Haryana

Yamunanagar

CC/354/2012

Yad Ram S/o Raghbir Singh - Complainant(s)

Versus

J.P.Hospital - Opp.Party(s)

Anil Kamboj

25 May 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

 

                                                                                         Complaint No.  354 of 2012.

                                                                                         Date of institution: 06.04.2012.

                                                                                         Date of decision: 25.05.2017.

Yad Ram aged about 32 years son of Sh. Raghbir Singh, resident of village and post office Aurangabad, District Yamuna Nagar. 

                                                                                                                   …Complainant.

                                    Versus

1. J.P. Hospital, near Luxmi Theatre, Jagadhri Road, Yamuna Nagar.
2. ICICI Lombard General Insurance Company Ltd. Jenith House, keshavrao Khadge Marg, Infront of Race Course, Maha Luxmi Mumbai Sthrough its Branch Manager.
3. Deputy Commissioner, Nodal Officer, under National Health Insurance Scheme, Yamuna Nagar.                                                                                                                                                                           

                                                                                                                  …Respondents. 

 

Before:           SH. ASHOK KUMAR GARG…………….. PRESIDENT.

                        SH. S.C.SHARMA………………………….MEMBER.

                        SMT. VEENA RANI SHEOKAND……….MEMBER

 

Present: Sh. Anil Kamboj Advocate, counsel for complainant.  

               Sh. Pardeep Garg, Advocate, counsel for respondent No.1.

               Sh. Parmod Gupta, Advocate, counsel for respondent No.2.

               Sh. Jagdeep Chaudhary, Nodal Officer, for respondent No.3.

             

ORDER

 

1.                     Complainant  Yad Ram has filed the present complaint under section 12 of the Consumer Protection Act 1986 amended up to date.

2.                     Brief facts of the complaint, as alleged by the complainant, are that the Government of India had floated a scheme known as National Health Insurance Scheme for the economically poor people. Under this scheme, a smart card was issued to the complainant and under the said scheme, the complainant and his other four family members were covered and in case of hospitalization of any member of the family, the expenses upto Rs. 30,000/- were to be paid to the concerned hospital through smart card and no charges were required to be paid in cash by the complainant or his family members. On 24.02.2012, the complainant met with an accident and suffered injuries and he went to respondent No.1 Hospital (hereinafter respondents will be referred as OPs) and admitted there. The OP No.1 Hospital is mentioned in the list of panel hospital at serial No.16 under the aforesaid scheme. The complainant remained admitted in the OP No.1 Hospital w.e.f. 24.02.2012 to 02.03.2012 and during that period various tests etc. were got done and a total sum of Rs. 20,003/- was spent by the complainant on treatment. At the time of admission of the complainant in Op No.1 hospital, he had shown the smart card to it and the doctor concerned had told that the smart card was accepted in their hospital and a written note to this effect was also mentioned on the board of the hospital. When the complainant was discharged from the hospital of OP No.1, he presented the smart card for the purpose of swipe but the Op No.1 refused to accept the smart card and insisted for cash payment. As such, the complainant, under compulsion, had to pay Rs. 20,003/- to the Op No.1. The Op No.1 acted illegally by pressurizing the complainant to pay the aforesaid amount whereas against smart card, no payment was required to be made by the complainant. Lastly, prayed for directing the OP No.1 to refund an amount of Rs. 20,003/- on account of expenses of treatment under the National Health Insurance Scheme alongwith interest and also to pay compensation as well as litigation expenses. Hence, this complaint.

