Before the District Consumer Disputes Redressal Commission, Rohtak.

Consumer Complaint No. 88

Instituted on : 21.02.2019

Decided on :07.10.2024.

Nambir Singh son of Sadhu Singh, resident of House no. 506, Sector-1, Rohtak.

                                                                                      ……..          ….Complainant

Vs

1. Holy Heart Advanced Cardiac Care and Research Centre, Delhi Bye pass chowk, Rohtak, through its Director.
2. Dr. Aditya Batra, Holy Heart, Advanced Cardiac Care and Research Centre, Delhi Bye pass chowk, Rohtak.

…….Opposite parties.

COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT.

BEFORE: SH. NAGENDER SINGH KADIAN, PRESIDENT.

                   DR. TRIPTI PANNU, MEMBER.

Present:       Sh. D.S. Chauhan, Advocate for complainant.

                   Sh. Nitin Goyal, Advocate for opposite parties.

                                      ORDER

SH. NAGENDER SINGH KADIAN, PRESIDENT:

1.               Brief facts of the present complaint, as per the complainant, are that as he suffered pain in his chest, so he visited the opposite party no.1 Holy Heart Advanced Cardiac Care and Research Centre at Rohtak on 12.12.2018 and consulted for his disease with Dr. Aditya Batra (opposite party No. 2). After checkup medically, the opposite party No. 2 told that one stent is to be affixed. The complainant was having  ICICI Prudential Health Insurance Policy and before admission, it was assured by the opposite party No. 2 that the complainantneed not to pay any amount of the treatment as the opposite party no.1 hospital was on panel of ICICI Prudential Health Life Insurance.The complainant was got admitted in the hospital on 12.12.2018 and one stent was affixed to the complainant and he was discharged on 13.12.2018.  But at the time of discharge from the hospital, the opposite parties have illegally and wrongly demanded Rs.1,40,416/- from complainant for the treatment, test and medicine etc. The complainant has also suffered a huge mental agony and harassment when the opposite partiesrefused to prepare the discharge voucher of complainant. Only after payment of amount, opposite parties  discharged the complainant.  After discharge from hospital, the complainant applied for reimbursement of the claim to the insurance company and the company reimbursed only Rs.1,07,716/- after deducting 20% saying that the complainant had taken treatment from the private medical of opposite parties. In this manner, the complainant suffered loss of Rs.32,700/- due to this act of opposite parties. Hence this complaint and it has been prayed that the opposite parties maybe directed to pay a sum of Rs.32,700/- to the complainant excessively charged by the opposite parties, alongwith interest @ 18% per annum, compensation of Rs.2,00,000/-, litigation expenses of Rs.22,000/- besides any other relief, which this Commission may found deem fit and proper.

2.                After registration of complaint, notices were issued to the opposite parties. Opposite parties appeared and filed their written statement. Some preliminary objections have been taken by the opposite parties that the complaint is not maintainable in its form, the complainant has no cause of action to file the complaint against the answering opposite parties, the complainant has not come with clean hands and that the complaint is bad for non joinder of necessary party. On merits, the opposite parties have denied the averments of the complaint in toto. It is averred that the opposite parties have no knowledge about the insurance policy, if any, taken by the complainant as henever disclosed about any insurance policy to the opposite parties. The opposite parties never assured that the Holy Heart Advanced Cardiac Care and Research Centre is on the panel of said insurance company. However, the complainant got the treatment from the opposite parties and paid the treatment charges and no assurance was given by the opposite parties to the complainant about any kind of claim of insurance policy. The opposite parties never refused to prepare the discharge voucher of the complainant. The opposite parties have no concern with any reimbursement of claim to the complainant because the same is matter between complainant and the insurance company. There is no deficiency in service on the part of opposite parties and the complainant is not entitled for any relief. Accordingly, dismissal of the complaint has been sought by the opposite parties.

3.                Learned counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A and documents Ex. C-1 to Ex. C-5 and closed his evidence on 01.06.2022. On the other hand, the learned counsel for opposite parties failed to adduce any evidence, hence, the evidence of opposite parties was closed by the court order on 05.06.2023.

5.                We have heard the arguments of learned counsel for the parties, perused the documents placed on record and have gone through material aspects of the case very carefully.

6.                    Through this complaint the complainant has demanded an amount of Rs.32700/- from the respondents. As per the complainant, assurance was given by the opposite party that full amount of treatment i.e. Rs.140016/- would be refunded  but thereafter the complainant received an amount of Rs.107716/- from the ICICI Prudential Life Insurance company  in the month of January 2019. As per the complainant, the wrong assurance was given by the respondents that whole amount would be refunded by the insurance company on account of expenditure spent by him on his treatment because the hospital of the respondent was on the panel of insurance company. We have minutely perused the document Ex.C4. Perusal of this document shows that total claim amount was Rs.140051/-. The insurance company disallowed an amount of Rs.5406/- as per the terms and conditions of the policy. An amount of Rs.26929/- was also deducted by the insurance company as a co-pay amount. In this way the net amount of Rs.107716/- has been paid by the ICICI Prudential Life Insurance Company to the complainant.  Now the remaining amount has been demanded by the complainant from the respondent. As per our opinion the complainant failed to place on record any document to prove the fact that co-pay amount has been wrongly deducted by the insurance company  and the amount of Rs.5406/- was wrongly disallowed. Moreover the complainant has not impleaded ICICI Prudential Life Insurance Company as necessary party. As per our opinion, ICICI Prudential Life Insurance Company should be impleaded as necessary party in the present complaint by the complainant. Moreover the complainant also failed to place on record any document that any assurance was ever given by the Holy Heart Hospital that whole amount would be refunded by the insurance company to the complainant. Hence there is no deficiency in service on the part of opposite parties and the present complaint stands dismissed with no order as to costs.

7.                Application(s) pending, if any, stand disposed of in terms of the aforesaid judgment.

8.                Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.

Announced in open court:

07.10.2024.

                                                          ................................................

                                                          Nagender Singh Kadian, President

                                                          ………………………………..

                                                          TriptiPannu, Member.