DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SAHIBZADA AJIT SINGH NAGAR (MOHALI)
Consumer Complaint No.558 of 2016
Date of institution: 07.09.2016 Date of decision : 19.04.2018
Raj Rani Gill wife of Shri Malkiat Gill, resident of House No.1447, Progressive Enclave, Sector 5-B, Chandigarh 160047.
…….Complainant
Vs
1. M/s. Max Super Speciality Hospital, Near Civil Hospital, Phase-VI, Mohali, Punjab 160055 (Through Zonal Director).
2. Max Super Speciality Hospital, Near Civil Hospital, Phase-VI, Mohali Punjab 160055 (through Medical Superintendent).
3. Central Govt. Health Scheme, Kendrya Sadan, Sector 9-A, Chandigarh 160009 (Through Additional Director).
……..Opposite Parties
Complaint under Section 12 of
the Consumer Protection Act.
Quorum: Shri G.K. Dhir, President,
Shri Amrinder Singh Sidhu, Member.
Mrs. Natasha Chopra, Member.
Present: Shri Gaurav Bhardwaj, counsel for complainant.
Ms. Parminder Kaur, counsel for OP No.1 and 2.
OP No.3 ex-parte.
Order by :- Shri G.K. Dhir, President.
Order
Complainant, retiree from Labour Bureau Organization, Govt. of India, Ministry of Labour & Employment w.e.f. 30.11.2012, claims herself to be a physically handicapped lady suffering from diseases RHENMATOID and SEVERE DRY EYES. Certificate regarding this handicappedness has been issued by the Director, Social Welfare Department, Chandigarh Administration which is duly counter signed by the Principal Medical Officer, Govt. Multispecialty Hospital, Sector 16, Chandigarh. OP No.2, the Max Super Speciality Hospital in Mohali, is duly notified by Govt. of India for free/cashless treatment to the retired employees under the Central Govt. Health Scheme. Complainant had been permitted by Chief Medical Officer, CGHS, Wellness Centre No.1, Sector 45, Chandigarh for availing free/cashless treatment of CYSTOPANEDOSCOPYB/L WITH D J STENING (765) at hospital of OP No.2. Permission letter dated 07.07.2016 in this respect has been issued. In that letter, it has been stated “bill as per package rates/approved rates/ceiling rates and as per guidelines be sent in duplicate to the ADDG, Chandigarh for payment”. Complainant visited Max Super Speciality Hospital near Civil Hospital, Phase-VI, Mohali on 08.07.2016 for treatment on the basis of permission letter, but for the reasons best known to the authorities concerned, she was refused admission for treatment, despite the fact that she was suffering from severe pain. Staff of Max Hospital disclosed complainant that from now onwards they have not taken any case of CGHS because the Max Super Speciality Hospital, Mohali bills had not been paid by CGHS authorities. Husband of complainant on advise of Additional Director CGHS Office, Sector 9-A, Chandigarh contacted Smt. Meenakshi concerned dealing hand of that office, who called upon complainant to get herself admitted for treatment in Max Super Speciality Hospital, Mohali. On that advice, complainant visited said hospital, but she was refused admission again, but by disclosing that she will have to bear expenses on her treatment. As complainant was having severe unbearable pain and as such under compelling circumstances, she got herself admitted in Max Super Speciality Hospital, Mohali for treatment by depositing a sum of Rs.20,000/- vide receipt dated 08.07.2016. Complainant was also charged of Rs.20,000/- on 09.07.2016. Final bill was issued on 11.07.2016 for amount of Rs.43,169/- at the time of discharge of complainant from said hospital. Complainant paid balance amount of Rs.3,169/- in cash on 11.07.2016 regarding which receipt was issued. This amount was charged from complainant despite the fact that she was entitled for free/cashless treatment at the Max Hospital, Mohali. Bills were actually to be paid by ADDG, Chandigarh as per permission letter. Even complainant had to purchase prescribed medicines from open market by paying amount of Rs.961/- on 11.07.2016, but of Rs.542/- on 16.07.2016. These medicines otherwise were to be given by hospital authorities, free of charge on providing of cashless treatment facility. Husband of complainant contracted a loan of Rs.50,000/- from Muthoot Finance Limited, Sector 46, Chandigarh for bearing the expenses. Complainant had to suffer lot of mental tension and agony and harassment and as such by pleading deficiency in service on part of OPs and after serving legal notice for refund of Rs.44,672/-, this complaint filed for seeking refund of Rs.44,672/- alongwith compensation for mental harassment and agony of Rs.1.00 lakh and litigation expenses of Rs.20,000/-.