3.                     Upon notice, OPs appeared and filed their written statement separately. OP No.1 filed its written statement by taking some preliminary objections such as the present complaint is liable to be dismissed on the sole ground that the present complaint has been filed regarding reimbursement of medi-claim towards the treatment rendered at the hospital of Op No.1, whose empanelment had already been terminated by OP No.2 on 25.01.2012; the present complaint is wholly misconceived, groundless, false, frivolous, vexatious and scurrilous which is unsustainable in the eyes of law as the same is cooked up and has been filed without justified reason; no specific scientific and justified allegations with regard to negligence or deficiency in providing services, has been made by the complainant against the Op No.1; no cause of action arose against the Op No.1; the complaint is bad for non arraignment and mis-arraignment of parties as OP No.1 Hospital is insured with United India Insurance Company Ltd. 54 Janpath, Connaught Place, New Delhi w.e.f. 26.07.2011 to 25.070.2012. On merit, it has been submitted that Shri Yad Ram was admitted in his hospital on 24.02.2012 with the history of road traffic accident. The patient was semi-conscious and there was smelling of alcohol at the time of admission. Necessary first aid and MLR of the patient was already done at Civil Hospital. The patient was not in condition to tell about his mediclaim policy  any health card at the time of admission and remained in the ICU for 3 days as the patient was not fully conscious. Moreover, the attendants of patient were informed about non-availabilities of service of the Heath Card. The OP No.1 has specifically denied that the OP No.1 Hospital was on the list of the panel hospital of ICICI Lombard General Insurance Company. It has been further mentioned that since the Op No.2 had de-empaneled of OP No.1 Hospital from its list, the Op No.1 had every right to collect the treatment amount from the complainant. It has been further alleged that the whole treatment was given most diligently and prudently with due care and caution using highest degree of skill to be best of abilities and further the treatment being in consonance with the medical line of treatment. So, the Op No.1 cannot be held liable to pay any compensation and lastly prayed for dismissal of complaint.

4.                     OP No.2 filed its written statement by taking some preliminary objections such as complaint is bad for non joinder and mis joinder of necessary parties; complainant has not come to this Forum with clean hands and has concealed the true and material facts. The Op No.1, who allegedly treated the complainant, was not on the panel of ICICI Lombard General Insurance Co. on 24.02.2012 because the J.P.Hospital, Yamuna Nagar through Dr. Amit Goel was de-paneled by ICICI Lombard General Insurance Co. vide letter dated 25.01.2012, which was very much in the knowledge of the complainant and in the knowledge of the Op No.1 and as such the complaint is not maintainable against the OP No.2. No claim is ever reported or lodged with the OP No.2 either by the complainant or by the Op No.1 or by the OP No.3, therefore, the complaint against the OP No.2 is not maintainable. It has been further alleged that the Op No.2 is not liable to refund the amount demanded in the complaint because the alleged treatment has taken place by the complainant from the hospital which was not on the panel of the Op No.2 and his agreement was cancelled on 25.01.2012 and it was the bounded duty of the OP No.1 to bring this fact in the knowledge of complainant and as such there is no deficiency in service and negligence on the part of OP No.2 and on merit controverted the plea taken in the complaint and reiterated the stand taken in the preliminary objections and lastly prayed for dismissal of complaint.  

5.                     OP No.3 appeared and filed its separate written statement by taking some preliminary objections such as complaint is not maintainable, no locus standi, no cause of action, this Forum has got no jurisdiction to entertain and hear the present complaint. In the present case dispute, if any, is between the complainant and OP No.1 Hospital and Op No.3 is not Nodal Officer under Rashtriya Swasthya Beema Yojna and separate specific Nodal Officer has been appointed in this scheme and on merit it has been mentioned that earlier the OP No.1 Hospital was on the panel of hospitals under the RSBY Scheme but w.e.f. 09.12.2011, the hospital was placed under suspension due to some investigation. As such, this hospital was not on the panel of hospitals under the scheme on 24.02.2012. It is wrong to allege that the complainant is entitled to get any payment of the amount spent by him on his treatment.  Hence, complaint qua O No.3 is liable to be dismissed.

