FINAL ORDER

            On 31.08.2016 the complainant No. 1 Smt. Anjali Dalui and 4Ors. lodged this complaint u/S 12 of the Consumer Protection Act, 1986 against the OP.

            The case of the complainants, in brief, is that in the first week of October, 2014, Mr. Kartik Chandra Das, who was the husband of the complainant No.1 and father of the complainant Nos. 2 to 5, fell seriously ill and was admitted under the OP on 07.10.2014. Then the complainant No.2 submitted all the documents before the OP as required. Mr. Kartik Chandra Das was an employee of Indus (I) Sub-Division of RBI Division, Sonamukhi and his identification number was Soneng/R/WB/492. His risk of health was covered under West Bengal Health Scheme and copy of the Health Scheme was deposited. As the condition of Mr. Kartik Chandra Das became serious, he was shifted to Burdwan Medical College & Hospital, after obtaining transfer certificate from the OP. But to ill luck, he expired on 18.10.2014. The complainants expended an amount of Rs. 71,272/- for his treatment under the OP and they also incurred a sum of Rs. 50,000/-Though the complainants gave required documents of Health Scheme to the OP yet, with ulterior motives,  and for obtaining undue gain, the OP raised general bill of huge amount instead of putting the treatment into the Health Scheme and the OP did not issue any receipt to that effect,  in spite of several requests the OP verbally assured to the complainant No.2 that they will issue bill as per health scheme. On the other hand, the complainant NO.2 also submitted those documents before the Burdwan Medical College & Hospital and got the benefit of the said scheme. After getting the general bill, the complainant No.2 requested the OP for several times , for putting the treatment under the health scheme but the OP, instead of doing so, only assured that at the time of putting signature on the D-2 Form , they would do the same. But, ultimately they did not put signature on D-2 Form and the complaints were constrained to submit a written representation before the OP on 29.07.2015 and lastly on 22.02.2016 the complainants sent a Legal Notice through the Ld. Lawyer through an e-mail to the OP. The OP also sent a reply to the said Legal Notice on 10.03.2016. The complainants are the bona-fide consumers under the OP.

            The cause of action arose on several days and the same lastly arose on 15.02.2016.

            In this way, the OP committed deficiency in service and unfair trade practice and the OP is liable to compensate the complainants with the loss.  

            Upon this background, the complainants prayed for directing the OP to pay a sum of Rs. (71,272/- + 50,000/- ) = Rs. 1,21,272/- as refund of the treatment expenses and medical bill to the complainants and Rs.5,00,000/- as compensation towards mental pain, agony and harassment suffered by the complainants along with litigation cost of Rs.20,000/-

            The OP has contested the case by filing W/V denying all the materials allegations, contending inter alia that the complainants have no cause of action to file this case and that the case is not maintainable in its present form and that the complainants are not consumers under the OP and that the complaint is barred by limitation and that the complaint is bad for defective of parties and liable to be dismissed.

         The specific case of the complainant is that the documents and records of the patient namely Mr. Kartik Chandra Das, reveals that the patient with the help, aid and assistance of his family members got admitted him under the OP on 07.10.2014 on critical conditions. The patient was discharged from the OP on 16.10.2014. From the time of admission till discharge of the patient from the OP, none of the complainants, the patient parties or the patient himself had ever submitted any scrap of documents before the OP in connection with the matter of coverage of the patient under the W.B. Health Scheme 2008 and/or provided any information to the OP to that effect at the material point of time. The OP was totally unaware of the fact of coverage of the patient under the aforesaid scheme from the date of admission of the patient in question till 29.07.2015 when one Mr. Surajit Dalui for the first time submitted an application to the OP and thereby asking for issuance of a D-2 Form related to the aforesaid scheme. The said person submitted an application on 13.10.2015. The OP, after scrutinizing all the documents in its reply, sent an e-mail to the said applicant on 16.02.2016.

