Chandigarh

DF-I

CC/381/2021

Devendra Thakkar - Complainant(s)

Versus

M/s Ansh Clinic - Opp.Party(s)

Manoj Kumar

01 Dec 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

 

                                     

Consumer Complaint No.	:	CC/381/2021
Date of Institution	:	11/06/2021
Date of Decision	:	01/12/2023

 

Devendra Thakkar s/o late Shri Kanubhai Tanna, permanent r/o House No.8, Padma Prabhu Nagar, IOC Road, Sabarmati, Ahmedabad, Gujarat-380019 and presently residing at House No.169, Model Town, Ward No.6, Opposite Sewa Kendra, Behind Kurali Bus Stop, Kurali, District SAS Nagar, Punjab-140103.

… Complainant

V E R S U S

1. M/s Ansh Clinic through its proprietor/partner/director/ Manager, A1, Nr. Jeshlngbhai Park, B/s Divine Buds School, Vatva Road, Mani Nagar, Ahmedabad-380008, Gujarat.
2. M/s United India Insurance Company Limited through its Director/authorised officer having its office at SCO 357-358, First Floor, Sector 35-B, Chandigarh 160035.
3. M/s Med Save Health Insurance (TPA) Ltd. through its Manager, SCO No.66, 2^nd Floor, Sector 40-C, Chandigarh 160036.

… Opposite Parties

CORAM :	SHRI PAWANJIT SINGH	PRESIDENT
	MRS. SURJEET KAUR	MEMBER
	SHRI SURESH KUMAR SARDANA	MEMBER

 

                                                                               

ARGUED BY	:	Sh. Manoj Kumar, Advocate for complainant
	:	OP-1 ex-parte.
	:	Sh. Gaurav Gupta, Advocate for OPs 2 & 3

 

Per Pawanjit Singh, President

1. The present consumer complaint has been filed by Devendra Thakkar, complainant against the aforesaid opposite parties (hereinafter referred to as the OPs).  The brief facts of the case are as under :-

1. It transpires from the allegations as projected in the consumer complaint that the father of the complainant namely Kanubhai Tanna had purchased a health insurance policy (Annexure C-2) namely “Individual Health Insurance Policy” (hereinafter referred to as “subject policy”) from OP-2, valid w.e.f. 1.10.2018 to 30.9.2019, which was the last policy as initially the said policy was purchased by him on 16.4.2013 and was renewed till the issuance of the subject policy.  The complainant is the nomine of his father i.e. the insured. Due to his illness, father of the complainant had taken treatment from OP-1/clinic who had issued UGI scopy report dated 4.7.2019 (Annexure C-3) and endoscopy report on 27.7.2019 (Annexure C-4) with OPD No.AC50858 referred by Dr.Rohit Chaudhary. For the aforesaid treatment, more than ₹77,880/- was paid in cash to OP-1/clinic. However, even after receiving the aforesaid amount, OP-1 had not issued bill/invoice on the ground that the printer was not working. Thereafter, complainant again approached OP-1 by making telephonic calls as well as personal visits for issuance of the bill/invoice, but, every time he returned with empty hands.  Later on, in the year 2020, father of complainant had died in the hospital during treatment. Complainant again approached OP-1 vide emails (Annexure C-5 & C-6) with the request to issue aforesaid bill/invoice, but, with no result and in this manner the aforesaid act of OP-1 amounts to deficiency in service and unfair trade practice. Complainant had also issued legal notice dated 4.11.2020 (Annexure C-9) to OP-1, which was not replied by it. Thereafter, complainant had submitted claim form with OP-3 on 4.12.2020 upon which OPs 2 & 3 asked him to provide original bill with break-up of ₹77,880/-, original discharge summary alongwith original test report etc., but, since the said documents were not issued by OP-1, he could not submit the same with OPs 2 & 3.  However, the complainant had submitted other documents i.e. original test report and medical documents except bill/ invoice. OP-3 was also approached, but, vide email dated 22.1.2021 (Annexure C-13), it flatly refused to process the claim. Thereafter, complainant had issued a legal notice dated 1.4.2021 (Annexure C-14) to the OPs, but, with no response.  In this manner, the aforesaid acts of the OPs amount to deficiency in service and unfair trade practice on their part. Earlier the complainant had also filed a consumer complaint against OP-1, but, the same was withdrawn by him with liberty to file a fresh one on the same cause of action as per order dated 3.12.2020 of learned District Commission-II, UT, Chandigarh. OPs were requested several times to admit the claim, but, with no result.  Hence, the present consumer complaint.
2. OP-1 did not turn up before this Commission, despite proper service, hence it was proceeded against ex-parte vide order dated 12.04.2022.
3. OPs 2 & 3 resisted the consumer complaint and filed their written version, inter alia, taking preliminary objections of maintainability, cause of action and concealment of facts.  However, it is admitted that the father of the complainant namely Kanubhai Tanna was insured with them vide the subject policy.  It is alleged that though the complainant has lodged claim with the answering OPs, but, due to non-submission of documents pertaining to the treatment of the insured, claim could not be processed. Even no time and date has been given during which the treatment was taken by the insured and in this manner, there is no deficiency in service or unfair trade practice on their part. On merits, the facts as stated in the preliminary objections have been reiterated. The cause of action set up by the complainant is denied.  The consumer complaint is sought to be contested.
4. In replication, complainant re-asserted the claim put forth in the consumer complaint and prayer has been made that the consumer complaint be allowed as prayed for.

