Haryana

Karnal

CC/374/2021

Shri Nar Singh Kamboj - Complainant(s)

Versus

Medical Superintend, Sanjiv Bansal Cygnus Hospital - Opp.Party(s)

Karm Singh

07 Mar 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 374 of 2021

                                                        Date of instt.04.08.2021

                                                        Date of Decision:07.03.2023

 

Shri Nar Singh Kamboj son of Shri Pala Ram, resident of house no.302, Vakilpura Mohalla, Karnal. Mobile 9354763223.

 

                                               …….Complainant.

                                              Versus

 

1.     Medical Superintendent, Sanjiv Bansal Cygnus Hospital, Railway Road Karnal, Haryana.

 

2.     The XEN, City Division, UHBVN, Vidhut Bhawan, Sector-12, Karnal.

 

3.     The M.D. UHBVN, Panchkula.

                                                                      …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.

              Shri Vineet Kaushik……Member

      Dr. Rekha Chaudhary…….Member

                   

Argued by: Shri Karan Singh, counsel for the complainant.

                   Shri Vishal Goel, counsel for the OP no.1.

                   Shri Amit Gupta, counsel for the OPs no.2 and 3.

 

                    (Jaswant Singh President)

 

ORDER:   

                

                The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant retired as J.E. from the office of OP no.2 and getting medical facilities/reimbursement from government/empanelled hospital of OPs no.1 and 2. OP no.1 is the designated authority of Sanjiv Bansal Cygnus Hospital, Railway Road, Karnal, which is empanelled hospital for treatment of employees and retirees of UHBVNL department. OP no.2 is the authority to reimburse the medical bills of complainant and OP no.3 is the authority controlling the complainant’s department. Complainant was admitted in the hospital of OP no.1 on 14.03.2021 and remained under treatment upto 19.03.2021. During treatment, OP no.1 conducted various tests and provided various medicines. Complainant spent Rs.79600/- on his treatment. The complainant submitted the medical bills to the OP no.2 for reimbursement and but OP no.2 has reimbursed only Rs.18850/- and an amount of Rs.60750/- is still pending for reimbursement.  Complainant visited the hospital of OP no.1 and requested to provide the revised medical bill including therein details of price/value of tests and medicines but OP no.1 has refused to provide the same as per requirement of OP no.2. OP no.1 has violated the terms and conditions of the agreement/MOU of empanelment with OP no.2. Then complainant sent a legal notice dated 29.06.2021 to the OPs but it also did not yield any result. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence complainant filed the present complaint seeking direction to the OPs to reimburse the remaining amount of Rs.60750/- to the complainant and also to pay Rs.1,50,000/- compensation for harassment, mental pain and agony alongwith litigation expenses.

