Chandigarh

DF-I

CC/586/2015

Meena Malik - Complainant(s)

Versus

Fortis Hospital - Opp.Party(s)

Charu Sharma

29 Mar 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, U.T. CHANDIGARH

==========

Consumer Complaint  No	:	CC/586/2015
Date  of  Institution	:	01/09/2015
Date   of   Decision	:	29/03/2017

 

 

 

 

 

Meena Malik wife of Late Shri Ram Pal Malik, resident of House No.83, Sector 27-A, Chandigarh.

…………. Complainant.

Vs

 

1.   Fortis Hospital, Sector 62, Phase-VIII, Sahibzada Ajit Singh Nagar, Punjab – 160062.

 

2.   The Secretary Health, Health Department, Govt. of Haryana, Civil Secretariat, Sector 1, U.T. Chandigarh.

 

3.   The Directorate of Agriculture, Haryana, Sector 6, Panchkula, Haryana.

………. Opposite Parties

 

BEFORE:   SH. S.S. PANESAR             PRESIDENT

MRS.SURJEET KAUR          MEMBER

                SH. S.K.SARDANA              MEMBER

 

For Complainant	:	Sh. Raman Sharma, Advocate.
For OP No.1	:	Sh. Munish Kapila, Advocate.
For OP Nos.2 & 3	:	None.

 

PER S.K. SARDANA, MEMBER

 

 

          Succinctly put, Late Sh. Rampal Malik - the husband of the Complainant, had undergone twice for his medical treatment at OP No.1 Hospital. Both the times, he underwent Angioplasty under Dr. R.K. Jaiswal when hospitalized from 11.12.2013 to 23.12.2013 and was operated on 16.12.2013 and from 12.05.2014 to 23.05.2014 and was operated on 19.05.2014. There was an agreement between the OP No.1 and OP No.2 with regard to providing treatment on the prescribed package rates. It has been averred that the medical procedure of Angiography was covered under the said prescribed package rates. After his discharge from the Hospital, Late Sh. Rampal Malik submitted his request for reimbursement of medical bills completing all the requisite formalities. OP No.2/3, however, did not reimburse the full amount and even assigned no reasons for the same. It has been alleged that in fact OP No.1 charged excessive rates than that of the prescribed package rates. The OP No.1 illegally overcharged an amount of Rs.3,53,156/-, which was not reimbursed by the OP No.2/3. Accordingly, Late Sh. Rampal Malik and then Complainant and her children had written various letters, representations and e-mails to the OPs to set the things right and pay/reimburse the medical bills/ overcharged amount, but to no success. Hence, with the cup of woes brimming, the Complainant has filed the instant consumer complaint, alleging that the aforesaid acts amount to deficiency in service and unfair trade practice on the part of the Opposite Parties.

 

2.      Notice of the complaint was sent to Opposite Parties seeking their version of the case.

 

3.      Opposite Party No.1 in its reply, while admitting the factual aspects of the case, has pleaded that Fortis Hospital, Mohali is empaneled by the Haryana Government and the matter of reimbursement is between the Govt. and the Complainant. It has been pleaded that the rate at which the implant cost is to be reimbursed to a Patient is prescribed by the Govt. irrespective of the implant cost chargeable from a Patient; as the Govt. has prescribed the maximum ceiling amount up to which is reimbursable to a Patient. It has been admitted that the husband of the Complainant was admitted multiple times including twice from 11.12.2013 to 23.12.2013 and from 12.05.2014 to 23.05.2014. It has been pleaded that the answering Opposite Party did not charge excessive rates as alleged. Regarding the admission from 11.12.2013 to 23.12.2013, the Patient was counselled as a normal patient billed as a normal patient and benefit of Haryana Govt. was not extended to him, as no I-Card was ever tendered during the course of this admission, till finalization of the bill. Therefore, the patient was rightly charged. Further, the answering Opposite Party has rightly charged for the admission from 12.05.2014 to 23.05.2014. However, in respect of consumables a Clerical error of the Billing Section was detected in this bill to the extent of Rs.21,768/- and the Hospital was/is ready and willing to pay the said amount to the Complainant. The disputed amount of Rs.3,53,156/- which the Complainant claims to have paid in excess to the Hospital has been stated to be absolutely wrong. Denying all other allegations and stating that there is no deficiency in service on its part, Opposite Party No.1 has prayed for dismissal of the complaint. 

 

4.      Opposite Party No.2 in its reply, while admitting the factual aspects of the case, has pleaded that State Govt. framed a Policy dated 6.5.2005 for reimbursing the medical claims in case of Haryana Govt. employees/ pensioners/ dependents and in case of approved Hospitals, the medical reimbursement was specifically as per terms and conditions of the said Policy. Govt. vide letter dated 24.6.2013 approved Fortis Hospital, Mohali (OP No.1) for a period of two years from 2.5.2013, with medical reimbursement at PGI rates plus 75% of balance amount. Further, the State Govt. vide instructions dated 6.8.2013 issued guidelines for implementing package rates i.e. lump sum amount charged by approved Hospital for packages/ procedures. It has been urged that OP No.1 vide letter dated 23.4.2013 consented for providing treatment on 21 identified package rates for a period of two years. As such, the Hospital is abided by the terms and conditions of the contract mutually accepted between the Parties. Also, the Surgeries/treatment for which the deceased Govt. employee underwent were the part of identified package rates. Therefore, the Hospital is liable to charge strictly as per the guidelines of the State Govt. and if any overcharging or beyond the package rates, the Hospital is entitled for disbursing the same. Denying all other allegations and stating that there is no deficiency in service on its part, Opposite Party No.2 has prayed for dismissal of the complaint. 