2. OP No.1 and 2 filed joint reply by pleading inter alia as if complainant has no cause of action; complaint contains false, baseless and frivolous allegations and owing to providing of due treatment as per standard medical procedure, deficiency in service on part of OP No.1 and 2 is not there. OP hospital admittedly is an empanelled hospital under CGHS as per MOA entered into between the hospital and the CGHS. If a patient comes with valid referral slip for treatment at the hospital from authorised CGHS authorities, then treatment is provided on cashless basis as per referral note of referral slip. OP hospital has duly informed OP No.3 way back in June, 2016 that as payments in respect of treatment given by it to ECHS patients not made by Govt. of India, Ministry of Health and Family Welfare, New Delhi and as such cashless facility is withdrawn by hospital authorities. Advance intimation to Govt./OP No.3 sent vide letter dated 30.06.2016 in this respect. Therefore, complaint alleged to be not maintainable. Max Hospital enjoys credibility for providing fair treatment and sometimes even helps the patients financially from Max India Foundation. In view of frivolous allegations leveled for tarnishing image of the hospital, it is claimed that OPs reserve right to initiate appropriate civil and criminal proceedings against complainant. No allegation is leveled in the complaint regarding non reimbursement of bill amount by Central Govt. In the absence of this allegation, the claim of complainant for refund of amount alleged to be not sustainable as the cashless facility to CGHS patients stopped by Max Hospital and that is why complainant was offered treatment at CGHS rates provided payment for the same made by complainant. Complainant was disclosed that she can get the paid amount reimbursed from the Central Govt. Only cashless facility was refused to complainant, but facility of admission for treatment was not denied. Complainant was admitted in hospital for treatment on 08.07.2016 and thereafter she was discharged in stable and satisfactory condition on 11.07.2016. As payments of earlier amounts not cleared by Central Govt. or its authorities, despite repeated reminders and as such cashless facility at CGHS rates was withdrawn under compelling circumstances. Service of legal notice by complainant to OPs not denied. OP No.1 and 2 vide reply dated 27.07.2016 has already explained reasons for withdrawal of cashless facility to CGHS patients. Each and every other averment of the complaint denied and prayer for dismissal of the complaint made.
3. OP No.3 filed reply through Dr. Ashwani Kumar, Additional Director, Central Govt. Health Scheme. In that reply it is claimed that OP No.1 is empanelled under CGHS, Chandigarh, due to which it is bound to provide cashless facility as per MOU and tender documents to the CGHS beneficiaries on production of valid CGHS card/permission letter issued by OP No.3. Admittedly counsel for complainant issued legal notice dated 23.07.2016 to OP No.1 and copy of that notice was forwarded to OP No.3. OP No.3 vide letter dated 27.07.2016 called the explanation from OP No.1, but no satisfactory reply was given by OP No.1. Again vide letter dated 03.08.2016 OP No.3 called upon OP No.1 to restore the cashless facility to CGHS beneficiaries immediately under intimation to competent authority, but no reply received from OP No.1. OP No.3 cleared the maximum pendency of bills of OP No.1 on receipt of funds from competent authority. Intimation in this respect was given to OP No.1 vide letter dated 01.11.2016. Thereafter direction was issued to OP No.1 to immediately re-start cashless treatment to CGHS patients for avoiding hardship to beneficiaries. Prayer, therefore, made for deleting name of OP No.3.
4. Complainant after tendering in evidence her affidavit Ex.CW-1/1 alongwith document Ex.C-1 and Ex.C-15 as well as Mark-A and B closed evidence. Counsel for OP No.1 and 2 tendered in evidence affidavit Ex.OP-1/1 of Shri Sandeep Dogra, Vice President of OP No.1 and 2 and thereafter closed evidence. As none appeared for OP No.3 on number of dates and as such OP No.3 was proceeded against ex-parte vide order dated 28.12.2017.
