as mental pain, agony etc. But the opposite parties have failed to do the needful in this regard till date. Hence, the present complaint is filed for seeking the following reliefs.- 

i)To to reimburse the claim amount of Rs. 3,04,771/- to the complainants.

ii)To compensate the complainants to the tune of Rs. 5,00,000/-for the physical as well as mental pain, agony, harassment, humiliation, anguish, tension and depression suffered by the complainants  and to pay Rs. 21,000/- as litigation expenses.  

3. The opposite party No. 1 was proceeded against exparte vide order dated 11.1.2022 due to non appearance.

4. Upon notice of this complaint, the opposite party No. 2 appeared and filed written version by taking preliminary objections interalia on the grounds that complainants have no locus-standi to file the present complaint. Complainants have not come with clean hands and suppressed the material facts. It is submitted that the opposite party No. 2 is only service provider under Ayushman Bhart-Sarbat Sehat Bima Yojna Scheme and the complainants never approached the answering opposite party at any time and in any manner. There is no role of opposite party No. 2 to pass or repudiated the claim and if any institute not accepted the card under the scheme then how the opposite party No. 2 can liable for that. The present complaint is bad for non-joinder of necessary party. 

5. On merits, it is submitted that no information was ever sent in this regard to answering opposite party No. 2 by the complainants and her family member at any time in any manner. It is submitted that the legal notice was vague and against law and facts and the answering opposite party No. 2 is not liable to pay any claim amount to the complainant in any manner rather complainants has dragged the answering opposite party No. 2 in a false litigation moreover the complainants never approached for any claim to answering opposite party No. 2 at any time and in any manner. All other allegations of the complaint are denied and prayed for the dismissal of complaint with costs.

6. The complainant filed rejoinder to the written statement filed by the opposite party No. 2 vide which the complainant denied the averments mentioned in the written statement.

7. To prove their case the complainants tendered into evidence their own affidavit Ex.C-1, copy of Prescription slip Ex.C-2, copy of report of Scan/Angiography Ex.C-3, copy of Ayushman Bhart-Sarbat Sehat Bima Yojna Card Ex.C-4, copy of bills and receipts Ex.C-5 (containing 19 pages), copy of death form Ex.C-6, copy of death certificate Ex.C-7, copy of legal notice Ex.C-8, copy of postal receipt Ex.C-9, copies of Track record Ex.C-10 & Ex.C-11, copy of lists of hospitals Ex.C-12 (containing 4 pages), copy of notification dated 24.5.2021 Ex.C-13 (containing 5 pages) and closed the evidence.    

8. To rebut the case of the complainant the opposite party No. 2 tendered into evidence affidavit of Gurminder Kaur Ex.O.P2/1 and closed the evidence.  

9. We have heard the learned counsel for the parties and have gone through the record on file. Written arguments filed by the complainants. 

10. The case of the complainants are that complainants are the legal heirs of Sh. Gagandeep Singh being his wife and mother respectively as the Gagandeep Singh was holder/beneficiary of Ayushman Bhart-Sarbat Sehat Bima Yojna vide Card No. PRVYMN07R and he was suffered from COVID-19 Pnemonia and after making the enquiry that Adesh Advanced Imagine Institute is registered with Ayushman Bhart-Sarbat Sehat Bima Yojna Sh. Gagandeep Singh was admitted in Adesh Advanced Imagine Institute on 14.5.2021 for the diagnose of COVID-19. So, the deceased Sh. Gagandeep Singh was required to be provided cashless treatment in the hospital, but the hospital authorities flatly refused to extend the benefit of cashless facility to Sh. Gagandeep Singh though the hospital authorities are under the legal and contractual obligation to extend cashless facility to the holders of Ayushman Bhart-Sarbat Sehat Bima Yojna Card as per their empanelment with Ayushman Bhart-Sarbat Sehat Bima Yojna. As the condition of Sh. Gagandeep Singh was critical being infected from COVID-19, as such there was no other option but to admit him in Adesh Advanced Imagine Institute due to his critical condition and Sh. Gagandeep Singh remained under treatment of Adesh Advanced Imagine Institute for the period 14.5.2021 to 22.5.2021, however unfortunately Sh. Gagandeep Singh could not recover and he expired on 22.5.2021 and the hospital authorities have charged a handsome amount of more than Rs. 3,04,771/- from the complainants towards treatment of Sh. Gagandeep Singh. But the charging of the above said amount by the opposite party No. 1 from the complainants is totally illegal and arbitrary and by doing these acts they have committed deficiency in service and unfair trade practice. The complainants also got served one registered legal notice dated 16.9.2021 upon the opposite parties through counsel but the opposite parties have failed to do the needful in this regard till date. 

11. On the other hand, the stand of the opposite party No. 2 is that the opposite party No. 2 is only service provider under Ayushman Bhart-Sarbat Sehat Bima Yojna Scheme and the complainants never approached the answering opposite party at any time and in any manner and there is no role of opposite party No. 2 to pass or repudiate the claim and if any institute not accepted the card under the scheme then how the opposite party No. 2 can liable for that. It is further the case of the opposite party No. 2 that no information was ever sent in this regard to answering opposite party No. 2 by the complainants and her family member at any time in any manner and the legal notice was vague and against law and facts and the answering opposite party No. 2 is not liable to pay any claim amount to the complainant in any manner, rather complainants has dragged the answering opposite party No. 2 in a false litigation moreover the complainants never approached for any claim to answering opposite party No. 2 at any time and in any manner. 

12. We have gone through the facts of the present case and are of the view that the complainants have failed to place on record any document/evidence to prove the fact that they have ever approached the opposite party No. 2 or lodged claim with the opposite party No. 2 at any point of time. Because the opposite party No. 2 has submitted in their written version that the complainants have never approached to them for the reimburse of claim in any manner. We are of the view that the complainant should have approached the opposite party No. 2 and have to lodge their claim with them for the reimbursement of expenses which was occurred on the treatment of Sh. Gagandeep Singh who was a beneficiary/holder of   Ayushman Bhart-Sarbat Sehat Bima Yojna vide Card No. PRVYMN07R and this fact is also not denied by the opposite party No. 2 in its written version. Therefore, without touching the merits of the present case we are of the view if a direction is issued to the complainants to lodge their claim for reimbursement of their claim with the opposite party No. 2 alongwith required documents and the opposite party No. 2 is directed to settle the claim of the complainants as per law within stipulated period that will suffice the purpose of the present complaint and no prejudice will be caused to the parties.

13. So, in view of the above discussion, we dispose of the present complaint with the direction that the complainants will approach to the opposite party No. 2 and lodge their claim for reimbursement alongwith all required documents within 30 days from the receipt of this order and thereafter the opposite party No. 2 will decide/settle the claim of the complainants within 60 days from the receipt of claim documents from the complainants as per law. There is no order as to costs or compensation. However, the complainants are at liberty to file a fresh complaint if they are not satisfied with the decision of the opposite party No. 2, if desires so. 

14. Copy of this order be supplied to the parties free of costs as per rules. File be consigned to the records after its due compliance.

ANNOUNCED IN THE OPEN COMMISSION:

       5th Day of June, 2024

 

            (Jot Naranjan Singh Gill)

            President

 

(Urmila Kumari)

Member

 

(Navdeep Kumar Garg)

Member