Shabeg Singh, Complainant (here-in-after referred to as complainant) has filed this complaint under section 12 of the Consumer Protection Act, (here-in-after referred to as 'Act') against the Jaswant Singh and others (here-in-after referred to as 'opposite parties).

2.       Briefly stated, the case of the complainant is that he is member of OP.No.1 society and he always got Health insurance policy from the OP.No.1 under Bhai Ghanya Sehat Sewa Scheme i.e.OP.No.3 and he is availing this facility since last many years and making payment of the premium through his Account No.074300103142181. The Health Insurance Policy covers the health insurance of complainant as well as his family members. It is alleged that on 23.05.2019, complainant paid amount of Rs.2,615/- to the OP.No.1 for continuation of his said Health Policy through his above mentioned account which covers the health insurance of  complainant and his family members. Entry to this effect has been made in the pass book of complainant. He was always given Cashless facility by the opposite parties by issuing Cashless cards of each complainant, his wife and son. It is further alleged that But this time, he and his family members were not provided any Cashless Card since the date, the premium for Health Policy was deducted from his account. It is pertinent to mention here that the wife of complainant namely Kamarjit Kaur and his son Sukhraj Singh are also entitled for Health insurance under the said scheme and separate cashless Cards were issued to them every time. Though complainant has paid premium on 23.05.2019 for himself, his wife and his son, but the opposite parties no.1 & 2 here still not issued Cards to them in this regard. It is further alleged that all of sudden wife of complainant namely Kamarjit Kaur fell ill and she remained admitted at K.D. Hospital Amritsar w.e.f  18.11.2019 to 23.11.2019. Prior to admission at the above mentioned hospital, wife of complainant remained under treatment from Fatehgarh Churian, Tehsil Batala District Gurdaspur and at Bajwa Clinic Naserke, Tehsil Batala District Gurdaspur and tests were also performed at Lali High Tech Lab Fatehgarh Churian and complainant spent about Rs.50,000/- on the treatment of his wife. It is further alleged that though the wife of complainant was entitled for free of cost treatment, but on account of non-issuance of Cashless Cards by the opposite parties no. 1& 2, the concerned Hospital denied cash less facility as well as free treatment to the wife of complainant and was forced to make cash payment from his own pocket for the treatment of his wife. It is further alleged that after discharge of wife of complainant from the Hospital, he many times requested the opposite parties to issue Cashless Cards for himself and his family members, as earlier issued by them and also requested to pay the amount of Rs.50,000/- so spent by him on the treatment of his wife, but the opposite parties always detailed the matter on one pretext or the other. Due to this illegal act and conduct of the opposite parties the complainant has suffered great loss and also suffered mental harassment and inconvenience. So, there is a clear cut deficiency on the part of the opposite parties.

          On this backdrop of facts, the complainant has alleged deficiency in service and unfair trade practice on the part of the opposite parties and prayed that the necessary directions may kindly be issued to the opposite parties to make the payment of Rs.50,000/- along with interest @ 18% P.A from the date of due till its realization. It is further prayed that compensation to the tune of Rs.50,000/- may also be awarded to the complainant besides the amount in question on account of mental and physical harassment and deficiency in service on the part of opposite parties. The complainant may also be granted litigation expenses to the tune of Rs.10,000/- in the interest of justice.

3.       Notice of the complaint was issued to the opposite party no.1 and appeared through their counsel and filed their written reply, stating therein that complainant is member of opposite party no.1 and he has got Health Insurance Policy from the opposite party no.1 under Bhai Ghania Sehat Sewa Scheme i.e. opposite party no.3. It was submitted that complainant is availing this facility since last two years only. It is pleaded that opposite partyno.1 received the amount of Rs.2615/- on 23.05.2019 and the said amount was disbursed to opposite party no.3. Thereafter opposite party no.3 issued insurance to the complainant. It was submitted that complainant was always given cashless facility by the opposite party by issuing cashless cards. Cashless cards were to be issued by the opposite party no.3. Complainant was issued cashless cards for the year 2018-2019 and the opposite party no.3 have to issue the cards in the year 2019-2020 also. The opposite party no.1 denied all the averments of the complaint and there is no deficiency in service on the part of the opposite party no.1. In the end, the opposite party no.1 prayed for dismissal of complaint with costs.