5. Written arguments submitted by OP No.1 and 2. Oral arguments heard and records gone through.
6. From contents of reply submitted by OP No.3 certainly it is made out that OP No.1 is empanelled under CGHS scheme, due to which it is bound to provide cashless facility to CGHS beneficiaries on production of valid CGHS certificate/permission letter/referral letter. Such letter on 07.07.2016 was issued in favour of complainant is a fact admitted in this reply. So virtually OP No.3 has admitted claim of complainant through reply that complainant being beneficiary of CGHS facility entitled to cashless treatment from OP No.1 hospital because of issue of permission letter in her favour. That permission letter dated 07.07.2016 is produced on record as Ex.C-1 by complainant and no denial of the same made by OPs. After going through Ex.C-1, it is made out that complainant has been permitted to undergo procedure/investigation at Max Hospital with respect to CYSTOPANEDOSCOPYB/L WITH D J STENING (765). So in view of this permission allowed by OP No.3 in favour of complainant, certainly complainant entitled for cashless treatment from Max Hospital. It is on account of this that complainant got herself admitted in Max Hospital and underwent above referred procedure/treatment. Complainant paid Rs.43,169/- in all for this treatment during the period from 08.07.2016 to 11.07.2016 is a fact borne from contents of Ex.C-4 accompanied by advance deposit receipts of Rs.20,000/- each namely Ex.C-2 and Ex.C-3. In each of Ex.C-2 to Ex.C-4 name of company is mentioned as CGHS NABH, Chandigarh 2014. So virtually OP No.1 and 2 also acknowledged as if complainant is entitled beneficiary under CGHS Scheme. Complainant even has to spend Rs.961/- for purchase of medicines on 11.07.2016 but Rs.542/- for same purpose on 16.07.2016 as revealed by copies of bills Ex.C-9 and Ex.C-10. This record produced by complainant undoubtedly establishes that an amount of Rs.44,672/- was spent by her for her above referred treatment during period from 08.07.2016 to 11.07.2016. As that treatment was got by complainant after getting permission from competent authority of CGHS through letter Ex.C-1 and OP No.1 as empanelled hospital liable to provide cashless treatment, as per MOU between Addl. Director Central Govt. Health Scheme and Max Hospital in respect of which copy of agreement is produced on record and as such certainly liability of OP No.1 and 2 to provide cashless treatment during subsistence of agreement was there. However, that cashless facility denied by OP No.1 and 2 to complainant despite her entitlement on basis of Ex.C-1 and as such certainly deficiency in service is on part of OP No.1 and 2.
7. It is the case of OP No.1 and 2 that they already expressed their inability to extend cashless facility at Max Hospital, Mohali w.e.f. 15.07.2016 to CGHS beneficiaries because of outstanding dues of Rs.4.21 crores and as such they are not liable to provide cashless facility to complainant, despite her being CGHS beneficiary. Letter Ex.C-15 in this respect was sent by officers of OP No.1 and 2 to Addl. Secretary and Director General CGHS, Ministry of Health & Family Welfare and as such it is vehemently contended that owing to withdrawal of this facility to CGHS beneficiaries, OP No.1 and 2 not liable to provide cashless facility to complainant. That submission of counsel for OP No.1 and 2 though looks ex facie correct, but in fact same is not correct because after going through Ex.C-13 = Ex.C-15, it is made out that said letter dated 30.06.2016 was received by CGHS Chandigarh on 29.07.2016. Date of dispatch of Ex.C-13 = Ex.C-15 not disclosed by OP No.1 and 2 or by anybody else. So by keeping in view the endorsement on footnote of Ex.C-13, it has to be held that unilateral withdrawal of CGHS cashless facility took place not from the date of issue of Ex.C-13 = Ex.C-15 namely 30.06.2016, but same to be treated to have taken place from the date it was communicated to OP No.3. That communication took place on 29.07.2016 in view of endorsement of receipt dated 29.07.2016 on footnote of Ex.C-13. However, complainant got treatment in question during period from 08.07.2016 to 11.07.2016 and as such unilateral revocation of facility, even if to be inferred, the same to be inferred w.e.f. 29.07.2016 and not before that.
