Delhi

Central Delhi

CC/239/2017

THAKUR DASS - Complainant(s)

Versus

DR. B.L. KAPUR MEMORIAL HOSPITAL - Opp.Party(s)

09 Feb 2024

ORDER

Heading1
Heading2
 
Complaint Case No. CC/239/2017
( Date of Filing : 07 Oct 2017 )
 
1. THAKUR DASS
H. NO. 44, A NEHRU KUTIYA, MALKA GANJ, DELHI-7
...........Complainant(s)
Versus
1. DR. B.L. KAPUR MEMORIAL HOSPITAL
DR. B.L.K. KAPUR MEMMORIAL HOSPITAL, PUSA ROAD, NEW DELHI -05.
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MR. INDER JEET SINGH PRESIDENT
 HON'BLE MRS. SHAHINA MEMBER
 
PRESENT:
 
Dated : 09 Feb 2024
Final Order / Judgement

Before the District Consumer Dispute Redressal Commission [Central District] - VIII,      5th Floor Maharana Pratap ISBT Building, Kashmere Gate, Delhi

                                      Complaint Case No. 239/07.10.2017

 

Thakur Dass s/o Late Sh. Bhagwan Dass

H. No.44, A Nehru Kutiya, Malka Ganj, Delhi-7 &

Falt No. J-3107, Gaur Green City,

Indirapuram, Ghaziabad-201014                                                  …Complainant

                                                Versus

OP1-Medical Superintendent

Dr. B. L. Kapur Memorial Hospital, Pusa Road,

New Delhi-110005

 

OP2-The Managing/Executive Director

Dr. B. L. Kapur Memorial Hospital, Pusa Road,

New Delhi-110005                                                                          ...Opposite Party

 

                                                                                    Senior Citizen Case

                                                                                    Date of filing:             07.10.2017

Coram:                                                                       Date of Order:             09.02.2024

Shri Inder Jeet Singh, President

Ms. Shahina, Member -Female

                                                       ORDER

Inder Jeet Singh , President

 

1.1. (Introduction to case of parties) –The complainant has grievances against the OPs that the complainant being pensioner/beneficiary of CGHS card holder was charged by the OPs by converting cashless facility into private/general patient cash rates, consequently raised bills of Rs.4,18,050/-  (i.e. Rs. 4,08,863+Rs. 9,187) was at the exorbitant rates, arbitrarily and against the norms, which is a gross negligence and violation of terms and conditions of MOD of empanelled hospital. But the complainant was reimbursed a sum of Rs. 1,15,282/- by the Government authorities out of total amount of Rs. 4,18,050/- charged by the OPs and the complainant suffered losses of amount of Rs. 3,02, 772/-, for which the complaint has been filed, besides claiming interest of 18% pa, loss of earning of Rs. 10 lakhs, litigation cost of Rs. 70,000/- besides other reliefs.

 

1.2. The OPs opposed the complaint that neither there was any negligence nor deficiency of services nor any exorbitant amount was charged but according to the norms and standard rates. The complainant’s son Mr. Jitender Dev (at the time of admission of the complainant) had got registered patient’s name Sh. T. Dass by MRD no. 49363 under the category of ‘cash’/private patient and there was no registration under cashless/pensioner beneficiary was got done. The OPs cannot be blame as such.

1.3 It is relevant to mention here that after completion of the pleadings, the parties led their evidence, then miscellaneous applications were filed, the same were dealt as per proceedings on record, especially by detailed order dated 18.08.2023. There is affidavit of evidence by the complainant followed by supplementary affidavit of evidence. Similarly, there is affidavit OPs’ witness followed by supplementary affidavit of same witness. All of them will be read to appreciate their cases.

1.4 In the pleadings and evidence of the parties, certain medical terminology have been used but without their meaning, therefore, it is being felt appropriate to refer some of them with simple meanings to understand and apprehend the nature of disease, its diagnosis and treatment. The same are as follows:-

 

(a) ERCP-Endoscopic etrograde cholagio pancreatography is a procedure/test to diagnose and treat problems in the liver, gall bladder, bile ducts, and pancreas. It is a less invasive procedure than surgery.