2.             On notice, OP no.1 appeared and filed its written version raising preliminary objections with regard to maintainability and concealment of true and material facts. On merits, it is pleaded that OP no.1 has charged the bill from the complainant as per the orders and directions bearing no.3PM(COVID)/2020/9047-9097 dated 25.06.2020 issued by Government of Haryana, Department of Health and Family Welfare to private medical hospitals. It is an admitted fact that employees of UHBVNL, Department are/were getting medial facilities/reimbursement from Government/ empanelled hospital of UHBVNL. OP no.1 is empanelled hospital for treatment of employees and retirees of UHBVNL Department. It is admitted that OP  no.2 is the authority to reimburse the medical bills of employees/retirees of the department and OP no.3 is the authority controlling the complaints of UHBVNL Department. The present complaint is only maintainable against the OPs no.2 and 3. It is further pleaded that complainant remained admitted in the hospital of OP no.1 on 14.03.2021 to 19.03.2021. It is also admitted that complainant was diagnosed as Corona positive and during admission of complainant in hospital of OP no.1, his daily investigations took place. The details of the tests are provided in medical bills issued by the OP no.1 but cost of tests were not mentioned in medical bills because as per directions of Government of Haryana, Department of Health and Welfare dated 25.06.2020 the corona patient admitted in private hospitals were to be charged as per the package rates suggested by the State Government and sickness was divided into three parts i.e. moderate sickness, severe sickness and very severe sickness and the rates to be charged by the private hospitals were Rs.10,000/- per day for moderate sickness, Rs.15,000/- per day for severe sickness and Rs.18,000/- per day for very severe sickness. When the amount was to be charged as per the package directed by the State Government then there is no need to provide cost of tests and other procedures in the medical bills as the same will create confusion to the patients and their attendants. This fact was told by OP no.1 to complainant and his attendants.  It is further pleaded that during the treatment of the complainant in hospital various medicines were given to the complainant and detail of which are given in medical bill, but at the sake of repetition when the direction were issued to private hospitals to charge from the patients as per the package then there is no need to mention the cost of the medicines in the medical bills. OP no.1 had charged Rs.79,600/- as package price of treatment of complainant. There is no deficiency in service and unfair trade practice on the part of the OP no.1. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             OPs no.2 and 3 filed its separate written version raising preliminary objections with regard to maintainability; cause of action; locus standi; mis-joinder and non-joinder of necessary parties and concealment of true and material facts. On merits, it is pleaded that complainant is a retired employee of UHBVNL, who retired as JE from the office of XEN City Division, UHBVNL, Karnal. As a retired employee of UHBVNL/State of Haryana, the complainant is entitled to medical facilities/reimbursement, as per government/departmental rules, regulations. The complainant has alleged in the complaint that he was diagnosed with Corona, for which he underwent treatment at “Sanjeev Bansal Cygnus Hospital”, Karnal that he remained admitted at the said hospital from 14.03.2021 to 19.03.2021, that the hospital charged an amount of Rs.79,600/-from complainant. Complainant submitted bills issued by the said hospital to the OPs for reimbursement and the OPs have reimbursed an amount of Rs.18,850/- to complainant. The bills submitted by the complainant forwarded to the office of Director, Medical Services, Haryana Power Utilities, Shakti Bhawan, Panchkula, who after processing the same, approves payment to the complainant and thereafter, the payment of the approved amount is made by the concerned office to the complainant as per rules. It is further pleaded that the Director, Medical Services, Haryana Power Utilities, Shakti Bhawan, Panchkula approved only Rs.18,850/-only and such amount was paid to the complainant. It is further pleaded that the Director, Medical Services, Haryana Power Utilities, Shakti Bhawan, Panchkula, is a necessary/proper party to the present complaint but complainant failed to implead the said authority as a party in the present proceedings. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

4.             Parties then led their respective evidence.

5.             Complainant has tendered into evidence his affidavit Ex.CW1/A, copies of medical bill, discharge summary Ex.C1, copy of legal notice Ex.C2, copy of reply of legal notice Ex.C3 and closed the evidence on 19.04.2022 by suffering separate statement.

6.             On the other hand, learned counsel for OP no.1 has tendered into evidence affidavit of Dr.Bhat Aabid Amin, Medical Superintendent Ex.OPW2/A, copy of memos dated 04.05.2021, 18.09.2020 Ex.OP2/1 and Ex.OP2/2, copy of order dated 25.06.2020 Ex.OP2/3, copy of reply to legal notice Ex.OP2/4, copy of postal receipt Ex.OP2/5, copy of certificate for medical reimbursement Ex.OP2/6, copy of detailed final bill Ex.OP2/7, copy of discharge summary Ex.OP2/8 and closed the evidence on 17.10.2022 by suffering separate statement.

7.             Learned counsel for the OPs no.2 and 3 has tendered into evidence affidavit of Sombir Bhalothia, XEN Ex.OP1/A, copies of letter dated 09.04.2014,21.05.2021,30.09.2020,30.07.2019, 08.05.2019, 02.05.2019 Ex.OP1, Ex.OP4, Ex.OP7, Ex.OP10, Ex.OP13 and Ex.OP16 respectively,  copies of sanction letters dated 07.05.2021,  26.05.2021, 15.06.2021, 08.07.2021, 21.05.2020, 04.06.2020, 04.09.2019, 20.09.2019, 10.06.2019, 01.07.2019, 31.05.2019, 20.06.2019 Ex.OP2, Ex.OP3, Ex.OP5, Ex.OP6, Ex.OP8, Ex.OP9, Ex.OP11, Ex.OP12, Ex.OP14, Ex.OP15, Ex.OP17, Ex.OP18 and closed the evidence on 16.08.2022 by suffering separate statement.

8.             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.

