DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANSA. Complaint No.09/23.01.2007 Decided on : 21.05.2008 Surjit Singh S/o Sh.Jwala Singh S/o Sh.Ganga Singh, Village Boha, Tehsil Budhlada, District Mansa. ..... Complainant. VERSUS 1. Med Save Health Care Limited, S.C.O.No.121to 123, 1st Floor, Sector 34-A, Chandigarh through its Chairman. 2.Chairman, Amar Hospital,8, Bank Colony, Income Tax Road, Patiala through Dr. Naresh Garg. 3.The Boha CASS Limited Boha, Tehsil Budhlada; District Mansa, through its President. 4.Chief Secretary, Punjab Government, Chandigarh. 5. I.C.I.C.I. Lombard, General Insurance Company, Regd.Office ICICI, Bank Tower, Bandra, Kurla Complex, Mumbai. ..... Opposite Parties. Complaint under Section 12 of the Consumer Protection Act, 1986. ..... Present: Sh.Sushil Kumar Bansal, counsel for the complainant. Sh.Zanny Kath, counsel for the opposite party No.3. Sh.S.K.Mehta, Counsel for Opposite Party No.5 OP No.1, 2 and 4 exparte. Before: Sh.Sarat Chander, Member. Smt.Neena Rani Gupta, Member ORDER: Surjit Singh (hereinafter called as the complainant) has filed Contd........2 : 2 : the present complaint against Med Save Health Care Limited Chandigarh, as well as Chairman, Amar Hospital Patiala through Dr. Naresh Garg; The Boha CASS Limited Boha; Chief Secretary, Punjab Government, Chandigarh and I.C.I.C.I. Lombard, Mumbai (hereinafter called as the opposite parties No.1,2,3,4 & 5 respectively) for issuance of a direction to the opposite parties to pay him Rs.78,000/- on account of expenditure incurred by him on his treatment along with Rs.50,000/- as compensation on account of mental agony. Brief facts of the complaint are that the complainant is a Member of OP No.3 Cooperative Agricultural Society, Boha. OP No.1 Trust had floated a scheme for providing Health Care Facilities to the Members of the Punjab Cooperative Societies registered under the Punjab Cooperative Societies Act, 1961 and under the Chairmanship of Chief Secretary of Punjab State a Trust known as Sanjivni Trust has been formed which was a nodal agency. To provide insurance cover to this scheme, ICICI Lombard General Insurance Company had offered its services. The Members of this Society were to be provided indoor treatment of their ailments through the hospitals on the panel. The complainant had become a Member of the said Sanjivni Trust through OP No.3 by depositing a sum of Rs.430/- for insurance cover to the tune of Rs.2,00,000/- and a Membership Card bearing No.86011100008116A had been issued to the complainant by OP No.1 with regard to insurance policy No.4016/0000968 valid from 14.01.2006 to enable the complainant to get free treatment upto Rs.2,00,000/- from the hospitals on the panel of OP No.1. It is alleged by the complainant that on 17.09.2006, he had fallen sick on account of some mental tension and took treatment from a Contd........3 : 3 : private doctor at Mansa and lateron got himself admitted at the hospital of OP No.2, which was on the panel of OP No.1. The formalities were duly completed by the complainant for claiming the amounts spent by him on his treatment, but the OP No.1 till date did not disburse him the amount incurred by him on his treatment despite his repeated verbal requests. According to the complainant, he had spent Rs.78,000/- on his treatment at the hospital regarding purchase of medicines etc. On the refusal of the opposite parties to pay the amount, he alleges to have suffered mental harassment also for which Rs.50,000/- has been claimed on account of compensation. OP No.3 in its written version has not disputed the facts about the membership of the complainant of this Society, as well as his enrollment as a member of Sanjivni Health Care Scheme. According to it, the claim of the complainant, if any, is to be paid by OP No.5. A prayer for dismissal of the complaint against the replying opposite party was accordingly made. Ops No.1, 2 and 4 did not appear despite service and, as such, were proceeded against exparte. OP No.5 though had appeared through counsel, but it failed to file any written version and, as such, its defense was struck off vide order dated 03.10.2007. The complainant had tendered into evidence his affidavit, as well as other documents exhibits C-1 to C-17. OP No.3 had also tendered into evidence Exhibit OP-1, while OP No.5 had produced a copy of Policy containing terms and conditions. We have considered the arguments advanced by the learned counsel for the complainant, as well as the contesting opposite parties and Contd........4 : 4 : have carefully gone through the entire evidence on record. From the written version filed by OP No.3, it is evident that the complainant, being a Member of the Cooperative Society, had been enrolled as a Member of the Sanjivni Health Care Scheme floated under the Sanjivni Trust by OP No.1 and Card bearing No.86011100008116A, copy of which is Exhibit C-3, had been issued to the complainant by OP No.1 with regard to insurance policy No.4016/0000968 valid from 14.01.2006. Under this scheme known as Sanjivni Health Care Scheme cashless hospitalization in Network Hospitals could be obtained in conjuction with this card and authority letter issued by MHCL. Exhibit C-17 is the Guide book and list of Network hospitals in Punjab under the Sanjivni Health Care Scheme floated by OP No.1 . OP No.2 hospital figures at Sr.No.142 of the list of the hospitals. From the receipts and bills exhibits C-4 to C-16 it stands established that the complainant had remained hospitalized with OP No.3 from 19.09.2006, but the claim of cashless facility to the complainant had not been made by OP No.1. Failure of OP No.1, to contest this claim also makes its bonafides doubtful. Ops No. 1 and 5 thus are held to be deficient in service towards the complainant in not disbursing the cashless facility to the complainant. Ops No. 2, 3 and 4 are not directly liable for providing cashless facility to the complainant as there was no privity of contract between the complainant and these opposite parties. OP No.2 was justified in claiming the hospital dues from the complainant in the absence of authorization to provide cashless facility to the complainant. The complainant has placed on record Exhibit C-4 to C-16, the details of the expenditure incurred by him on his treatment. These Contd........5 : 5 : documents included the receipts issued by OP No.2. The total amount of the expenditure incurred by the complainant as per exhibits C-4 to C-16 comes to Rs.47,150/-. He is thus entitled to recover this amount from Ops No.1 and 5. Failure of Ops No.1 and 5 to provide cashless facility to the complainant for his treatment definitely is a cause for mental harassment to the complainant for which the complainant is entitled to the compensation. As a consequence of the foregoing reasons, we are constrained to allow this complaint with a direction to Ops No.1 and 5 to pay an amount of Rs.47,150/- jointly and severally to the complainant on account of expenditure incurred by him on his treatment. They shall also pay a sum of Rs.10,000/- by way of compensation on account of mental harassment, as well as litigation costs. Ops No. 2, 3 and 4 , being not directly liable to the complainant , the complaint against them is dismissed. Compliance of the order be made within one month from the date of receipt of the copy of the order which shall be provided to the parties free of charges under the rules and file be arranged, indexed and consigned to record. Pronounced: 21.05.2008 Neena Rani Gupta, Sarat Chander, Member. Member.