 

5.      Opposite Party No.3 in its reply, while admitting the factual aspects of the case, has pleaded that it is not a service provider and rather was an employer of husband of the Complainant - Late Sh. Rampal Malik, Addl. Director Agriculture (Retd.), therefore, the husband of the Complainant is not covered under the definition of consumer under Section 2(1)(d) of the Consumer Protection Act, 1986. It has been urged that medical reimbursement is not covered in the definition of service envisaged in Section 2(1)(o) of the Consumer Protection Act, as the same is only a reimbursement. It has been asserted that there are medical policy and instructions/rules framed by the State Govt., to regulate the medical reimbursement being provided by the State Govt. to the Govt. employees. Hence, the medical bills of treatment of Late Sh. Rampal Malik, duly submitted by the Complainant, have been worked out and paid in accordance with the policy/instructions. Denying all other allegations and stating that there is no deficiency in service on its part, Opposite Party No.3 has prayed for dismissal of the complaint. 

 

 

6.      The Complainant also filed replication to the written statement filed by the Opposite Party No.1, wherein the averments as contained in the complaint have been reiterated and those as alleged in the written statement by the Opposite Party No.1 has been controverted.

 

7.      Parties were permitted to place their respective evidence on record in support of their contentions.

 

8.      We have heard the learned Counsel for Parties and have also perused the record.

 

9.      On perusal of the entire record placed before us, it is evidently clear that the Complainant’s husband Late Sh. Rampal Malik had undergone the treatment at Fortis Hospital, twice, firstly, from 11.12.2013 to 23.12.2013 and secondly, from 12.05.2014 to 23.05.2014. During first time treatment, the deceased Sh.Rampal Malik (husband of the Complainant) had not produced the valid I.D. and had paid all the dues to the Fortis Hospital, without raising any protest. Subsequently, the Complainant submitted the bills to OP Nos.2/3, who in turn, reimbursed to the Complainant the amount which was due as per rules. It is important to note that medical reimbursement of bills is to be governed under relevant rules/instructions of the concerned/appropriate Govt. At any rate, the Complainant has also not been able to produce any such authority under which the medical reimbursement is covered under the authority of service to the Consumer. In case still, the Complainant has any grievance with respect to this bill, she can approach the competent Appellate/ Administrative authority/ any other competent Court of law, for the redressal of her grievance. As far as bills/payments pertaining to the second treatment are concerned, on perusal of document Annexure OP-1/1 placed on record by the Opposite Party No.1, we find that the Stent of a superior quality/cost was put, for which the concurrence was given by the Complainant’s daughter herself. This is implied and unconditional consent for choosing a higher value Stent/Implant Pace Maker and, therefore, the Complainant cannot ask for higher value reimbursement than admissible under the rules. Admissible amount under the rules has already been paid to the Complainant.

 

10.      The Opposite Party No.1 in Para 5 of the Preliminary Objections of their reply has admitted that at the time of finalization of Bills, due to oversight of the bills, their Clerk included a sum of Rs.21,768/- in the payable cost of Angioplasty and they are willing to reimburse the said amount. Thus, to this extent, there is definite deficiency in service on the part of the Opposite Party No.1, we have no other alternative, but to allow the present complaint partly qua that amount.

 

11.      For the reasons recorded above, the present complaint of the Complainant deserves to succeed partly against the Opposite Party No.1, and the same is allowed. The Opposite Party No.1 is directed to:-

 

[a]  Pay Rs.21,768/- to the Complainant along with interest @9% per annum from the date of payment, till realization;     

 

[b]  Pay Rs.10,000/- as compensation on account of deficiency in service and causing mental and physical harassment to the Complainant;  

 

[c] Pay Rs.7,000/- towards costs of litigation;

          The complaint against Opposite Parties No.2 & 3 and is accordingly dismissed with no order as to costs. 

12.      The above said order shall be complied within 30 days of its receipt by the Opposite Party No.1; thereafter, Opposite Party No.1 shall be liable for an interest @12% per annum on the amounts mentioned in sub-paras [a] & [b] above from the date of institution of this Complaint, till it is paid, apart from costs of litigation mentioned in sub-para [c] above. 
13.      Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced

29^th March, 2017                                         

Sd/-

(S.S. PANESAR)

PRESIDENT

 

Sd/-

 (SURJEET KAUR)

MEMBER

 

Sd/-

(S.K.SARDANA)                                                                                                      MEMBER

 “Dutt”