2. In order to prove their case, contesting parties have tendered/proved their evidence by way of respective affidavits and supporting documents.
3. We have heard the learned counsel for the contesting parties and also gone through the file carefully, including the written arguments.
   1. At the very outset, it may be observed here that vide his statement recorded on 12.10.2023, learned counsel for the complainant stated that, at this stage, he does not press claim against OPs 2 & 3/insurer as they have assured that on submission of documents, the claim will be settled.  In this manner, complainant has confined his claim against OP-1 only.
   2. In order to prove his case, complainant has supported his case by tendering his affidavit in which he deposed as maintained in the consumer complaint and in addition to that has also submitted other documents.  Annexure C-2 is the subject policy which indicates that the insured/Kanubhai Tanna had purchased the subject policy which was valid w.e.f. 1.10.2018 to 30.9.2019. Annexure C-3 is the UGI scopy report which clearly indicates that OP-1 had issued the said report in the name of Kanubhai Tanna. Annexure C-4 is another report for UGI scopy issued by OP-1/clinic to the patient/Kanubhai Tanna.  Annexure C-5 and C-6 are copies of emails which clearly indicate that the complainant had requested OP-1 to supply the bill/receipt qua the treatment given to his father/Kanubhai Tanna in the OP-1/clinic.  Annexure C-9 is the legal notice dated 4.11.2020 issued by the complainant again requesting the OPs to supply the bill/payment receipt qua the treatment of his father in the OP-1/clinic.
   3. From perusal of the documentary evidence led by the complainant, as discussed above, which is unrebutted by OP-1, one thing stands proved on record that OP-1 has not been supplying the medical bills/receipts qua the treatment taken by the patient/insured from it, despite of payment made by him for the same and repeated requests of the complainant, and the said act clearly amounts to deficiency in service and unfair trade practice on the part of OP-1 as the father of complainant, being its patient, has every right to get the said record from OP-1.  The written version of OPs 2 & 3 at this stage is not required to be discussed as the complainant has not resisted his claim against them.
   4. In view of the aforesaid discussion, it is safe to hold that the complainant has successfully proved the cause of action set up in the consumer complaint and the present consumer complaint deserves to succeed against OP-1.
4. In the light of the aforesaid discussion, the present consumer complaint succeeds, the same is hereby partly allowed and OP-1 is directed as under :-

1. to immediately provide/supply the necessary documents i.e. original bill(s)/receipt(s) and other relevant documents/medical record pertaining to the treatment of the patient/insured Kanubhai Tanna to the complainant;
2. to pay ₹5,000/- to the complainant as compensation for causing mental agony and harassment;
3. to pay ₹5,000/- to the complainant as costs of litigation.

5. This order be complied with by OP-1 within forty five days from the date of receipt of its certified copy, failing which, the payable amount, mentioned at Sr.No.(ii) above, shall carry interest @ 12% per annum from the date of this order, till realization, apart from compliance of remaining directions.
6. The consumer complaint against OPs 2 & 3 stands dismissed with no order as to costs. 
7. Pending miscellaneous application(s), if any, also stands disposed of accordingly.
8. Certified copies of this order be sent to the parties free of charge. The file be consigned.

Announced 01/12/2023 hg		Sd/- [Pawanjit Singh] President
		Sd/- [Surjeet Kaur] Member
		Sd/- [Suresh Kumar Sardana] Member