Sh.Anoop Sharma, Presiding Member.
1. Sh.Gurinder Singh has brought the instant complaint under the Consumer Protection Act, on the allegations that son of the complainant namely Karabir Singh got admitted in Fortis Escort Hospital, Amritsar on 14.9.2016 and remained admitted upto 27.9.2016 and on the treatment, the complainant spent Rs.2,06,250/-, but the complainant did not get the cashless facility in the said hospital though said hospital was registered under the scheme of M.D.India Health Services. Vide instant complaint, the complainant has sought the following reliefs.
a) Opposite Parties may be directed to refund the amount of Rs.2,06,250/- spent on the treatment of his son in the hospital.
Hence, this complaint.
2. Upon notice, opposite parties No.1 & 3 appeared, but however, none appeared on behalf of Opposite Party No.2, hence Opposite Party No.2 was proceeded against exparte.
3. Opposite Party No.1 contested the complaint by filing written statement taking preliminary objections therein inter alia that the complainant has absolutely no locus standi to file the present complaint under the provisions of the Act. Various material facts have been concealed and distorted version of facts have been deliberately presented in or to pressurise and harass the replying Opposite Party No.1. There is no evidence worth its name to show that there is any negligence or deficiency or delay in service at the hands of the Opposite Party No.1. Thee is no privity of contract between the complainant and Opposite Party No.1 since Opposite Party No.1 was not a party to the contract of insurance as far as the present insurance policy is concerned. The complainant neither got the insurance policy in question from Opposite Party No.1 nor paid the insurance premium relating thereto. The answering Opposite Party Dr.Arun Chopra who is director cardiology, is neither the medical superintendent of hospital, nor director and has not treated the patient. Opposite Party is unnecessarily being made part of the case, the case can not be therefore proceeded against answering Opposite Party. On merits, it is submitted that it is a matter of record that the total bill of hospitalisation of the patient as per bill dated 27.9.2016 from 14.9.2017 to 27.9.2016 was Rs.1,60,214/-. Remaining facts mentioned in the complaint are also denied and a prayer for dismissal of the complaint with cost was made.
4. Written version by Opposite Party No.3 not filed, but however, at this stage, Sh.Sandeep Khanna, Advocate appeared on behalf of Opposite Party No.3 has made statement that the claim in question has not been decided yet by Opposite Party No.3 and the present complaint is pre mature. However, Opposite Party No.3 be given time of 45 days (from the date of receipt of copy of order) to decide the claim case of the complainant. The claim shall be decided subject to furnishing of all the relevant documents by the complainant and as per the terms and conditions of the insurance policy.
5. On the other hand, the complainant has made statement that he accept the offer made by the counsel for Opposite Party No.3 and he has already received Rs.1,00,500/- through NEFT. He has claimed Rs.2,06,250/- from the Opposite Party and he shall furnish the requisite documents to the Opposite Party No.3 within a week’s time from today. Directions may be given to Opposite Party No.3 for making remaining amount to the complainant.
6. Keeping in view the statement made by the complainant as well as Opposite Party No.3, as admitted by the complainant himself vide his statement recorded today separately, the complainant is directed to supply all the documents within one week to Opposite Party No.3 and thereafter, Opposite Party No.3 shall decide the claim of the complainant within further period of one month from the receipt of required documents from the complainant. The complaint stands disposed of accordingly. Copies of the order be furnished to the parties free of cost. File is ordered to be consigned to the record room.
Announced in Open Forum