4.       Opposite parties no.2 and 3 did not appear and despite the service of notice and was proceeded against exparte wide order date 19.02.2021.

5.       Learned counsel for the complainant has filed affidavit of Shabeg Singh (Complainant) Ex. CW-1 alongwith other documents as Ex.C-1 to Ex.C-20alongwith complaint.

6.       Learned counsel for the opposite party no.1 has tendered into evidence affidavit of Jaswant Singh, as Ex.OPW-1.

7.       Rejoinder not filed by the complainant.

8.       Written arguments filed by complainant but not filed by opposite party no.1.

9.       Counsel for the complainant has argued that complainant is member of opposite party No.1 society and is getting health insurance policy from opposite party No.1 under Bhai Ghanya Sehat Sewa Scheme for the last many years. It is further argued that on 23.05.2019 complainant had made payment of premium regarding insurance i.e. Rs.2615/- to opposite party No.1 for continuation of health policy. However, the opposite parties failed to issue cash less cards in favour of complainant, his wife and son as the said cards were earlier issued separately in favour of all the family members of the complainant. It is further argued that wife of the complainant under took treatment from K.D. Hospital Amritsar w.e.f. 18.11.2019 to 23.11.2019 and prior to that she under took treatment from Bajwa Clinic and in this way complainant had spent amount of Rs.50,000/- on the treatment of his wife. However, on account of non availability of cash less treatment cards the complainant could not avail the facility of cash less treatment and had to pay amount of Rs.50,000/- from his own pocket. It is further argued by the counsel for the complainant that Bhai Ghanya Sehat Sewa Scheme is a welfare scheme for the benefit of common man but illegal act on the part of the opposite parties of having received amount of Rs.2615/- from the complainant and having failed to issue cash less cards and thereafter failure to get reimbursement of Rs.50,000/- amounts to deficiency in service on the part of the opposite parties.

10.     On the other hand counsel for the opposite party no.1 has argued that complainant is admittedly member of opposite party No.1 society and get health insurance policy from opposite party No.1 under Bhai Ghanya Sehat Sewa Scheme, the receipt of premium of Rs.2615/- on 23.05.2019 is also admitted. However, it is argued that cash less treatment and cards were to be provided by opposite party No.3 and deficiency if any is on the part of opposite party No.3.

11.     We have heard the Ld. counsels for the parties and gone through the written arguments submitted by the complainant. It is admitted fact that the complainant being member of the society i.e. The Kotli Dhadian Co-operative Society had availed facility of cash less treatment under Bhai Ghanya Sehat Sewa Scheme provided by opposite party No.3 and all the three family members of the complainant were entitled to receive the cash less treatment facility under the said scheme. It is further admitted fact that on 23.05.2019 Rs.2615/- was received from the complainant by opposite party No.1 as premium which is also proved from copy of pass book Ex.C4. It is further admitted fact that wife of the complainant Kamarjit Kaur remained admitted at K.D. Hospital Amritsar w.e.f. 18.11.2019 to 23.11.2019 as per discharge slip Ex.C5 and the complainant had spent amount of Rs.35,819/- as per medical bills Ex.C6 to  Ex.C17. 12.     We are of the view that since the complainant had paid premium of Rs.2615/- to the opposite party No.1 and as such was definitely entitled to receive cash less treatment cards as earlier provided by opposite party No.3 Ex.C1 and Ex.C3 as per which the opposite party No.3 was having tie up with United India Insurance Co. Ltd. But the since the opposite parties failed to provide fresh cash less cards to the complainant after receiving premium of Rs.2615/- as per Ex.C4, as such complainant could not avail cash less treatment facility as such this Commission is of the view that the complainant had fully proved the deficiency in service on the part of the opposite parties no.1 and 3. Accordingly, present complaint is partly allowed and opposite parties no.1 and 3 are directed to pay Rs.35,819/- to the complainant alongwith interest @ 9% P.A. from the date of filing of complaint till its realization within 30 days from the receipt of copy of this order.

13.      The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.

14.     Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record room. 

                               (Lalit Mohan Dogra)

                                                                        President 

Announced:                                          (B.S.Matharu)

Aug. 14 2023                                                Member

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