Haryana

Karnal

CC/478/2022

Ravinder Kumar - Complainant(s)

Versus

Madanta The Medicity - Opp.Party(s)

Gopal Singh Chauhan

11 Jun 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No.478 of 2022

                                                        Date of instt.17.08.2022

                                                        Date of Decision:11.06.2024

 

Ravinder Kumar aged about 58 years son of Shri Tara Chand, resident of 31, Mishran Gali, ward no.4, Taraori, tehsil Nilokheri, District Karnal. Aadhar card no.6270-6383-9164.

 

                                                                   …….Complainant.

                                              Versus

 

Medanata the Medicity Sector -38, Gurugram, Haryana, 122001, through its Medical Superintendent.

                                                                   …..Opposite Party.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.      

      Sh. Vineet Kaushik…….Member

      Dr.  Suman Singh…..Member

 

 Argued by: Shri Gopal Singh Chauhan, counsel  for the

   complainant.

                    Shri Mukul Sharma, counsel for the OP.

 

                     (Dr. Suman Singh, Memebr)

ORDER:   

                

The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that in the month of June 2021, the complainant was seriously ill and hence the family members of complainant took him to Amritdhara My Hospital, ITI Chowk, Karnal but doctor after thoroughly examining the complainant suggested to take him to higher medical institution for further treatment. Thereafter, on 14.06.2021, complainant was admitted in the hospital of OP as the hospital of OP is on the panel of Haryana Government. Dr. Hardeep Singh, MBBS, M.S. Mch, (Plastic Surgery) examined the complainant and diagnosed  the complainantwith the disease of “Infected Wound over dorsum of left foot with Faciotomy wound from below knee at latral malleolus smoker.” At the time of admission, concerned staff of hospital asked about the health policy or job of complainant, at that time brother of complainant told the staff that the complainant is an employee of Police Department in Haryana Police as Lab Assistant in the office of Forensic Science Lab. Madhuban, Karnal. On hearing the job of complainant, the hospital staff admitted the complainant in general ward and during the whole tenure of treatment, the complainant remained admitted in general ward being an employee of Haryana Government. Thereafter, the treatment of complainant was carried on and during the treatment the left foot of the complainant was amputated due to the infected wound over dorsum of left foot with exposed dead tendon and bone. Thereafter, the complainant was discharged from the hospital on 13.07.2021 and OP issued a bill of Rs.7,40,431/-. The complainant was under the impression that the bill has been made by the OP by treating the complainant as Government Employee of Haryana Government and the medical expenses would be reimbursed by the Government of Haryana. Brother of the complainant at the time of admission had submitted the identity card of complainant at the reception counter where the hospital employee took his signature on admission form. After discharge from the hospital, the complainant remained under treatment for a long period as outdoor patient. After recovering from his disease, the complainant submitted the treatment expenses bill to his department for the reimbursement of treatment expenses and hospitalization. The concerned department directed the complainant to get an essential certificate from the OP about his treatment as well as treatment expenses. Complainant approached the OP for the essential certificate as well as routine checkup on 15.11.2021. The doctor of OP issued the essential certificate and in the said certificate, the official of OP clearly mentioned the designation of complainant as Lab Assistant in Forensic Science Lab and the same has been counter signed with stamp by Dr. Hardeep Singh, MBBS M.S. MCH (Plastic Surgery), Medanta-The Medicity, sector-38, Gurugam-122001. The said certificate was submitted by the complainant to his department (Haryana Police) and on the perusal of all the relevant documents i.e. discharge summary, bills, essential certificate, the department of complainant advised the complainant to get his bills corrected as the OP had treated the complainant as a general patient  and issued the bill accordingly whereas the complainant is a government employee and the official of OP needed to rectify the medical treatment bill of complainant as per the norms of Government of Haryana. Thereafter, complainant sent an email to the OP on 03.12.2021 with the request to correct/rectify the treatment bill of complainant as per the norms of Government of Haryana but OP did not pay any heed to the request of complainant. Thereafter, complainant made a written application to the M.S. Medanta hospital, Gurugram on 17.12.2022 with the request to correct his medical bill as per the norms of Government of Haryana, as the complainant is facing problem in reimbursement of his treatment expenses bill from the department, but of no avail. After waiting for sufficient time, when the OP failed to correct his medical treatment bills, then the department of complainant reimbursed only Rs.1,97,130/- to the complainant and refused to return the whole treatment expenses by making a note “the bill has been calculated for Rs.1,97,130/- as per the Haryana Government policy, but the rates taken by the hospital are not according to the Haryana Government reimbursement policy.”  The complainant came to know that the OP despite showing him as Government employee, has charged excess price from the complainant as a private/general patient and due to which the complainant suffered a huge financial, physical and mental loss. As per Haryana Government policy the bill was calculated to be Rs.1,97,130/- which was reimbursed out of total amount of Rs.7,40,431/- and an amount of Rs.5,43,301/- is still pending against the complainant. The complainant approached the OP and requested to correct his bills as per the norms of Government of Haryana and to return the excess amount to the complainant as the complainant is facing so much physical, financially, mental pain and agony as he paid the hospital bill after borrowing money on heavy interest, but the OP did not pay any heed to the request of complainant. In this way there is deficiency in service and unfair trade practice on the part of the OP. Hence this complaint.

