COMPLAINT FILED: 25.06.2008<br /> <br /> BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT BANGALORE (URBAN)<br /> <br /> 19th AUGUST 2008<br /> <br /> PRESENT :- SRI. A.M. BENNUR PRESIDENT<br /> SRI. SYED USMAN RAZVI MEMBER <br /> SMT. M. YASHODHAMMA MEMBER <br /> <br /> <br /> COMPLAINT NO. 1404/2008<br /> <br /> <br /> COMPLAINANT Smt. K. Pramila,<br /> Wife of late Sri. D.A. Vasanth,<br /> Aged about 57 years,<br /> Residing at No. 98, <br /> 12th A Cross, 1st Stage, <br /> 1st Phase, Gokul Extension,<br /> Bangalore – 560 054.<br /> <br /> <br /> Advocate (S. Shivanand)<br /> <br /> <br /> V/s.<br /> <br /> <br /> OPPOSITE PARTY M/s. TTK Health Care <br /> Services Pvt. Ltd.,<br /> Crimson Court – II, No. 5, <br /> Main Road, Jeevan Bhima Nagar, HAL III Stage,<br /> Bangalore – 560 075.<br /> <br /> <br /> Advocate (Dr. S.V. Joga Rao)<br /> <br /> <br /> <br /> O R D E R<br /> <br /> This is a complaint filed U/s. 12 of the Consumer Protection Act of 1986 by the complainant to direct the Opposite Party (herein after called as O.P) to refund Rs.4,120/- along with interest and pay a compensation of Rs.50,000/- and for such other reliefs on an allegations of deficiency in service. <br /> <br /> The brief averments, as could be seen from the contents of the complaint, are as under:<br /> Complainant and her husband availed the services of the OP. As the complainant was suffering from high fever and severe weakness, she was admitted to Subbaiah Hospital for treatment on 15.07.2007. Complainant did intimate the hospital that they are covered with the OP insurance and health care. Then the hospital authorities contacted the OP to permit them to go ahead with the treatment under the cashless benefit. Though complainant made repeated requests and demands, OP failed to provide the said opportunity. Ultimately complainant got discharged on 18.07.2007. The hospital raised the bill for Rs.4,120/-, complainant paid the same. The hostile attitude of the OP has caused her both mental agony and financial loss. When her repeated requests and demands to settle the said bills, went in vain, she felt the deficiency in service on the part of the OP. Under the circumstances she is advised to file this complaint and sought for the relief accordingly.<br /> <br /> 2. On appearance, OP filed the version denying all the allegations made by the complainant in toto. According to OP they did not receive the proper communication from the hospital concerned for pre-authorization in time, that is why they are unable to process the same for the cashless benefit. On receipt of the legal notice from the complainant they verified the entire records and settled the claim on 14.12.2007 for a sum of Rs.3,997/-. With all that complainant has come up with false and frivolous complaint. Complainant has not deposited the said cheque to her account, for that OP cannot be blamed. On coming to know of the non-deposit of the said cheque OP sent an intimation to the concerned Bank to stop payment. Till today OP is ready to issue the fresh cheque in favour of the complainant for the said amount. Due to some lack of communication of both the ends there aroused some inconvenience. There is no deficiency in service on the part of the OP. Under the circumstances OP is not liable to pay any compensation. Among these grounds, OP prayed for the dismissal of the complaint.<br /> <br /> 3. In order to substantiate the complaint averments, the complainant filed the affidavit evidence and produced the documents. OP has also filed the affidavit evidence. Then the arguments were heard.<br /> <br /> 4. In view of the above said facts, the points now that arise for our consideration in this complaint are as under:<br /> <br /> Point No. 1 :- Whether the complainant has proved <br /> the deficiency in service on the part of the OP?<br /> <br /> Point No. 2 :- If so, whether the complainant is <br /> entitled for the reliefs now claimed?<br /> <br /> Point No. 3 :- To what Order?<br /> <br /> <br /> 5. We have gone through the pleadings of the parties, both oral and documentary evidence and the arguments advanced. In view of the reasons given by us in the following paragraphs our findings on:<br /> <br /> Point No.1:- In Affirmative<br /> Point No.2:- Affirmative<br /> Point No.3:- As per final Order.<br /> <br /> <br /> R E A S O N S<br /> <br /> 6. At the outset it is not at dispute that the complainant and her husband are the beneficiary under the health scheme floated by the OP. On 15.07.2007 complainant got admitted herself at Subbaiah Hospital as she had high fever and severe weakness. It is the contention of the complainant that though she made immediate request to OP to provide cashless benefit as contemplated, but OP turned its deaf ears. As against this it is contended by the OP that they could not receive the intimation from the complainant in time, that is the reason why they are unable to extend the help under the cashless benefit. The document produced by the complainant goes to show that she without making any undue delay has sought for pre-authorization request. Hence for this simple reason the contention of the OP that they did not receive the pre-authorization rather does not hold much force.<br /> <br /> 7. It is further contended by the complainant that as OP failed to extend cashless benefit, she was forced to settle the medical bill to the tune of Rs.4,120/- at the time of her discharge which took place on 18.07.2007. Complainant has produced the medical records pertaining to the said Subbaiah Hospital, wherein she has taken the treatment as inpatient. There is nothing to discard the sworn testimony of the complainant. It is the quality of evidence that is more important than that of the quantity. As already observed by us, OP had an information about the complainant being admitted in the said hospital for the said treatment, but still neither it extended the cashless benefit service in time nor settled the medical bill. Here we find the deficiency in service.<br /> <br /> 8. Of course OP has come up with a defence that it settled the claim on 14.12.2007 that is nearly after 6 months, that too for Rs.3,997/- wherein the claim of the complainant is for Rs.4,120/-. The complainant has produced the document to show that she has actually incurred an expenses of Rs.4,120/-. So it would have been fair on the part of the OP to settle the claim of the said amount, but it failed. Of course the cheque sent by the OP is not deposited by the complainant, reasons are not known. <br /> <br /> 9. On the perusal of the complaint, nowhere complainant has stated about the receipt of the said cheque alleged to have been sent by the OP. When that is so, the burden lies on the OP to show that they have actually sent the said amount through the cheque which is delivered to the complainant. But no such documents are produced by the OP. In addition to that OP itself has submitted that they sent an intimation to the Bank to stop payment. So complainant is prevented from actually reaping the fruits of the said cheque. Here also we find the deficiency in service.<br /> <br /> 10. Of course OP has come up with the say that even till today they are ready to issue fresh cheque for the amount of Rs.3,997/-. That means to say OP admits its fault. So viewed from any angle, complainant for no fault of her, is made to suffer both mental agony and financial loss. Under such circumstances she is entitled for the relief claimed. Accordingly we answer point nos.1 and 2 and proceed to pass the following: <br /> <br /> O R D E R<br /> <br /> The complaint is allowed. OP is directed to settle the medical bill for Rs.4,120/- and pay the same together with interest at the rate of 7% p.a. from August 2007 till realization and also pay a litigation cost of Rs.1,000/- to the complainant. This order is to be complied within 4 weeks from the date of its communication. <br /> <br /> (Dictated to the Stenographer and typed in the computer and transcribed by him, verified and corrected, and then pronounced in the Open Court by us on this the 19th day of August 2008.) <br /> <br /> <br /> <br /> <br /> MEMBER MEMBER PRESIDENT<br /> <br /> <br /> <br /> <br /> <br />