Orissa

Cuttak

CC/113/2023

Bisikesan Pradhan - Complainant(s)

Versus

M/s Sun Hospital Pvt Ltd - Opp.Party(s)

S Ranjit & associates

09 May 2024

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL COMMISSION,CUTTACK.

C.C.No.113/2023

 

Bisikesan Pradhan,

S/o: Kapila Charan Pradhan,

Plot No.1D/329,Sector-10,C.D.A,

P.O:Markat Nagar,PS.:Phase-II,

                  Sector-11,Dist:Cuttack,PIN-753014.

 

          Vrs.

 

1.        M/s. SUN Hospital Pvt. Ltd.,

Srivihar Colony,Tulsipur,

                  P.O:Tulasipur,P.S:Bidanasi,

                  Dist:Cuttack,PIN-753008.

 

2.        Managing Director,

Central Organisation ECHS,

AG’s Branch,IHQ of MoD(Army),

Thimaya Marg,Near Gopinath Circle,

Delhi Cantt.-110010.

 

3.        Director,Regional Centre ECHS,

C/o: Station Headquarters,Bhubaneswar,

PIN-900403,C/O 56 APO.

 

4.        OIC ECHS PC

C/o: Station Headquarters,Bhubaneswar,

PIN-900403, C/O 56 APO .                                            ...Opp. Parties.

 

Present:         Sri Debasish Nayak,President.

                      Sri Sibananda Mohanty,Member.

 

Date of filing:   12.04.2023

Date of Order:  09.05.2024

 

For the complainant:             Dr. S. Ranjit,Adv. & Associates.

For the O.P No.1       :             Mr. R.Roy,Adv. & Associates.

For the O.Ps no.2 to 4:           Mr. B.S.Rayaguru(CGC)

 

Sri Debasish Nayak,President.

Case of the complainant as made out from the complaint petition bereft unnecessary details in short is that he is a member of Ex-serviceman Contributory Health Scheme (ECHS) with effect from 1.6.2005 and was contributing a sum of Rs.300/- per month, Rs.400/- per month and ultimately Rs.1000/- per month towards the said scheme.  Malati Pradhan, the wife of the complainant is also entitled for the benefits alongwith the complainant under the said ECHS.  Malati Pradhan had sustained fracture of her left-hand wrist joint on 29.8.2021 and there was severe pain which was unbearable for her.  She was taken to SUN Hospital by her son and at the reception counter of the said hospital she had disclosed to be a beneficiary of ECHS.  Dr. Kishore Kumar Panda had plastered her fractured hand there and had prescribed certain medicines.  Though Malati Pradhan is ECHS beneficiary, SUN Hospital (O.P no.1) had collected a sum of Rs.2895/- from her towards her plaster and treatment there.  On 3.9.2021, Malati Pradhan was again treated by O.P no.1 and she had to pay another sum of Rs.1726/- towards her treatment and bandage there.  Though O.P no.1 is empanelled hospital under O.P No.4, it had received Rs.4621/- from Malati Pradhan towards her medical treatment as she had sustained fracture of her wrist of left hand and when she protested through his representation dated 8.9.21, there was no response even from O.P no.3 to that effect.  Ultimately, after receiving a letter dated 12.10.2022 from the PIO of Station Headquarters,ECHS,Bhubaneswar wherein O.P no.3 vide e.mail dated 27.11.21 had requested to O.P no.1 to refund the charges received from the wife of the complainant  to the complainant at the earliest.  O.P no.3 had subsequently sent e.mail dated 3.10.22 to O.P no.1 seeking confirmation from O.P no.1 if the amount as taken from the wife of the complainant was refunded.  But ultimately when the money paid towards the treatment of Malati Pradhan who is also ECHS beneficiary alongwith her husband; was not reimbursed, the complainant has come up with this case before this Commission seeking refund of Rs.4621/- as paid by his wife to O.P no.1.  He has claimed a sum of Rs.5,00,000/- towards deficiency in the services of the O.Ps, a sum of Rs.4,00,000/- towards his mental agony and another sum of Rs.20,000/- towards his litigation expenses.

Together with his complaint petition, the complainant has annexed copies of several documents in order to prove his case.

2.       All the O.Ps have contested this case but O.P no.1 has filed his separate written version whereas O.Ps no.2,3 & 4 have filed their joint written version in this case.