 

(b) MRCP- Magnetic resonance cholangio pancreatrography is a special kind of MRT test, to look at the billary and pancreatic system. This includes the pancreas, the pancreatic duct, the bile ducts, gallbladder & liver. It is non-invasive procedure and as an alternate to ERCP

 

(c) LAP- Cholecytectomy- LAP Cholecytectomy is a surgery to remove gallbladder.

 

(d) Endoscopy - Endoscopy is procedure that allows a doctor to view the inside of  a patient's and it is done for the purposes to diagnose diseases in stomach.

 

2.1. (Case of complainant) –The complainant has retired from the post of Deputy Legal Advisor/CBI, New Delhi having pensioner CGHS beneficiary card. He is a practicing lawyer in Delhi. OP1 is a Medical Superintendent and OP2 is a Executive Director of Dr. BL Kapoor Memorial Hospital (hereinafter as the hospital), which is approved in the list/panel of CGHS. 

2.2. The complainant was suffering from pain in abdomen for the last one month due to stone in the gall-bladder, it was 19.10.2016 when permission for removal of stone was obtained from CGHS dispensary, Shakti Nagar, Delhi  to be done from R.G. Stone Hospital, New Delhi. On 29.10.2016 the complainant attended OPD of R. G. Stone Hospital, New Delhi, where he was examined by the doctor and complainant was referred to Dr. V. C. Vij of Dr. B.L. Kapoor Hospital, Pusa Road, New Delhi.

2.3  In the midnight of 30.10.2016, the complainant had acute pain in the abdomen and he was taken to the emergency of Hospital, where the examining doctor advised admission in writing, then the complainant along-with his son Mr. Jitender Dev visited the admission counter for admission and produced his CGHS ID 1030670 and CGHS card no. 933110 to the desk clerk at admission counter but he refused to allow the admission, being pensioner/beneficiary of CGHS card holder by stating that there is outstanding bills of hospital of Rs.2 crore approximately against the Central Government. The complainant obtained permission for MRCP on 31.10.2016 from CGHS dispensary, Shakti Nagar/ Sabji Mandi, Delhi for the Hospital. Again on 31.10.2016 and 01.11.2016 the complainant along-with his son went to emergency ward of the hospital due to acute pain, where  Radiology, MR-Cholecystox, kidney function, pancreatography were done on the basis of cashless facility but admission was again refused for pensioner of CGHS card holder; the complainant was further advised to attend OPD-5 of 01.11.2016.

            The complainant while following the instructions, attended OPD-5 of the hospital and Dr. J.C. Vij advised admission after examining the complainant. The admission request form dated 01.11.2016 written by the said doctor along-with permission from CGHS dispensary was produced before the admission counter clerk but it was again refused on the same very reason. Further, the complainant was asked that admission in the hospital would be on payment in cash as a general patient but not as CGHS beneficiary/card holder. On 03.11.2016 at 2 pm the complainant again visited at the emergency of the hospital but no treatment was provided and it was refused for admission, with an advised to attend OPD-5. However, the condition of complainant was serious due to acute pain in the abdomen and large hiatus hernia. Again on 03.11.2016 the complainant attended OPD-5 of the hospital and Dr. J.C. Vij advised admission but the admission counter clerk refused the admission by reiterating the same ground that there is outstanding bill of Rs. 2 crore approximately against Central Government.

2.4   On 03.11.2016 the complainant was admitted in the hospital as per advises of the doctor but the hospital did not extend credit facility despite it was very well in the knowledge of OPs and admission counter clerk that complainant is beneficiary of CGHS scheme and entitled for cashless facility. The cashless facility was refused deliberately. The hospital themselves converted the cashless facility into private/general patient rate, they raised bill of Rs.4,08,863/- and Rs. 9,187/- illegally, wrongly and arbitrarily, since it is against the approved rates, terms and conditions of CGHS for the removal of gallbladder, large hiatus and removal of stone on 11.11.2016 and 27.12.2016. But subsequently, on 12.12.2016 the consultancy of Rs. 150/- in OPD was on the basis of CGHS card.

