DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANSA. Complaint No.178/22.09.2006 Decided on : 21.05.2008 Singara Singh S/o Sh.Gobind Singh, Village Bappiana, Tehsil and District Mansa. ..... Complainant. VERSUS 1.Med Save Health Care Limited, F-701, A, Lado Sarai, Backside of Golf Course, New Delhi through its competent authority.. 2.I.C.I.C.I. Lombard Health Insurance Company Limited, Regd.Office ICICI, Bank Tower, Bandra, Kurla Complex, Mumbai. 3.The Bappiana CASS Limited Bappiana, Tehsil and District Mansa, through its Secretary. 4.Chairman, Punjab State Cooperative Bank Limited, Sector 34-A, Chandigarh. ..... Opposite Parties. Complaint under Section 12 of the Consumer Protection Act, 1986. ..... Present: Sh.Major Singh Sandhu, counsel for the complainant. OP No.1 exparte. Sh.S.K.Mehta, Counsel for Opposite Party No.2 Sh.Zanny Kath, counsel for the opposite party No.3. Sh.Sunil Bansal, Counsel for Opposite Party No.4. Before: Sh.Sarat Chander, Member. Neena Rani Gupta, Member. ORDER: Singar Singh (hereinafter called as the complainant) has filed Contd........2 : 2 : the present complaint against the Med Save Health Care Limited, New Delhi, as well as I.C.I.C.I. Lombard Health Insurance Company Limited, Mumbai; The Bappiana CASS Limited Bappiana and Chairman, Punjab State Cooperative Bank Limited, Chandigarh (hereinafter called as the opposite parties No.1,2,3 & 4 respectively) for issuance of a direction to the opposite parties to pay him Rs.2,50,000, along with interest @ 18% per annum w.e.f. 27.4.2006/- on account of expenditure incurred by him on the treatment of his wife, along with Rs.3,500/- as costs and 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, Bappiana. 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.463/- through bank draft No.669939 dated 19.12.2005 for insurance cover to the tune of Rs.2,00,000/- and Membership Cards bearing No.860111001866-10 A,C,D,E & J had also been issued to the complainant which were valid upto 30.03.2007 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 his wife, namely, Manjeet Contd........3 : 3 : Kaur, was admitted in Satluj Hospital, Ludhiana w.e.f. 27.04.2006 till 16.05.2006 and further admitted in Mohan Dai Oswal Cancer Treatment and Research, Ludhiana from 16.05.2006 onwards. It is further alleged by the complainant that since both the hospitals are enlisted in the list furnished by OP No.1, as such, the complainant was entitled to get free treatment of his wife. The complainant had not been issued any card within time and as such he had to pay more than Rs.2,50,000/- for hospitalization charges and his wife is still under treatment. Despite various efforts made by the complainant and even upon the service of a registered legal notice dated 27.5.2006 on the opposite parties, no positive response has been received by the complainant. The membership cards have been issued to the complainant at a later stage. The Ops No.1 and 2 have duly received the premium amount from the complainant, but failed to render the service to the complainant as well as family members. . According to the complainant, he had spent Rs.2,50,000/- on the treatment of his wife on account of various laboratory tests and regarding purchase of medicines. 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.1 did not appear despite service and, as such, it was proceeded against exparte. OP No.2 though had appeared through counsel, but it failed to file any written version and, as such, its defense was struck off vide order dated 25.05.2007. 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, Contd........4 : 4 : the claim of the complainant, if any, is to be paid by OP No. 1 & 2. Both the hospitals, as referred by the complainant, are enlisted in the list of OP No.1. OP No.4 in its written version has denied all the allegations of the complainant as he is neither their member nor he has any link with the answering opposite party. A prayer for dismissal of the complaint against this opposite party was accordingly made. The complainant had tendered into evidence his affidavit, as well as other documents . OP No. 2 and 3 had also tendered certain documents, while Ops No.4 failed to lead any evidence and, as such, its evidence was closed. We have considered the arguments advanced by the learned counsel for the complainant, as well as the contesting opposite parties and 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 Bappiana Cooperative Society, had been enrolled as a Member of the Sanjivni Health Care Scheme floated under the Sanjivni Trust by OP No.1 and Cards, copy of which are Exhibit C-2 to Ext.C-6, had been issued to the complainant by OP No.1 with regard to insurance policy No.4016/0000968 valid upto 30.03.2007. Under this scheme known as Sanjivni Health Care Scheme cashless hospitalization in Network Hospitals could be obtained in conjuction with these cards and authority letter issued by MHCL. Exhibit C-14 is the Guide book and list of Network hospitals in Punjab under the Sanjivni Health Care Scheme floated by OP No.1. Both the hospitals viz Satluj Hospital, Ludhiana, as well as Mohan Dai Oswal Cancer Treatment and Research, Ludhiana figures at Sr.No. 111 and 117, respectively of the Contd........5 : 5 : list of the hospitals. From the receipts and bills exhibits C-7/1 to C-96 it stands established that the wife of the complainant had remained hospitalized with Satluj Hospital, Ludhiana from 27.04.2006 till 16.05.2006 and w.e.f.16.05.2006 in Mohan Dai Oswal Cancer Treatment and Research, Ludhiana, 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 2 thus are held to be deficient in service towards the complainant in not disbursing the cashless facility to the complainant. Ops No.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. The complainant has placed on record Exhibit C-7/1 to C-96 the details of the expenditure incurred by him on the treatment of his wife. These documents included the bills issued by the above referred hospitals, as well as the cash memos regarding the purchase of the medicines from the S.H. Drug Store , Ludhiana, as well as Gurmail Drug Store, Ludhiana and Jain Medicos, Ludhiana. Exhibit C-99 are the details of the expenses incurred for the treatment of Manjit Kaur, wife of the complainant. The total amount of the expenditure incurred by the complainant comes to Rs.3,08,861/-. The complainant is entitled to recover the amount of Rs.2,00,000/- only from Ops No.1 and 2 because as per Guide Book under the title Policy Details on page No.11, copy of which is exhibit C-14, the complainant is entitled to claim the amount upto Rs.2,00,000/- only on account of the treatment taken by him. A membership Card No. 86011100-186610C has been issued in the name of Manjeet Kaur by OP No.1. Contd........6 : 6 : Failure of Ops No.1 and 2 to provide cashless facility to the complainant for the treatment of his wife is 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 2 to pay an amount of Rs.2,00,000/- jointly & severally to the complainant on account of expenditure incurred by him on the treatment of his wife. They shall also pay a sum of Rs.25,000/- by way of compensation on account of mental harassment, as well as litigation costs. Ops No. 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.
