BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, JALANDHAR.

Complaint No.361 of 2015

Date of Instt. 24.08.2015

Date of Decision: 06.06.2017

Kuldeep Singh Matharu Age 65 years, S/o Sh. Kishan Singh, R/o 47-Doordarshan Enclave, Phase-I, Near Wadala Chowk, Jalandhar City Mob. No.98146-48340. ..........Complainant

Versus

1. M.D. India Health Care Services (T.P.A) Pvt. Ltd. (Bhai Ghanhya Sehat Sewa Scheme) Max Pro Info Park, D-38, Phase-I, Industrial Area, Mohali-160056, Punjab.

(Through its Managing Director/Director/Authorized Representative.)

2. M.D. India Health Care Services (T.P.A) Pvt. Ltd. (Bhai Ghanhya Sehat Sewa Scheme) 50-Golden Avenue, Near S.G.L. Hospital, Garha Road, Phase-I, Jalandhar-144022

(Through its Director/Co-ordinator/Authorized Representative.)

3. United India Insurance Co. Ltd.

SCO 72, Phase-9, Mohali-160063

.........Opposite parties

Complaint Under the Consumer Protection Act.

Before: Sh. Karnail Singh, (President)

Sh. Parminder Sharma (Member)

Present: Complainant in person.

Sh. Rahul Pushkarna, Adv. Counsel for OP No.1 to 3.

Order

Karnail Singh (President)

1. This complaint presented by complainant, wherein alleged that the complainant alongwith his wife Smt. Ranjit Kaur Age 60 years is subscriber of Bhai Ghanya Sehat Sewa Scheme vide Card No.MD15-BGSSS-00244187-S in the name of Kuldeep Singh Matharu and Card No.MD-BGSSS-00244187-SP in the name of Ranjit Kaur issued by OPs against membership of complainant in The Citizens Urban Coop Bank Ltd. The complainant paid Rs.896/- to OPs for both cards. As per terms and conditions of the guide book provided by OPs to complainant, the beneficiary can get cashless treatment from any private hospital or Nursing Home approved by OPs under the said scheme and the expenses of treatment for patient shall be paid by OPs. Unfortunately complainant's wife Ranjit Kaur subscriber of above said card, fell down from roof of house. Her right leg badly fractured. As per rules and guidelines of the OPs, she was admitted in hospital approved by OPs at serial No.121 in the guide book of OP. She was admitted in above said hospital on 07.03.2015 for treatment and an iron rod was implanted in her leg. She was discharged on 17.03.2015. That intimation for admission in said hospital of complainant's spouse as well as expenses on treatment was given to OPs. During admission in hospital, the total expenses of hospital charges including expenses of medicines, Nail, Echocardiography, tests etc came to Rs.68,843/-. As per policy No.112100/48/14/41/00000026 of said scheme, the hospital authorities sent the claim vide claim No.MDI 0035124 to OP No.1 for getting the payment of Rs.70,000/- on account of expenses elaborately detailed above. After receipt of the claim form alongwith all necessary documents/bills, the OP demanded the original documents/bills which the complainant handed over to Coordinator/OP No.2 on 16.04.2015.

2. That after handing over the photocopies and original documents/bills to OPs, the complainant visited the office of OP No.2 located at Jalandhar to know the status of claim and also made so many calls to OP No.1 but the complainant came to know that the Coordinator/OP No.2 had gone to attend their other office at Kapurthala. When the complainant talked with OP No.1, either they ignored to attend the call or told the complainant to wait for some time. If by chance, the OP No.1 attended the call, they put the matter on one pretext or other and ignore to give the claim. That on 01.08.2015, the complainant sent registered notice to OP No.1 and 2. The OP No.1 received the registered notice but the notice from OP No.2 returned with the remarks that “the office closed”. Despite several visits and so many telephonic calls, the OPs have not given the claim which tantamount to unfair trade practice and negligence and deficiency in service on the part of the OPs and further prayed for acceptance of the complaint and also sought direction to the OPs to give claim amount of Rs.70,000/-, cost of litigation expenses of Rs.5500/- and compensation to the tune of Rs.2,50,000/-.