2.5.  It is well within the knowledge of OPs by virtue of approval letter dated 31.10.2016 that the complainant is pensioner/beneficiary of CGHS scheme and entitled for cashless facility but it was not extended; the original approval letter was endorsed on 31.10.2016 by Ms. Kaveri of OPs against bill. The complainant had also submitted medical reimbursement form to the hospital for attestation to be within period of limitation but it was returned without mentioning any reason by the OPs. On 24.03.2017 the complainant had again submitted reimbursement form for seeking clarification from the OPs for want of extending credit facility despite there was certificate issued by the treating doctor for admission. Thence, on 18.04.2017 at 12:30 pm the complainant received telephone call to receive reimbursement paper, however, till then it was unnecessary delay in attesting the claim form along-with reply of query raised by CGHS.

            On 24.07.2017 the complainant submitted reimbursement medical bill of Rs. 4,08,863/- and Rs.9,187/- for reimbursement to CMO, CGHS dispensary, Shakti Nagar/ Shastri Nagar, Delhi but the complainant received reimbursed amount of Rs. 1,15,282/- from CGHS dispensary out of Rs. 4,18,050/-, consequently the complainant suffered losses of Rs. 3,02,772/- due to negligence of the hospital, since the hospital charged the amount at exorbitant rates, which was not as per CGHS approved rates besides against violation of terms and conditions of MOD of empanelment. Moreover, the complainant had produced beneficiary ID and requested the OPs to make the charges as per CGHS approved rates, however, it was refused.

2.6.  Since the   OPs have charged the amount illegally and arbitrarily, which has caused financial losses besides physical and mental sufferings due to the acts of OPs, which amounts to gross negligence. The complainant also sent legal notice dated 20.04.2017 to the OPs to refund the amount with interest besides to compensate the earnings and loss for mental torture; it was replied by the OPs, without compliance of notice. That is why the complaint was filed.

2.7 The complaint is accompanied with documents, comprising pensioner card, CGHS card, approval dated 31.08.2016 and 11.08.2016, OPD assessment and plan of care, admission request form under MRD no. 430617, emergency certificate dated 12.12.2016, letters bearing date 04.02.2016, checklist for reimbursement of medical claim, letter dated 24.03.2017, its reply dated 17.04.2017 by OP, advised admission dated 12.12.2016, discharge summary, final summary bill, final bill detail, department of emergency and acute care medicine case summary dated 01.11.2016, cash bills, advance receipt, final summary bills.   

3.1 (Case of OPs)-The OPs give introduction about its status and its profile of medical institute being world class services to its patients and it enjoys and enviable reputation, in its league. However, the complaint is without cause of action as it does not reflect any lapses or bbbnegligence on the part of OPs to entitle him for the relief being sought. There was no refusal for admission as alleged being CGHS card holder on the allegation of outstanding bill of Rs. 2 crore against the Government. In fact, at that material time of treatment of complainant in the hospital, the hospital was already treating approximately 30-40 other patients, who were CGHS card holders and they were being treated as per that criteria.

3.2. In fact, the complainant got registered with the hospital with the MRD no. 491363 (for general cash billing) by name Mr. T. Dass by his son Mr. Jitender Dev, being patient’s attendant. He failed to disclose to the hospital at the time of admission that complainant is a CGHS card holder. The Face sheet was signed by Sh. Jitender Dev on 03.11.2016 at the time of admission of complainant and in its heading ‘sponsor’, it is clearly mentioned ‘cash’, which indicates that neither the complainant nor his son disclosed that complainant is a CGHS card holder. Moreover, in the same Face sheet, it was also declared that complainant does not belong to any health insurance scheme such as ECHS/ESI/CGHS and opted for general cash billing. Accordingly, the complainant was given treatment and bills were charged as per norms.