8. Section 6 of Indian Contract Act provides that revocation of proposal can take place by communication of notice of revocation by proposer to the other party. That communication of revocation of proposal to be treated as complete, when the communication is received by the party (proposer) as per Section 4 of the Indian Contract Act. However, Section 5 of Indian Contract Act provides that revocation of proposal and acceptance can take place at any time before the communication of its acceptance is complete as against the proposer, but not afterwards. So even if this unilateral revocation forwarded through Ex.C-13 = Ex.C-15 to be considered as binding, despite that the same cannot be considered as binding until the communication of the same received by OP No.3 on 29.07.2016. However, complainant got treatment before that period and as such denial of cashless benefit to complainant by OP No.1 and 2, the empanelled hospital, is absolutely illegal and against terms and conditions of contract arrived at between OP No.3 and OP No.1 and 2.
9. As per terms of agreement between Addl. Director CGHS and Max Hospital, Mohali, the empanelled health care organization cannot charge more than CGHS approved rates, when a patient is admitted with valid CGHS card with prior permission or under emergency. So amount charged through bill Ex.C-4 to be taken as charged at CGHS rates because OP No.1 and 2 hospital being empanelled health care organization can charge CGHS approved rates only.
10. Section 2 of agreement between Addl. Director CGHS and Max Super Speciality Hospital provides that agreement will remain in force for a period of two years till it is modified or revoked, whichever is earlier. This agreement may be extended for another year subject to fulfillment of all the terms and conditions of this agreement and with mutual consent of both the parties. So if this agreement to be modified or revoked, then same by keeping in view the above quoted provisions of Indian Contract Act can be issued on notice of modification/revocation only. Communication of revocation regarding CGHS or its beneficiaries to be deemed to be complete as and when the communication received by CGHS, which in this case took place on 29.07.2016 as endorsed on footnote of Ex.C-13. In view of treatment got by complainant, before completion of communication of revocation, certainly complainant was entitled for cashless facility for her treatment during period from 08.07.2016 to 11.07.2016. So OP No.1 and 2 have certainly committed deficiency in service or adopted unfair trade practice by denying benefit of cashless facility to complainant. Even if OP No.3 to pay for the treatment got by complainant from OP No.1 and 2, despite that OP No.1 and 2 during subsistence of CGHS agreement could not have denied the cashless benefit facility to complainant, who otherwise was entitled for such facility. Being so, in view of fact that complainant herself borne expenses of Rs.44,672/- from her pocket, she is entitled for refund of this amount from OP No.1 and 2, who may later on claim same from OP No.3. Complainant was not aware of revocation of benefit of cashless facility and moreover unilateral revocation against law is not permissible and as such also OP No.1 and 2 should be held liable for refund of amount of Rs.44,672/-. That amount must be refunded by OP No.1 and 2 within 40 days from date of receipt of copy of order, failing which they will be liable to pay interest @ 6% per annum w.e.f. today till payment. After making such payment, OP No.1 and 2 will be entitled to recover the paid amount from OP No.3. Complainant certainly suffered mental harassment and agony due to wrong denial of cashless benefit facility. Complainant has been dragged in this litigation on account of fault of OP No.1 and 2 and as such complainant entitled for compensation and litigation expenses of reasonable amount in that respect from OP No.1 & 2.
11. Even if there may not be privity of contract between complainant and OP No.1 and 2, but OP No.3 entered into CGHS contract for the benefits of CGHS beneficiaries with OP No.1 and 2 on consideration of refunding the treatment expenses and as such certainly complainant is consumer of OP No.1 and 2, being beneficiary under CGHS scheme.
12. As a sequel of above discussion, complaint allowed in terms that OP No.1 and 2 will refund the amount of Rs.44,672/- incurred by complainant as medical expenses within 40 days from date of receipt of copy of order failing which they will be liable to pay interest @ 6% per annum with effect from today till payment. After such payment, OP no.1 and 2 will be at liberty to recover this amount from OP No.3. Compensation for mental harassment and agony of Rs.4,000/- and litigation expenses of Rs.4,000/- more allowed in favour of complainant and against OP No.1 and 2. Payment of these amounts of compensation and litigation expenses be made within 30 days from date of receipt of copy of order. Certified copies of order be supplied to the parties free of cost as per rules. File be indexed and consigned to record room.
Announced
April 19, 2018.
(G.K. Dhir)
President
(Amrinder Singh Sidhu)
Member
(Mrs. Natasha Chopra)
Member
