Per Justice Sham Sunder , President This appeal is directed against the order dated 17.2.2010, rendered by the District Consumer Disputes Redressal Forum-I, U.T. Chandigarh (hereinafter to be referred as the District Forum only), vide which it disposed of the complaint, in the following manner ; “In view of the above discussion, we are of the opinion that the complainant is entitled to the compensation from the OPs. He shall either produce the original reports as demanded by the OPs through Annexure C-3 or obtain a certificate from the PGI that the original reports are attached with their record and get an attested copy from the PGI Authorities and produce the same before the OPs. The original prescription slips for which the medicine bills were submitted shall also be produced by him along with original Discharge Certificate. The OPs shall process the claim within two months from the date on which all the documents are submitted by the complainant and make the payment to the complainant. Since the fault was on the part of the complainant in not producing the documents, as required by the OPs, we are not inclined to grant any litigation cost or compensation. The complaint stands disposed of accordingly.” 2. The complainant purchased a cashless medical policy of OP-1, from OP-2, for himself, his wife and children. Unfortunately, daughter of the complainant developed some medical complication and was hospitalized at Fortis Hospital on 26.7.2007, where she remained admitted till 31.7.2007. She was referred to the Post Graduate Institute of Medical Education and Research, Chandigarh. The bill of Fortis hospital was to the tune of Rs.60,940/-, but OP-2 made payment of Rs.10,000/- only despite advance notice. The complainant had to issue a security cheque for the remaining amount, before the discharge of his daughter. It was stated that when the Fortis Hospital did not receive the payment, it deposited the cheque with its bankers, which was dishonoured and a complaint under Section 138 of the Negotiable Instruments Act,1881, was filed against him. Subsequently, the daughter of the complainant remained admitted in the Post Graduate Institute of Medical Education and Research, Chandigarh till 20.8.2007. The complainant further incurred an expenditure of Rs.70,000/- which he paid directly despite the fact that OP No.2 was informed. It was further stated that on the advice of OP-3, the complainant submitted the claim for an amount of Rs.61,114/- alongwith all the original bills and discharge summary dated 20.8.2007, but despite reminders, as well as legal notice, his claim was not passed. It was further stated that the aforesaid acts of the OPs, amounted to deficiency, in service, and indulgence into unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act,1986(hereinafter to be called as the Act only) was filed by him. 3. In their joint written reply, OPs No.1 & 2, denied that the insurance policy was a cashless policy. It was stated that the nature of the ailment suffered by the daughter of the complainant, was not informed. It was further stated that, in the absence of the same, it could not be said that the claim was covered under the Policy. It was further stated that the intimation regarding treatment at Fortis hospital was never given to the OPs. It was also denied that any document pertaining to the treatment was ever produced or supplied to the OPs. It was also denied that the Post Graduate Institute of Medical Education and Research, Chandigarh was covered under the cashless facility. It was further stated that no payment was required to be made by the OPs to the Fortis Hospital. It was further stated that even, in the notice, the complainant did not raise any demand for payment of any amount to Fortis Hospital. It was denied that the OPs were deficient, in rendering service and indulged into unfair trade practice. The remaining allegations, were denied, being wrong. 4. OP No.3 could not be served, for want of address, for which a number of opportunities were given by the District Forum and, ultimately, vide order dated 8.1.2010 complaint against OP No.3, was ordered to be dismissed, on the ground, that it had unnecessarily been joined as a party. 5. The parties led evidence, in support of their case. 6. After hearing the Counsel for the parties, and, on going through the evidence, on record, the District Forum disposed of the complaint in the manner, referred to, in the opening para of the instant order. 7. Feeling aggrieved, the instant appeal was filed, by the appellant/complainant. 8. We have heard the Counsel for the parties, and have gone through the evidence and record of the case, carefully. 9. The Counsel for the appellant/complainant, submitted that, the discharge summary of the Post Graduate Institute of Medical Education and Research, Chandigarh was supplied to the OPs. He further submitted that, in the discharge summary, complete history of the case, was recorded. He further submitted that the OPs should have processed the claim of the complainant, on the basis of the history, recorded in the discharge summary, but they did not do so. He further submitted that, no doubt, the documents asked for vide letter annexure C-3 by the OPs, were not supplied by the complainant, yet they (OPs), could verify the facts, from the Post Graduate Institute of Medical Education and Research, Chandigarh, as the daughter of the complainant, was an indoor patient, but they did not do so. He further submitted that it was for the Fortis Hospital to send record, to the Insurance Company, and if the same had not been sent by it, they (OPs) could obtain the same from the said hospital, but they failed to do so. He further submitted that the OPs could not refuse to process and settle the claim of the complainant, merely, on the ground, that he did not supply them the documents, mentioned in the letter annexure C-3. He further submitted that during the pendency of the appeal, the documents were supplied by the complainant, to the OPs(respondents) and a sum of Rs.1,10,000/- has already been received by him(complainant). He further submitted that since the claim of the appellant/complainant was not processed and settled by the OPs, on flimsy grounds, he was entitled to compensation and interest, but the District Forum, was wrong, in denying the same. He further submitted that the order of the District Forum, being illegal, is liable to set aside 10. On the other hand, the Counsel for the respondents, submitted