            Had the complainant or his son disclosed or declared CGHS detail within relevant time to the hospital, then appropriate steps would have been ensured to treat the complainant accordingly. There is neither negligence nor bills were raised illegally, wrongly or at exorbitant rate.

3.3   So far complainant’s visit at OPD-5 is concerned, he had provided MRD no. BLK490617 (cashless/pensioner CGHS) in the name of Thakur Dass, accordingly, cashless facility was provided/ registered. However, the name and address in MRD no. 490617 and in MRD no. 491363 are completed different. There was neither refusal of admission nor denial of health insurance scheme, since the complainant opted for cash billing. The complainant was treated from 03.11.2016 to 11.11.2016 under separate MRD no. 491363 (he was admitted on 03.11.2016, he underwent a procedure call Endoscopy on 04.11.2016 and he was operated on 07.11.2016; he was discharged on 11.11.2016) but for another bill of date 12.12.2016, he was registered under separate MRD no. 490617 for cashless payment.

3.4 The OPs denies other allegations of complaint in respect of letter dated 31.10.2016 that it was not received by Ms. Kaveri as alleged nor the noting suggests any acknowledgement being written in 'third form'.  Moreover, the letter dated 24.03.2017 was responded by mentioning clearly that at the time of admission,  the complainant has not disclosed of CHGS beneficiary, the reply is already part of the record of complainant.

            Consequently, there is no merit or cause of action in favour of complainant or against the OPs. The complainant is not entitled for any amount or relief claimed. The OPs' written statement is accompanied with Face sheet dated 03.11.2016 (MRD no. 491383 of cash/general patient billing).

4. (Replication of complainant) –The complainant filed his detailed replication, it reaffirms the contents of complaint as well as it denies all the allegations of written statement. The complainant also explains that the hospital deliberately changed the MRD from cashless facility to private/general patient, besides change of name from Thakur Dass to T. Dass as well as the residential address. It was done deliberately. The complainant is not liable in case signature of a family member was obtained on the Face sheet, especially the complainant was not in a good health at that moment as well as his rights of cashless facility under CGHS scheme cannot be denied by the OPs, when it was already known to the OPs.

5.1. (Evidence)-The complainant filed detailed affidavit of evidence followed by supplementary affidavit with the support of documents filed with the pleadings, besides affidavit u/s 65B of the Evidence Act that he was supplied with the record of bills etc.

5.2. Similarly, OPs led evidence by filing affidavit of evidence of  Dr. Sanjay Mehta, Head Medical Services, followed by supplementary affidavit, on the pattern of written statement with the support of Face sheet already filed with the reply. The supplementary affidavit high lights statistic data that number of patient under CGHS were attended in OPD and as indoor patient during that tenure of treatment of complainant.

5.3 It is relevant to mention that there were applications inclusive of application to endorse the documents exhibits at the stage of final arguments, this issue was resolved by detailed reasoned order dated 18.08.2023 that the documents mentioned in the affidavits of both the sides will be read as part of the evidence irrespective of the facts, whether there is omission to write/endorse exhibits numbers on the documents, since proceedings under the Consumer Protection Act, 1986 are summary in nature.

6.1 (Final hearing)- The complainant and the OPs filed their respective detailed written arguments, followed by oral submissions by the complainant (himself) and Sh. Mohit Sharma, Advocate for OP1 & OP2. The written arguments are blend of pleadings and evidence. However, the issues addressed during the oral submission or other contentions are not repeated here, they will be dealt appropriately.

6.2. The rival contentions are based on the material on record, which were highlighted during the oral submissions. Further, the OPs derive reasons from Sri Mihir Kr. Roy Burman Vs. Ministry of Health and Family Welfare, Govt. of India FA. A/444/2017 SCDRC, Best Bengal, dod 10.02.2017 that the appellant got admitted his wife by availing medical insurance policy instead of covered under CGHS, consequently for raising of the bills accordingly would not be construed that there is violation of terms and conditions of the scheme. In  Ravneet Singh Bagga Vs. KLM Royal Dutch Airlines and Ors. CA No. 8701/1997 SC dod 02.11.1999 it was held the deficiency of services cannot be alleged without attributing, fault, imperfection, short-coming or inadequacy in the quality and manner of performance which is required to be performed by  a person in pursuance of a contract or otherwise in relation to any service. However, there is no medical negligence or other negligence or deficiency of services.