9.             Learned counsel for complainant while reiterating the contents of complaint, has vehemently argued that complainant has retired as J.E. from the office of OP no.2 and getting medical facilities/reimbursement from government/empanelled hospital of OPs no.2 and 3. Complainant was suffering from Covid-19 and admitted in the hospital of OP no.1 on 14.03.2021 and remained under treatment upto 19.03.2021. Complainant spent Rs.79600/- on his treatment. The complainant submitted the medical bills to the OP no.2 for reimbursement but OP no.2 has reimbursed only Rs.18850/- and an amount of Rs.60750/- has not been reimbursed by the OPs without any cogent reason and lastly prayed for allowing the complaint.

10.           Per contra, learned counsel for the OP no.1 while reiterating the contents of written version, has vehemently argued that OP no.1 had charged the bill from the complainant as per the orders and directions issued by Government of Haryana, Department of Health and Family Welfare to private medical hospitals on 25.06.2020 and lastly prayed for dismissal of the complaint qua OP no.1.

11.           Learned counsel for the OPs no.2 and 3, while reiterating the contents of written version, has vehemently argued that complainant is a retired employee of UHBVNL. As a retired employees of UHBVNL are entitled to medical facilities/ reimbursement, as per government/departmental rules, regulations. The complainant remained admitted at the hospital of OP no.1 from 14.03.2021 to 19.03.2021 and the hospital charged an amount of Rs.79,600/-from complainant. Complainant submitted bills issued by the said hospital to the OPs for reimbursement and the OPs have reimbursed an amount of Rs.18,850/- to complainant as approved by the higher authority and lastly prayed for dismissal of the complaint qua OPs no.2 and 3.

12.           Admittedly, complainant retired as J.E. from the office of OP no.2 and getting medical facilities/reimbursement from Government/empanelled hospital of UHBVN. It is also admitted that complainant was diagnosed as Corona positive. It is also admitted that complainant had taken treatment from the hospital of OP no.1 i.e. Sanjiv Bansal Cygnus Hospital, Karnal and remained admitted from 14.03.2021 to 19.03.2021 and spent Rs.79,600/-.

13.           OP no.1 had charged Rs.79,600/- from the complainant as per order and directions bearing no.3PM(COVID)/2020/9047-9097 dated 25.06.2020 issued by Government of Haryana, Department of Health and Family Welfare to private medical hospitals. Complainant had submitted the medical bills for reimbursement but OPs no.2 and 3 has reimbursed only Rs.18,850/-.

14.           OPs no.2 and 3 had made huge deduction of Rs.60,750/- in the medical bill of complainant. The onus to reason made deduction was relied upon the OPs but OPs have miserably failed to prove the deduction by leading any cogent and convincing evidence. Neither in their written version nor evidence produced by the OPs has explained that on what ground they have made such huge deduction in the medical bill. Rather, OP no.1 has placed on file, copy of instruction dated 04.05.2021 Ex.OP2/1 issued by Director General Health Services, Haryana, copy of letter dated 18.09.2020 as Ex.OP2/2 also issued by Director General Health Services, Haryana and order dated 25.06.2020 Ex.OP2/3 issued by Additional Chief Secretary, Government of Haryana, Health Department. As per above, instructions, OP no.1 has rightly charged the treatment amount. Thus, the act of the OPs no.2 and 3 amounts to deficiency in service and unfair trade practice.

15.           Complainant has paid Rs.79,600/- on his treatment to OP no.1 and OPs no.2 and 3 had reimbursement only Rs.18,850/-. Hence the complainant is entitled for remaining amount of Rs.60,750/- alongwith interest, compensation for harassment, mental pain and agony alongwith litigation expenses.

16.           Thus, as a sequel to abovesaid discussion, we allow the present complaint and direct the OPs no.2 and 3 to pay Rs.60,750/- to the complainant alongwith interest @ 9% from the date of part payment of  made to the complainant i.e. 26.05.2021 till its realization.  We further direct the OPs no.2 and 3 to pay Rs.15,000/- to the complainant on account of mental agony and harassment suffered by him and Rs.5500/- for the litigation expense. This order shall be complied with within 45 days from the date of receipt of copy of this order till its realization. Complaint qua OP no.1 stands dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 07.03.2023

                                                                President,

                                                      District Consumer Disputes

                                                      Redressal Commission, Karnal.

 

             (Vineet Kaushik)     (Dr. Rekha Chaudhary) 

                   Member                  Member