          According to the written version of O.P no.1, which has been filed through one Biswajit Sahoo, working as Chief Operating Officer for O.P no.1, it is stated therein that he being the power of attorney holder of O.P no.1 has questioned through the written version that the complainant is not a consumer as per the C.P. Act, as he do not possess any authorisation on behalf of Mrs. Malati Pradhan in order to pursue this case on her behalf. The case of the complainant is thus not maintainable and there was no deficiency in service or practice of unfair trade as alleged.  It is admitted that the complainant is a member of the ECHS scheme with effect from 1.6.2005.  On 29.8.21 the wife of the complainant had sustained fracture at her hand wrist for which she had approached O.P no.1 without obtaining referral from ECHS Poly Clinic but it is alleged that she had not disclosed to be a beneficiary of ECHS.  At the hospital she was attended and treated but she had to pay for her treatment there.  Again on 3.9.21, being treated at the O.P no.1 hospital she had to pay for her medical treatment since because no documents were provided by her in order to establish her identity as a ECHS beneficiary.  According to O.P no.1, the wife of the complainant had gone to the hospital at 9.48 A.M when X-Ray of her hand was done.  Again on 3.37 P.M she had visited the said hospital for getting herself checked there.  She had not produced any document in order to establish her identity as one ECHS beneficiary.  It is further averred in the written version of O.P no.1 that the wife of the complainant had agreed to pay cash and get the same reimbursed from the ECHS directly.  Subsequently, the case of the wife of the complainant was intimated vide letter dated 4.10.22 to the Joint Director,ECHS in reply to their letters dated 27.11.21 and 3.12.22; mentioning therein that the claim amount of the complainant only is to be returned after money is received from the ECHS.   Thus, it is prayed by O.P no.1 to dismiss the complaint petition as filed since because the complainant has approached this Commission with unclean hands and is abusing the process of law. 

          Together with the written version, O.P no.1 has filed copy of a letter addressed to the Joint Director, ECHS regarding the claim amount of Malati Pradhan, the wife of the complainant of this case.

          As per the written version of O.Ps no.2,3 & 4, the case of the complainant is not maintainable as he has no cause of action which  is liable to be dismissed.  O.Ps no.2,3 & 4 through their written version have urged that the complainant is not a consumer and his case being not maintainable is liable to be dismissed.  They have stated through their written version that O.P no.1 was instructed to refund the medical expenses as collected from the ECHS beneficiary  Malati Pradhan, through  letter no.1107/23/Med. dated 27.11.21 and letter no.1107/23 Med dated 3.10.22 alongwith e.mails dated 11.10.22,18.11.2 and 9.5.23.  They have urged through their written version that there is no monthly contribution to the ECHS letter but one time contribution is required to avail the said scheme.  It is noticed that the O.Ps no.2,3 & 4 have urged through their written version that the contention  of the complainant regarding depositing monthly fees to be the ECHS beneficiary is not correct.  The O.Ps no.2,3 & 4 admit that the wife of the complainant is an ECHS beneficiary with 64 KBECHS Card bearing Regd. No.BU000007372861.  They admit in their written version that in case of emergency, in case of life-threatening conditions, no referral is required from the ECHS for it’s beneficiary and the empanelled hospitals are to provide cashless medical services to the ECHS beneficiaries.  But according to the O.Ps no.2,3 & 4 revisit of Malati Pradhan, the wife of the complainant to the hospital(O.P No.1)  on 3.9.21 for plaster replacement was a planned visit and not an emergency case for which the said beneficiary is not entitled to avail cashless treatment at the said empanelled hospital(O.P no.1) since there was no referral obtained.  Thus, according to O.Ps no.2,3 & 4 , they have  urged through their written version that the expenses incurred by the complainant or his wife towards the medical treatment of the wife of the complainant at O.P no.1 hospital on 29.8.21 to the tune of Rs.2875/- is reimbursable but regarding the subsequent visit on 3.9.21, the amount spent towards the treatment of the wife of the complainant to the tune of Rs.1726/- is not reimbursable since because it was a planned visit and without referral.

          Alongwith the written version, O.Ps no.2,3 & 4 have filed copies of several documents in order to support their stand.

          Evidence affidavit on behalf of O.P no.1 is filed through one Biswajit Sahoo who is the Chief Operating Officer of O.P no.1.  The evidence affidavit of said Biswajit Sahoo when perused, it is noticed to be a reiteration of the averments as made in the written version on behalf of O.P no.1.

          Similarly, the complainant has also filed his evidence affidavit here in this case, which appears to be a reiteration of the averments as made by the complainant in his complaint petition.

          O.Ps no.2,3 & 4 have also filed evidence affidavit through one Colonel Kirtiman Goutam Mohanty and while going through the said evidence affidavit as filed by the said Colonel Kirtiman Goutam Mohanty, it appears t be a reiteration of the contents of the written version as filed on behalf of O.Ps no.2,3 & 4.

3.       Keeping in mind the averments as made in the complaint petition and the contents of the written versions of the O.Ps, this Commission thinks it proper to settle the following issues in order to arrive at a definite conclusion here in this case.

i.          Whether the case of the complainant is maintainable?

ii.         Whether there was any deficiency in service on the part of the O.Ps ?

iii.        Whether the complainants are entitled to the reliefs as claimed by him?

Issue no.II.

Out of the three issues, issue no. ii being the pertinent issue here in this case is taken up first for consideration.