            However, the complainant opposed these submissions of OPs that ratio of case law does not applies to the feature of this case, since the facts are entirely different.

7.1 (Findings)- The rival contentions are considered, keeping in view the material on record especially the documentary record, the provisions of law under the Consumer Protection Act 1986 and the case law presented.

            On plain reading of case of the parties, there is no dispute in respect of the treatment rendered to the complainant, the bills raised and the entire bills amount paid by the complainant to the hospital. There is also no dispute the bills were raised as cash/general patient billing. But the dispute rests upon other issue "whether or not the complainant is entitled for the amount being claimed in the present complaint?", Whether or not there is deficiency of services?". Further, the narrow controversy is the complainant is making the claim as CGHS beneficiary (pensioner) but on the other side the case of OPs is that the complainant had opted as ‘cash’/general private patient option instead of CGHS beneficiary.

            At the outset, the answer of this controversy is existing in the documentary record itself, it is to be peeped into and to be demonstrated with the chronology of event, which are also in the record itself.

7.2. One of the issue is in para-8 of evidence of OPs that there are scandalous allegations by the complainant against OPs, whereas no such expression mentioned  in the written statement by OPs nor there were such expression in the complaint. The OPs are deriving their own reasons by mentioning so in the affidavit of evidence; this is beyond written statement.

7.3. By taking into account chronology of the event along-with the documentary record, the following conclusions are drawn:-

(i) The case of OPs is that they were not having knowledge about the status of complainant as CGHS beneficiary (pensioner) for want of such disclosure in the Face sheet but on the other side the complainant’s case is that OPs, its doctor and admission counter clerk was having complete information in this regard because the relevant record was repeated produced.

 

(ii) The complainant had proved his identity card/pensioner and CGHS beneficiary card, besides authorization/permission dated 11.08.2016 and 31.10.2016 (pages-14,15,16 &18, of paper book of complainant).  The permission dated 31.10.2016 mentions at its bottom bill no. 16-17 CR/125293 dated 31.10.2016. The complainant has also proved cash/credit bill dated 31.10.2016 12:53 pm issued by the hospital and this receipt mentions bill no. 16-17 CR/125293 dated 31.10.2016. This cash receipt is in respect of MRD no. BLK490617, which is a cashless facility, being CGHS pensioner card holder.

            It is relevant to mention that for CGHS beneficiary in service has to pay the amount and then get is reimbursed as per rules. However, for CGHS pensioner, cash is not charged by medical hospital but credit bill is issued. That is the complainant was issued that credit bill.

 

(iii) The complainant has proved admission request form (at page no. 19 of the paper book), being admission request form and it mentions expected date and time of admission of 01.11.2016 under MRD no. 490617 under Dr. J. C. Vij, which is also signed by him. Simultaneously, the complainant has also proved cash/credit  bill dated 01.11.2016 17:51 pm, for Rs. 1583/- which is also under bill no. 16-17 CR/125293 dated 31.10.2016 and MRD No. BLK490617 (cashless). There is another similar receipt  of Rs. 2,492/- under the same particulars. This receipt was issued by the hospital/OPs.

 

(iv) The complainant has also proved case summary (at page-45 of the paper book) of his admission in  the hospital on 01.11.2016 at 1:50 pm and his discharge on the same very day in the evening hour, this admission and discharge was under MRD no. BLK490617 (cashless/CGHS pensioner).

 

(v) It is crystal clear and it  also proves  that complainant along-with his son had visited the hospital on 31.10.2016  and on 01.11.2016 and that is why the record is reflecting MRD no. BLK490617.