2.             On notice, OP appeared and filed its written version raising preliminary objections with regard to maintainability; jurisdiction; cause of action; locus standi and concealment of true and material facts. On merits, it is pleaded that the patient was admitted in the hospital on 14.06.2021 and the hospital is on the panel of Haryana Government except this all the contents are denied as the same does not relate to the OP. At the time of admission when the hospital staff asked about the insurance policy or any sort of job entitlement the attendant submitted the identity card of the complainant stating that he is an employee of Police Department in Haryana Police as Lab Assistant in Forensic Science Lab, Madhuban, Karnal, which is false and denied. It is further pleaded that the patient/attendant never submitted any documentary proof that the patient was a Haryana Government beneficiary. The hospital cannot provide special rates to any patient if they do not submit any documentary proof to the hospital. It is further pleaded that the patient was discharged from the OP hospital on 13.07.2021 and a bill of Rs.7,40,431/- was issued by the OP hospital. The bill was paid without any demur and protest. The patient patient/attendant did not submit the documents which could prove that the patient was a beneficiary of the Haryana Government and because of the aforementioned reason the complainant was charge as per general rates. It is further pleaded that essentiality certificate is a form which is provided by the Government department of the claimant and claimant brings the same to the hospital for doctor’s execution. The concerned doctor fills the same basing the representation of the patient. It is important to note that the charges mentioned in the essentiality certificate are same as the bill charged to the complainant and no dispute was raised by the complainant even at that time. The patient or his attendant did not submit the required document and the patient was charged general rates for the service provided. The complainant submitted a written application (without attaching the required documents for availing the Haryana Government benefits) to the Medical Director’s office of OP hospital on 17.12.2021. The said application was forwarded to the concerned department who further replied by demanding the required documents for the purpose of correcting bill but the complainant never returned with the documents. The patient only informed but never submitted the documents, submitting the documents is necessary to avail the Haryana Government beneficiary rates. There is no deficiency in service on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of discharge summary Ex.C1, copy of bills Ex.C2, copy of essentiality certificate Ex.C3, copy of letter no.7694 dated 23.11.2021 Ex.C4, copy of calculation of rates of medical bills Ex.C5, copy of mail dated 03.12.2021 Ex.C6, copy of application by complainant to OP regarding issue the bill as per Haryana Government rate Ex.C7, copy of Identity card of Ravinder Kumar Ex.C8, copy of aadhar card Ex.C9 and closed the evidence on 14.03.2023 by suffering separate statement.

5.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of Dr. Arnab Ganguly Ex.OP1/A, authority letter Ex.OP1 and closed the evidence on 04.12.2023 by suffering separate statement.