6.                     To prove the case, counsel for the complainant tendered into evidence affidavit of complainant as Annexure CW/A and documents such as photo copy of bill of Rs. 16,500/- as Annexure C-1, Bills of chemist as Annexure C-2 to C-5, Receipt of clinical laboratory of J.P. Hospital as Annexure C-6 and C-7, C.T. Scan receipt as Annexure C-8, C.T.Scan report as Annexure C-9 Bill of ultrasound report as Annexure C-10 and C-11, Photo copy of list of hospital panels as Annexure C-12, Photo copy of ration card as Annexure C-13 and closed the evidence on behalf of complainant.

7.                     On the other hand, counsel for OP No.1 tendered into evidence affidavit of Dr Amit Goel as Annexure R1/A and documents such as Photo copy of notice for termination of service agreement dated 01.09.2011 as Annexure R-1/1, Photo copy of insurance policy as Annexure R1/2, Photo copy of insurance cover note not readable as Annexure R1/3, Photo copy of summary of patient not readable as Annexure R1/4, Photo copy of degree of M.S. Orthopedic as Annexure R1/5  and closed the evidence on behalf of OP No.2.

8.                     Sh. Jagdeep Chaudhary, Nodal Officer of Op No.3 tendered into evidence his affidavit as Annexure R3/A and documents such as photo copy of process note for de-empanelment of hospitals as Annexure R3/1, Photo copy of show cause notice cum suspension of hospital from the RSBY Scheme for J.P.Hospital as Annexure R3/2, Photo copy of notice for termination of service agreement dated 01.09.2011 as Annexure R3/3 and closed his evidence.

9.                     We have heard the learned counsel of both the parties and have gone through the pleadings as well as documents placed on file very minutely and carefully. The counsel for the complainant reiterated the averments mentioned in the complaint and prayed for its acceptance whereas the counsel for OPs No.1 &2 as well as representative of OP No. 3 reiterated the averments made in their reply and prayed for dismissal of complaint.

10.                   It is not disputed that complainant Yad Ram and his family belongs to BPL and was registered under the Rashtriya Swasthya Bima Yojna of Haryana Government and was having a smart card bearing No. 00048  63106   011310  7. It is also not disputed that complainant Yad Ram remained admitted from 24.02.2012 to 02.03.2012 in the hospital of OP No.1 i.e. J.P. Hospital, Yamuna Nagar. Learned counsel for the complainant argued at length that as the complainant remained admitted in the hospital of Op No.1 and was covered under the Rashtrya Swasthya Bima Yojna of Haryana Government, so he was entitled to get the medical benefits and free treatment from the hospital of OP No.1 and an amount of Rs. 20,003/- has been illegally charged from the complainant by OP No.1. It has been further argued that after the discharge from the hospital, complainant many times requested the OP No.1 to refund/return the amount of Rs. 20,003/- but the OP No.1 remained lingering the matter on the point that hospital of Op No.1 was de-paneled by OP No.2 on 25.01.2012 whereas the hospital of Op No.1 is mentioned in the list of panel hospital at serial No.16 under the aforesaid scheme  and lastly prayed that OPs be directed to make the payment of Rs. 20,003/- spent on hospital charges treatment and medicine etc.

11.                   On the other hand, counsel for OP No.1 Sh. Pardeep Garg, Advocate, hotly argued that there is no deficiency in service on the part of OP No.1 as the complainant never disclosed that he belongs to BPL family and was having a smart card registered under Rashtriya Swasthya Bima Yojna and further had not shown the smart card to the Doctor as well as staff of the Hospital as the patient was admitted with the history of road traffic accident and was in semi-conscious and was having smell of alcohol at the time of admission. The patient was not in condition to tell about his mediclaim policy/ health card at the time of admission and remained in the ICU for 3 days as the patient was not fully conscious. Learned counsel for the OP No.1 further argued that the attendants of the patient were informed about non availability of the services of the health card and the seriousness of the patient in writing. It has been further argued that if the complainant was having any complaint then he must have informed the Nodal Officer which is situated near the hospital of Op No.1 or on toll free number. Further Learned counsel of OP No.1 argued that complainant  is not entitled to get any amount from the OP No.1 as empanelment of the Op No.1 had already been terminated by OP No.2 on 25.01.2012 i.e. prior to admission of the complainant in hospital. Learned counsel for the OP No.1 argued that the complainant paid the hospital bill voluntarily without any protest because he was already disclosed that Op No.1 hospital is not on panel of the hospitals under RSBY Scheme. Lastly, prayed for dismissal of complaint.