that after going through the record, the District Forum recorded clear cut finding, to the effect, that the documents, asked for, from the complainant, vide annexure C-3, were not supplied to them, as a result whereof, the claim could not be processed and settled. He further submitted that instead of supplying the documents, asked for vide letter C-3, the complainant approached the District Forum to get the claim settled. He further submitted that, in pursuance of the order of the District Forum, when the documents were submitted, by the complainant, during the pendency of appeal, a sum of Rs.1,10,000/- was paid to him. He further submitted that since there was fault, on the part of the complainant, in not producing the documents, as required by the OPs, the District Forum was right, in coming to the conclusion, that the complainant was not entitled to compensation and litigation costs. He further submitted that the order of the District, being legal and valid, is liable to be upheld. 11. After giving our thoughtful consideration, to the rival contentions, raised by the Counsel for the parties, in our considered opinion, the appeal is liable to be dismissed, for the reasons, to be recorded hereinafter. No doubt, the Policy, which was purchased by the complainant, was not produced. However, it was an admitted fact, that the complainant purchased the Policy of OP No.1. The claim was also submitted by the complainant regarding the treatment of his daughter. OPs NO.1 & 2 appointed T.T.K. Health Care Services Pvt. Ltd. to process and examine the claim, submitted by the insured. On behalf of OP Nos.1 & 2, OP No.3 T.T.K. Health Care Services Pvt. Ltd. wrote a letter annexure C-3, requiring the complainant, to produce the following documents; “Required all Original lab reports, Echo report, ABG report, USG report, X-ray report for which bills are submitted. - Required all Original prescriptions for which medicine bills are submitted. - Required Original discharge card with detailed line of treatment with final diagnosis.” 12. There is, no dispute, about the factum, that the aforesaid documents were not supplied to OP No.3. The Insurance Company could only process and settle the claim of the complainant, in case, the original documents or attested to be true copies thereof regarding the treatment of the daughter of the complainant, had been supplied, to OP NO.3. It is not understood, as to why, the complainant was hesitant in producing the documents asked for vide letter annexure C-3. He could certainly get certified copies or attested to be true copies of the record, from the Fortis Hospital, and from the Post Graduate Institute of Medical Education and Research, Chandigarh. The complainant adopted an adamant attitude by not submitting the documents, and, on the other hand, wanted to shift burden on to the OPs, to obtain the same, from the Fortis hospital and the Post Graduate Institute of Medical Education and Research, Chandigarh. The work, which was required to be done, by the complainant, with a view to ensure that the claim filed by him, before the Insurance Company, was properly processed and settled, was not done by him, but, on the other hand, he wanted the OPs to do the same. The District Forum, in these circumstances, was right in holding in para-7 of its order, that a trend had developed amongst the litigants, to get the claim processed and settled, in the Consumer Foras, instead of producing the documents before the Insurance Company and the complainant was doing the same. The District Forum, was also right, in holding, that even the discharge certificate from the Post Graduate Institute of Medical Education and Research, Chandigarh had not been produced by the complainant. It is only after the production of the original or attested to be the true copies of the documents, asked for, from the complainant, that the Insurance Company could verify the genuineness of the same, with a view to process and settle the claim. The complainant, right from the very beginning, did not cooperate with the Insurance Company, and, on the other hand, adopted a rigid attitude and chose the District Forum, to get settled his claim instead of properly approaching the Insurance Company with the relevant documents, to process and settle the same. It was, under these circumstances, that the District Forum was right, in coming to the conclusion, that the complainant should produce all the documents asked for from him, within two months, and thereafter his claim should be processed and settled. It was, in pursuance of such order, passed by the District Forum, that during the pendency of appeal, the documents were submitted by the appellant/complainant, to the Insurance Company, and his claim was processed and settled in the sum of Rs.1,10,000/-. This amount has admittedly been received by the complainant. There was, therefore, no deficiency, in service, on the part of the OPs/respondents. 13. Coming to the factum, as to whether, the appellant/complainant, was entitled to the compensation, and litigation expenses, it may be stated here, that he was not entitled to the same, for the reasons, to be recorded hereinafter. The District Forum, in clear-cut terms, held that since the fault lay on the shoulders of the complainant, in not producing the documents, as required by the OPs, as a result whereof, they could not process and settle the claim, he was not entitled to the compensation and litigation costs. Had there been deficiency, in service, on the part of the OPs, the District Forum would have certainly granted compensation, as also litigation costs. For the fault of the complainant, the OPs could not be fastened with the liability of compensation and litigation costs. It is settled principle of law, that no person can take benefit of his own wrong. In case, the compensation and litigation costs are granted to the appellant/complainant, that would amount to giving him premium for his own fault. The findings of the District Forum, in this regard, being correct, are affirmed. 14. The order of the District Forum does not suffer from any illegality or perversity, warranting the interference of this Commission. 15. For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed, with no order as to costs. 16. Certified Copies of this order be sent to the parties, free of charge. 17. The file be consigned to record room.
| | HON'BLE MRS. NEENA SANDHU, MEMBER | HON'BLE MR. JUSTICE SHAM SUNDER, PRESIDENT | , | |