 

(vi) Similarly, the OPs have proved Face sheet dated 03.11.2016 and in that Face sheet there is a declaration by Sh. Jitender Dev that the complainant does not belong health insurance scheme such as ECHS/ESI/CGHS. This is an exclusive document, on the basis of which OPs rest their case that complainant or his son has opted cash category and accordingly treatment was rendered as per norms and billings were also raised.  However, there are some other important aspects,  they need to be looked into, which are:-

 

            (a) This Face sheet mentions MRD no. BLK491363 and the date/time of admission mentioned is 03.11.2016/04:40 pm. The complainant has proved cash bill of date/time 03.11.2016/15:34 pm for Rs. 1200/- and another cash bill/receipt 03.11.2016/ 04:11 pm of advance of Rs. 20,000/- made to the hospital. By reading the timings mentioned on the receipt [being auto generated receipts from the system of hospital], are prior to  the timings mention in Face sheet, as Face sheet mentions its preparation at 04:40 pm. To say,  what emerged is that complainant was asked to  first deposit the amount at the cash counter and lateron Face sheet was prepared since the cash receipt were already assigned MRD no. BLK491363 ,which was  mentioned in the Face sheet which was prepared after timings of cash deposit receipts. Then complainant's son had signed the declaration or it was got signed.  

 

(b) The  chronology of dates/timings is reflecting that complainant alongwith his son has been visiting the hospital to seek admission for his treatment and admission was refused for such treatment for which permission was granted, he was asked to seek treatment as a general patient and that is why the record of 03.11.2016 is reflecting MRD no. BLK491363 (cash/general patient) on admission on 03.11.2016.

            In addition there is case sheet of 01.11.2016, the complainant was admitted but discharged on same date, why? This also corroborate the case of complainant that he was being refused the admission as CGHS pensioner.

 

(c) The complainant has also proved the payment receipt from 03.11.2016 onwards and all the receipts issued are showing MRD no. BLK491363, since he was charged as a private general patient.

 

(vii) The documentary record is also showing that the complainant was under the treatment of Dr. J. C. Vij throughout irrespective of the fact there was MRD no. BLK490617 (cashless facility/CGHS pensioner) or MRD no. BLK491363 (cash/general patient).  The emergency admission for 01.11.2016 was for treatment under Dr. J C Vij. Similarly after during general category patient, the discharge summary also refers name of same doctor - Dr. J C Vij. To say, the documentary record does not establish the plea of OPs that it was not in their knowledge or for want of disclosing the CGHS pensioner by the complainant, that benefit was not extended.

            The OPs or its doctor or its attending staff was knowing well that it is the same complainant, being CGHS beneficiary pensioner, taking the treatment from the hospital. The record is also speaking volume about it.

 

(viii). The OPs shield them that there were many other CGHS beneficiary under treatment during that tenure, however, it would not given benefit to the OPs because of specific evidence in respect of present complainant.

            Moreover, it is own plea of OPs that had it been known  or made known to the OPs that complainant is CGHS beneficiary/Pensioner, he would have been treated so and extended him that benefit. The evidence on record proves that it was already known to the OPs, the complainant was also being treated as CGHS beneficiary (pensioner) prior to 03.11.2016. It also made known to the OPs by furnishing record and permission from the competent authority in the name of complainant for this treatment, much prior to 03.11.2016 .

 

(ix) What appears is that after frequent visits with the referral and permission of treatment,  when the complainant was not entertained as a CGHS pensioner for treatment but he was a need of treatment, he was constrained bow for the requirements asked for and before his discharge he had deposited the entire medical bill amount. The bill amount or its payment by the complainant is not disputed.  

 

7.4 Since the complainant has succeeded to prove the circumstances that he had entered the hospital as a CGHS beneficiary (pensioner)  with referral and permission for treatment, the hospital is on the empanelment of the government, the complainant was also entertained as CGHS beneficiary (pensioner) by the hospital for which there is documentary record of receipts issued by the hospital besides case summary of 01.11.2016. However, from 03.11.2016 onwards, the complainant was registered and entertained under new MRD no. 491363 (cash/general patient billings) and accordingly the bills were raised and bills amount was paid by the complainant.