3. Notice of the complaint was given to the opposite parties who appeared through their counsel and filed joint reply, whereby contested the complaint by taking preliminary objections that the present complaint is not maintainable hence liable to be dismissed on this ground alone and further alleged that the complainant has availed the insurance policy of the OP and has agreed with all the terms and conditions of the said insurance policy and even the OPs have duly processed the claim of the complainant and total payable amount to be paid to complainant assessed at Rs.11,892/- and complainant was duly informed about the same however intentionally and deliberately just to harass the OPs complainant has filed present false complaint and same is liable to be dismissed. On merits, it is admitted that the complainant and his wife had availed the services of the OP but the other allegations as made in the complaint are categorically denied and lastly prayed the complaint of the complainant is without merit and same may be dismissed.

4. In order to prove the case of the complainant, complainant himself tendered into evidence two affidavits Ex.CA and Ex.CB alongwith some documents Ex. C-1 to Ex.C-6 and Ex.C-6-A and Ex.C-7 to Ex. C-9 and closed the evidence.

5. Similarly, counsel for OP No.1 to 3 tendered into evidence affidavit Ex.OP1/A alongwith some documents Ex.OP-1 & Ex.OP-2 and closed the evidence.

6. We bestowed our thoughtful consideration to the submissions made by the learned counsel for the respective parties and also gone through the case file very minutely.

7. This complaint required attention of this Forum to adjudge how the complainant Kuldeep Singh Matharu is a consumer of the OP. The complainant himself stated in the Para No.1 of the complaint that complainant alongwith his wife Ranjit Kaur are subscriber of Bhai Ghanya Sehat Sewa Scheme vide card No.MD15-BGSSS-00244187-S in the name of complainant Kuldeep Singh Matharu and card No.MD15-BGSSS-00244187-SP in the name of Ranjit Kaur issued by the OP against membership of complainant in the Citizens Urban Coop Bank Ltd and for that the complainant paid Rs.896/- to OPs and as per these cards, the holder of the card as well as the beneficiary can get cashless treatment from any Private Hospital or Nursing Home. In this case, Ranjit Kaur got the treatment and if she has not holding her own independent card then she can be considered as beneficiary of the complainant Kuldeep Singh Matharu but when she has her own card issued by the Bhai Ghanya Sehat Sewa Scheme and the said card is available on the file Ex.C-2 whereas the card of the complainant is Ex.C-1. So, it means that Ranjit Kaur is the independent and individual consumer of the OP and she is entitled to get services from the OP in regard to medical treatment and obviously as per record available on the file i.e. Discharge Slip of the Jalandhar Nursing Home, the treatment was given to Ranjit Kaur who remained admitted in hospital from 07.03.2015 to 17.03.2015 as per document Ex.C-4 and as per document i.e. United India Insurance Company Ltd also shows the name of the patient Ranjit Kaur and said insurance policy is Ex.C-5 and further bills Ex.C-6 and Ex.C-6A also show that Ranjit Kaur wife of Kuldeep Singh Matharu remained admitted in Jalandhar Nursing Home and Maternity Hospital and even the name of the patient has been mentioned in the Claim Form Ranjit Kaur, the said Claim Form is Ex.C-7 and as per the claim of the complainant, they demanded treatment charges of Rs.70,000/- from the OP, as per bills issued by the said Hospital but the OP has paid only Rs.11,892/- and now demanded the remaining amount.

8. But here the question remains whether the complainant Kuldeep Singh Matharu is a consumer in this case or not. The answer is in negative form?. As per documents, it is established that a separate and individual card Ex.C-2 has been issued to the patient Ranjit Kaur and treatment was got by said Ranjit Kaur and the complainant has not filed this complaint as attorney or agent and then what is the locus-standi to Kuldeep Singh Matharu to file the instant complaint regarding that the counsel for the complainant could not able to satisfy this Forum and accordingly, we find that the complainant is not a Consumer in this complaint and as such he is not entitled for the relief claimed through this complaint and therefore, this complaint is dismissed with no order of cost. Parties will bear their own cost. Complaint could not be decided within stipulated time frame due to rush of work.

9. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated Parminder Sharma Karnail Singh

06.06.2017 Member President