DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA CC.No.51 of 27-01-2011 Decided on 09-02-2011
Gurtej Singh, aged about 37 years s/o Sh.Major Singh, r/o village Gumit Khurd, Tehsil Jaito, District Raridkot. .......Complainant
Versus ICICI Lombard General Insurance Co. Ltd., (Health Insurance), Sharma Complex, Ist Floor, Guru Kashi Marg, Corner Power House Road, Bathinda, through its Branch Manager. MD Healthcare Service (TPA) Pvt. Ltd., Regional Office, Maxpro Info Park, D-38, Industrial Area, Phase-I, Mohali, through its Regional Manager/Director/MD. Chand Ram Co-operative society, village Chand Bhan, District Faridkot, through its Secretary. The Assistant Registrar, Co-operative Societies, Jaito, District Fraidkot. The Faridkot Central Co-operative Bank Ltd., Near Govt. Hospital, Jaito, through its Branch Manager. Delhi Heart Institute and Research Centre, Namdev Marg, 40 Ft. Road, Bathinda.
......Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986.
QUORUM
Smt. Vikramjit Kaur Soni, President. Dr. Phulinder Preet, Member. Sh.Amarjeet Paul, Member. Present:- For the Complainant: Sh.Naesh Garg, counsel for the complainant.
ORDER
VIKRAMJIT KAUR SONI, PRESIDENT:-
1. The present complaint has been filed by the complainant under Section 12 of the Consumer Protection Act, 1986 as amended up-to-date (Here-in-after referred to as 'Act'). The brief facts of the complaint are that the complainant and his wife namely Veerpal Kaur were duly insured w.e.f. 01.02.2010 to 31.01.2011 for Medical cashless insurance under Bhai Ghanhya Sehat Sewa Scheme (BGSSS) with opposite party Nos.1&2 through opposite party Nos.3 to 5 for the amount of Rs.1.5 lac each and in this regard, the only card No.MD5-BGSSS-00044670-SP was issued to the complainant and Veerpal Kaur. This was a Cashless Insurance Scheme under which the Insured persons can undergo the treatment from the scheduled hospitals, under the said scheme, the insured can take treatment free of cost upto the Insurance liability. Veerpal Kaur wife of the complainant who was insured under the said scheme, had some pain in her stomach in the month of March, 2010. She got treatment from Dr. Amar Singh Brar who referred her to Dr. Rupinder Singh Sidhu on 02.04.2010, he conducted biopsy and endoscopy of Veerpal Kaur on 15.04.2010 and after taking the report of Biopsy test on 18.04.2010, the doctor diagnosed the cancer to Veerpal Kaur in her food pipe i.e. CA Esophagus and the doctor advised her stunting of Esophagus. The complainant and his wife told Dr.Rupinder Singh Sidhu that they are insured under BGSSS and the doctor told them that his hospital i.e. opposite party No.6 is duly registered under BGSSS and the total treatment upto Rs.1.5 lac is free and cashless. The complainant and his wife submitted all the required documents with the Hospital. Dr. Rupinder Singh Sidhu treated Veerpal Kaur by inserting the stunt near food pipe and discharged her on 23.04.2010 and demanded Rs.55,762/- for her treatment against Cashless Insurance Scheme. The opposite party No.6 has also filed this claim with opposite party Nos.1&2 and sent the Original Treatment File alongwith Original Bills of Rs.55,762/- to the opposite party Nos.1&2 but they did not release the said payment to their registered hospital i.e. opposite party No.6 and the opposite party No.6 demanded the same from the complainant. The complainant having no alternative, paid the said amount to the opposite party No.6. The complainant approached to the officials of the opposite parties for their Cashless Insurance Scheme but they did not listen and thereafter, Dr. Rupinder Singh Sidhu also advised Veerpal Kaur for Chemotherapy on regular intervals in order to save her life. The complainant approached several times to the officials of the opposite party Nos.1 to 5 and demanded the list of the registered hospitals under BGSSS from where Veerpal Kaur can take the Chemotherapy under Cashless Insurance Scheme as the complainant was suffering from financial crunch as they have not enough money with them for the treatment of Veerpal Kaur. Veerpal Kaur also wrote registered letter to the opposite party Nos.1&2 on 16.08.2010 but all in vain. The opposite parties did not supply the list of hospitals to the complainant from where, the complainant/insured took the Chemotherapy under BGSSS. The complainant alleged that due to non supplying of the list of hospitals, Veerpal Kaur failed to get Chemotherapy, as such, she died on 14.09.2010 due to the said disease. The opposite party Nos.1 to 5 did not provide the proper treatment. The opposite party Nos.1&2 offered Rs.84,000/- to the complainant after the death of Veerpal Kaur in the Consumer Complaint No.348/2010, decided on 06.12.2010 at District Consumer Forum, Bathinda which was pending against the bills of the opposite party No.6 and other hospitals etc. The complainant accepted the said offer of opposite party Nos.1&2 and withdrew the said complaint on 06.12.2010 qua the above said medical bills. The complainant has further alleged that the present complaint has no concern with regard to the medical bills. He has filed the present complaint for seeking directions to the opposite parties to pay Rs.16 lacs on account of death of Veerpal Kaur as compensation alongwith interest @ 18% P.A. from the date of death on 14.09.2010 till payment, Rs.2 lac for mental agony alongwith litigation expenses to the tune of Rs.1 lac. 2. Preliminary hearing have been given to this compliant. Documents placed on file by the complainant have been perused. 3. The complainant has filed the previous consumer complaint No.348 dated 02.08.2010 under the title of Veerpal Kaur Vs. M.D.India Health Care Service later on Gurtej Singh being legal heir has stepped into the shoes of Veerpal Kaur as she died during the pendency of the complaint. This complaint was withdrawn by the complainant on 06.12.2010 after suffering the statement that :- “I have heard the above said statement of counsel of the opposite party No.2. The same is acceptable to me qua medical bills of Veerpal Kaur as full and final settlement including bills incurred during pendency of complaint. The same may be disposed off accordingly.” As per statement of the parties, the complainant has received a sum of Rs.84,000/- and filed the present complaint No.51 dated 27.01.2011 for cost and compensation for death due to said disease. At the time of accepting Rs.84,000/-, he has never demanded any claim with regard to compensation on account of death of Veerpal Kaur and for litigation expenses. 4. Hence, once the complainant has settled his full and final claim with the opposite parties. He has received the said amount without any protest. Thus, he is barred by his own act and conduct to file the present complaint. Moreover, the complaint on the same cause of action is not maintainable in the eyes of law. Therefore, this complaint is dismissed in liminie without any order as to cost. 5. A copy of this order be sent to the parties concerned free of cost and file be consigned for record. ' Pronounced in open Forum 09-02-2011 (Vikramjit Kaur Soni) President
(Dr. Phulinder Preet) Member (Amarjeet Paul) Member |