After perusing the complaint petition, the written versions, written notes of submissions as filed from both the sides, evidence affidavit as filed by both the parties as well as the copies of documents available in the case record, it is not in dispute that the complainant Bisikesan Pradhan is a Ex-Serviceman and is also a beneficiary of the ECHS having contributed for the said scheme.  It is also not in dispute that Malati Pradhan is the wife of the complainant who is also a beneficiary under the ECHS.  Admittedly Malati Pradhan had sustained fracture at her left-hand wrist on 29.8.21 for which she had gone to O.P no.1 for medical treatment.  After being treated there, she was to pay a sum of Rs.2895/- even though she was an ECHS beneficiary alongwith her husband.  Per contra, it is the contention of the O.P no.1 that she had not produced any document so as to establish her claim under ECHS for which the medical expenses as incurred towards her treatment was collected from her.  It is further contention of the complainant that Malati Pradhan had again visited O.P no.1 for her medical treatment on 3.9.21 where she had to pay Rs.1726/- towards her medical treatment there.  As per the statement of O.Ps no.2,3 & 4, Malati Pradhan being a beneficiary of ECHS  had visited O.P no.1 on 29.8.21 towards fracture of her left hand wrist which is a case of emergency and where no referral is required. As such, the complainant is entitled for reimbursement of the said amount from O.P no.1 but the subsequent visit of Malati Pradhan on 3.9.21 to O.P no.1 is termed as a planned visit by O.Ps no.2,3 & 4.  It is for the said reason they have urged through their written version that the said subsequent visit of Malati Pradhan to O.P no.1 not being a case of emergency had required referral and as such the complainant would not be entitled for reimbursement of the amount spent on 3.9.21 to the tune of Rs.1726/- towards the treatment of Malati Pradhan at O.P no.1.  In this context, while perusing the copy of standard operating procedure treatment and management in ECHS as provided by O.Ps no.2,3 & 4 vide Annexure-B/2, keeping in mind the facts and circumstances of this case, it is noticed that infact the visit of Malati Pradhan to O.P no.1 on 29.8.21 appears to be genuine being a case of emergency as she has sustained fracture of her left hand wrist joint and was sustaining severe and unbearable pain.  But for her subsequent visit to O.P no.1 on 3.9.21 she should have obtained referral for which the amount spent on the said occasion to the tune of Rs.1726/- at O.P no.1 could have been reimbursed.  But in absence of any such referral, the subsequent claim of Rs.1726/- is not reimbursable.

When admittedly Malati Pradhan is a beneficiary of ECHS and O.P no.1 is admittedly one empanelled hospital, Malati Pradhan should have been extended cashless treatment by O.P no.1 on her first visit, but she was asked to pay an amount of Rs.2895/- towards her treatment on 29.8.21.  The plea of O.P no.1 in this regard is that Malati Pradhan had not disclosed to be a beneficiary of ECHS and she had not produced any document to that effect and that she had volunteered to pay the medical expenses stating that she has no problem to pay the same; appears to be a planned afterthought statement which is only ridiculous. It is because, Malati Pradhan being a beneficiary of ECHS had gone for treatment to O.P no.1 whom she knew to be one empanelled hospital under ECHS.  When there is provision for cashless medical treatment, no beneficiary would prefer to pay without availing the free treatment scheme to which he or she is entitled being a bonafied beneficiary.  Moreso, if at all the beneficiary of ECHS Malati Pradhan agreed to pay the medical expenses, what prevented O.P no.1 from obtaining a written document from her that she is ready and voluntarily willing to pay her medical expenses and that she is not producing any document in support to establish that she is ECHS beneficiary.  As such, the plea taken by O.P no.1 shingles down and the effort of O.P no.1 to escape from the liability though in a camaflouged manner here in this case, silhouette of truth is well significant and thus by charging for the medical expenses from the patient Malati Pradhan who is a beneficiary of ECHS on the first occasion appears to be undoubtedly deficiency in service on the part of O.Ps.  The act of O.Ps no.2,3 & 4 who had mechanically pursued the matter by simply writing letters and sending e.mails to O.P no.1 also signifies deficiency in their service.  Accordingly, this issue goes in favour of the complainant.

Issues no.i & iii.

              From the discussions as made above, the case of the complainant is definitely maintainable and she is entitled to the reliefs as claimed by her from the O.Ps here in this case.  Hence it is so ordered;

                                                         ORDER

               The case is decreed on contest against the O.Ps who are found to be jointly and severally liable here in this case. The O.P no.1 is directed to refund to the complainant a sum of Rs.4621/- alongwith interest thereon @ 12% per annum with effect from 29.8.21 till the total amount is quantified.  All the O.Ps are directed to pay to the complainant a sum of Rs.1,00,000/- towards compensation for causing mental agony and harassment to him and his wife and also to pay him a sum of Rs.20,000/- in order to meet his litigation expenses .  This order is to be carried out within a period of 30 days from the date of receipt of copy of this order.

                Order pronounced in the open court on this the 9^th day of May,2024 under the seal and signature of this Commission.                                                                        

 

                                                                                                Sri Debasish Nayak

                                                                                              President

 

 

                                                                                          Sri Sibananda Mohanty

                                                                                                        Member.