12.                   Learned counsel for the OP No.2 Insurance Company argued at length that when the patient was admitted in the hospital of Op No.1 doctor on 24.02.2012, the Op No.1 hospital was not on panel of OP No.2 Insurance Company and his hospital had already been de-paneled vide letter dated 25.01.2012, which was very much in the knowledge of the complainant and in the knowledge of the Op No.1 doctor. Learned counsel for the further argued that the OpNo.2 is not liable to refund the amount demanded in the complaint because the alleged treatment has taken place by the complainant from the hospital which was not on the panel of the Op No.2 and his agreement was cancelled on 25.01.2012 and as such there is no deficiency in service and negligence on the part of OP No.2.   

13.                   Dr. Jagdeep Chaudhary Nodal Officer ESI Hospital appeared on behalf of OP No.3 in person and argued that there is neither any deficiency in service on the part of OP No.3 nor any relationship of consumer and supplier between the parties. He further argued that if any patient, having smart card, is admitted in a hospital, he/she is required to show the BPL card to the hospital authority at the time of admission. Moreover, if the patient has any complaint against the hospital relating to dispute regarding BPL card he/she is required to file a complaint with the Nodal Officer OP No.3 under the Rashtriya Swasthya Bimba Yojna scheme but in the present case, complainant has not made any complaint to OP No.3/Nodal Officer or to any higher authority. Further Dr. Jagdeep Chaudhary Nodal Officer argued that hospital of OP No.1 had already de-paneled from the list of hospitals vide letter dated 12.01.2012. Lastly, prayed that complaint qua OP No.3 may kindly be dismissed.

14.                   After hearing both the parties, we are of the considered view that there is no deficiency in service or unfair trade practice on the part of Ops as the complainant has totally failed to prove on file that he ever lodged any protest with the Op No.1 doctor at the time of making the payment of Rs. 20,003/- on discharge from the hospital of OP No.1. Further, the complainant has also not placed on file any application or any complaint made to the Nodal Officer or any Higher Authority vide which he ever made any complaint against the Op No.1 Doctor that the Op No.1 doctor has illegally and wrongly charged the amount of Rs. 20,003/- from the complainant despite the fact .That he was having health card. Even, the complainant has not placed on file any affidavit of his family members or any relative who got admitted him in the hospital of Op No.1 to rebut the version of Op No.1 that family member/relatives were not told by the OP No.1 that his hospital had already de-paneled from the list of the hospital. The complainant made the payment of hospital charges to the OP No.1 doctor on discharge, voluntarily without any protest, all these things shows that the complainant as well as his family members were disclosed by the OP No.1 doctor that hospital of OP No.1 was not on panel of the hospitals to provide treatment under health card. So, we are of the considered view that the Op No.1 has rightly charged the amount of medical expenses from the complainant. From the other angle also, when the Op No.1 doctor was not entitled to get the reimbursement of the amount from the Op No.2 Insurance Company due to de-panel then why he will treat the complainant/patient free of costs and kept in dark to the complainant by  not disclosing the true facts.

15.                   Resultantly, in the circumstances noted above, we are of the considered view that there is no merit in the present complaint and the same is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced in open court.  25.05.2017.

                                                                                             (ASHOK KUMAR GARG )

                                                                                              PRESIDENT,

                                                                                              DCDRF,YAMUNANAGAR

 

                                                                                     

                                                VEENA RANI SHEOKAND             (S.C.SHARMA )

                                                 MEMBER.                                           MEMBER