            However, it may happen that a CGHS beneficiary (pensioner) may avail the services of hospital as a general/private patient but it ought to have been voluntarily and as a personal choice, it may be for so many reasons like availing of higher class room, choice of a particular doctor and do so on. But in the situation of the present case of complainant, it  is not so, since there is no proof of such circumstances by the OPs but proof of compulsions and other features proved by the complainant. Consequently, the ratio of case law Sri Mihir Kr. Roy Burman (supra) does not apply to the situation in hand.

7.5     Since it is well known to the OPs that the complainant is CGHS beneficiary pensioner and complainant was already getting treatment from the hospital till 01.11.2016 but from 03.11.2016,  he was treated as a general patient and the medical bills were charged accordingly as a general private patient instead of at the rates approved for CGHS beneficiary pensioner as cashless facility. The complainant was constraint to pay the entire medical bills amount and when complainant requested for reasons, it was also delayed.  It amounts to deficiency of services (it is not out of context to mention that during the course of arguments on behalf of OPs an impression was being given as if the complainant alleged case of medical negligence, it needs to dispel the cloud,  that nowhere in the complaint or in his evidence,  he has uttered any instance of medical negligence nor the allegations of negligence are qualified by word 'medical' to infer 'medical negligence' . There are allegations  of negligence of other services,  which stand proved by the complainant).

7.6  Since the complainant had paid total bill amount of Rs. 4,18,050/- to the OPs and OPs have charged them as a general patient from the complainant but the complainant being CGHS beneficiary has been reimbursed amount of Rs. 1,15,282/- by the competent authority. Had the complainant been treated as CGHS beneficiary pensioner, he would not have to suffer the remaining amount of Rs. 3,02,772/- as medical expenses nor the OPs would have charged such amount from CGHS beneficiary. Therefore, the OPs are held liable through the hospital to reimburse/refund the amount of such bill of Rs. 3,02,772/-. (It is relevant to mention that the hospital have charged the amount as per rates for general private patient, which are more than the approved rate for CGHS beneficiary but there is no evidence by the complainant that OPs had over charged the complainant than rates for general private patient). Accordingly, complainant is held entitled for reimbursement/return amount of Rs. 3,02,772/- from hospital through OPs.

7.7  The complainant has claimed interest of 18% pa on the said amount but there is no proof of such rate of interest. However, the complainant had parted with the amount at the time of his discharge, therefore, in order to meet both ends, simple interest at the rate of 4%pa from the date of complaint till realization is allowed in favour of complainant and against the hospital/ OPs.

7.8 The complainant also claims amount of Rs. 10 lakhs as loss of earnings and for suffering mental torture  besides cost of litigation of Rs. 70,000/-. However, loss of income is alien to the concept of issue involved, therefore, request loss of income does not sustain but for compensation in lieu of suffering, inconvenience, harassment and  agony faced for seeking treatment and then reimbursement of medical claim amount, it is quantified as Rs.25,000/- in favour of complainant and against OPs  Since the complainant was constrained to file the present complaint to seek redressal of his grievances, therefore, the cost of Rs. 20,000/- in favour of complainant and against OPs.

8. Thus, the complaint is allowed in favour of complainant and against the OPs while directing the OPs to pay an amount of Rs. 3,02,772/- along with interest at the rate of 4% pa from the date of complaint till the realisation of amount besides damages of Rs. 25,000/- and costs of Rs. 20,000/- payable within 45 days from the date of order.  In case the amount is not paid by the OPs within 45 days from the date of this order, then the interest rate will be 6% pa on amount of Rs. 3,02,772/- (instead of rate of 4%pa).  

9. Announced on this 9th day of  2024 [माघ 20, साका 1945].

10. Copy of this Order be sent/provided forthwith to the parties free of cost as per rules for compliances besides upload on the website of this Commission.                                                                                                                                                                                                                                                                                                                                     

  [ijs-23]                                                                                                                                                            

 
 
[HON'BLE MR. INDER JEET SINGH]
PRESIDENT
 
 
[HON'BLE MRS. SHAHINA]
MEMBER
 

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