6.             We have heard the learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for the complainant, while reiterating the contents of complaint, has vehemently argued that the complainant joined as Lab. Attendant in the year 1997 and retired in November, 2022 as Lab. Assistant. On 14.06.2021, the complainant was admitted in the hospital of OP as the hospital of OP is on the panel of Haryana Government. At the time of admission, brother of complainant informed the staff of OP that complainant is an employee of Police Department in Haryana Police as Lab Assistant in the office of Forensic Science Lab. Madhuban, Karnal and submitted the copy of identity card of the complainant. During the treatment the left foot of the complainant was amputated. Complainant was discharged from the hospital on 13.07.2021 and OP issued a bill of Rs.7,40,431/- to the complainant. Complainant paid the said amount under impression that OP issued the said bills as per beneficiary of the Haryana Government. The complainant submitted the medical bills to his department for reimbursement of the said amount but the department of complainant reimbursed only Rs.1,97,130/- to the complainant and refused to refund the whole treatment expense on the ground that the bill should have been calculated for Rs.1,97,130/- as per the Haryana Government policy, but the rates taken by the hospital are not according to the Haryana Government reimbursement policy.  The OP has charged excess amount from the complainant as a private/general patient and due to which the complainant suffered a huge financial, physical and mental loss. The complainant approached to the OP and requested to correct his bills as per the norms of Government of Haryana and to refund the excess amount to the complainant but OP did not pay any heed to the request of complainant and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OP, while reiterating the contents of written version, has vehemently argued that OP hospital is on the panel of Haryana Government and it is the responsibility of the beneficiary to inform the hospital about his/her status as a Beneficiary and submit a proof of identity i.e. a valid ID card to avail Haryana Government benefits and cashless services in the hospital but in the present case the complainant failed to submit the valid ID card, failing to establish his identity as a Haryana Government Beneficiary. So, the bills were charged as per Medanta Prevailing rates and the said bills were paid by the complainant without any demur or protest and lastly prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, complainant was hospitalized in Medanata the Medicity Sector -38, Gurugram and OP charged an amount of Rs.7,40,431/- for his treatment. It is also admitted that the Department of the complainant reimbursed only Rs.1,97,130/- to the complainant.

11.           The complainant was a Lab Assistant in the office of Forensic Science Lab. Madhuban, Karnal. Being a Government Employee, he has taken the treatment from Medanata the Medicity Sector -38, Gurugram because the said hospital is on the panel of Haryana Government.

12.           The OP has alleged that complainant has not submitted  his identity card to avail the benefit of Haryana Government beneficiary at the time of admission. OP itself issued the essential certificate Ex.C3 dated 15.11.2021, in the said certificate, the official of OP clearly mentioned the designation of complainant as “Lab Assistant in Forensic Science Lab” and the same has been counter signed with stamp by Dr. Hardeep Singh, MBBS M.S. MCH (Plastic Surgery), Medanta-The Medicity, sector-38, Gurugam. Complainant joined the Police Department in the year 1997 and retired in the year 2022. It is not possible a person who has rendered service in Government Department for more than 24 years, do not know the norms/requirements of the Government while taking the treatment in the Panel Hospital. The complainant has placed on file copy of his identity card Ex.C8. The said identity card has been issued on 21.04.2021 and complainant has taken treatment on 14.06.2021. Thus, it is not possible the complainant has not submitted his identity card with the OP when the same was valid at that time and in his possession and it is clearly proved on record that OP knew about the status of complainant as a Haryana Government Employee. Moreover, it is also unbelievable that a person/employee would conceal his identity and suffer such huge losses and indulge himself in unwanted litigation. Hence, in view of the above, the plea taken by the OP has no substance and the complainant is entitled for remaining amount of Rs.5,43,301/- (Rs.7,40,431-1,97,130) from the OP alongwith interest, compensation for mental pain, agony and harassment and towards the litigation expenses.

13.           As a sequel to abovesaid discussion, we allow the present complaint and direct the OP to refund the amount of Rs.5,43,301/- (Rs.7,40,431-1,97,130) to the complainant with interest @ 9% per annum from the date of filing the present complaint i.e. 17.08.2022 till its realization. We further direct the OP to pay Rs.25,000/- to the complainant on account of mental agony and harassment and Rs.11,000/- for the litigation expenses. This order shall be complied within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:11.06.2024                                                                    

                                                                President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.      

 

(Vineet Kaushik)        (Dr. Suman Singh)    

                     Member                   Member