It is further stated that the OP, in reply to legal notice of the complainants, served the reply through the Counsel of the OP on 10.03.2016 whereby the OP expressed the legal bar in issuing the D-2 Form to the Complainants. The OP neither on 29.07.2015 nor on any other subsequent dates had any right, permissible under the law to issue any D-2 Form under the aforesaid scheme in favour of the complainants after a long gap of one year as the same became time barred due to lapse of time as per the Guidelines for receiving the medical treatment and settlement of claims under the West Bengal Health Scheme, 2008. In view of the aforesaid provisions of the West Bengal Health Scheme, 2008, this OP has no authority to sign D-2 Form in favour of the complainant and in prejudice to the interest of the State of West Bengal and for the said reason the State of West Bengal is a necessary party to the case.

            Under the above facts and circumstances, the OP prays for dismissal of the case.  

                                               Decision with Reasons.

            In order to prove the case, the complainant No. 2 , Surajit Dalui, has  given evidence on affidavit for himself and on behalf of other complainants. The OP filed questionnaire and the complainants gave reply. The OP did not adduce evidence but the OP has filed W/N/A whereas the complainants did not file any W/N/A. Complainant also filed Xerox copies of some documents.

            Perused the complaint, W/V, evidence-on-affidavit of the complainant, questionnaire and reply, W/N/A filed by the OP and Xerox copies of the documents so filed by the complainant.

            It is found that the complainants corroborated the fact depicted in the complaint by their evidence-on-affidavit. It is the evidence of the complainants that Kartik Chandra Dolui,   who was the husband of the complainant No.1 and father of the complainant Nos. 2 to 5 was admitted on 07.10.2014 under the OP and he was a Govt. employee as per the statements of the complainants and Xerox copies of the documents. It is also alleged that he was under the coverage of West Bengal Health Scheme, 2008 and accordingly he is entitled to get medical facilities and treatment but though it was informed to the OP ,  the OP instead of doing the same, only assured that at the time of putting signature on the D-2 Form , they would do the same and ultimately the OP did not issue the D-2 Form in respect of treatment of Kartik Chandra Dolui. On the other hand, the OP in his W/V alleged that on critical condition the said patient Kartik Chandra Dolui was admitted with the help, aid and assistance of the family members on 07.10.2014 and he was discharged on 16.10.2014 and from the time of admission till the date of discharge of the patient, none of the complainants , patient parties  or patient himself had ever submitted any scrape of documents before the OP in connection with the matter of coverage of the patient under the West Bengal Health Scheme , 2008 or they did not provide any information to the OP to that effect at the material point of time. According to the Medical Science, the doctor gave treatment to the patient as per the requirement of the disease of the patient. The West Bengal Health Scheme, 2008, only disclosed what benefits are entitled by a Government employee who is the patient. It cannot understand why the doctor did not put the treatment into the Health Scheme to the patient. There is no scrape of paper submitted by the complainants to show that at the time of admission or at the time of discharge, they submitted the health card under the West Bengal Health Scheme, 2008 before the OP or gave any information to the fact that patient was under the coverage of West Bengal Health Scheme, 2008 to the OP. The complainant No. 2 Surajit Dalui on 13.10.2015 write a letter to the OP stating that his father was under the coverage of Health Scheme  at the time of treatment i.e. long after discharge of the patient from the OP. Ld. Advocate for the OP sent a letter dt. 22.02.2016 disclosing the fact of the complaint to the effect that general bill of Rs.71, 272/- has been drawn against the patient party for the treatment of the patient and he expended Rs. 50,000/- extra which was paid by the complainants but D-2 Form has not been issued by the OP and this fact has already been stated by the complainant in their complaint. In this connection, the question No. 3 to the complainants and answer to it is also vital. The question was asked to the complainant No. 2 who gave the evidence-on-affidavit as to “whether the patient or any of his family members ever submitted any document or application or any information in the matter of coverage in question before the O.P at the material point of time while under treatment?  If so, can you produce any    cogent evidence to that effect?  The complainant No. 2 gave answer, “Yes. No, as you, intentionally and reason behind, firstly assured me that endorsement is not required and thereafter refused to give any endorsement of receipt of the document of West Bengal Health Scheme.”

    From this question-answer , it is clear at first the witness gave answer in ‘Positive’ and then and there  he gave answer in Negative as because he could not produce any documents to that effect and in the Brief Notes of Argument,  the OP argued that the patient party got admitted the patient as a Cash Patient . The OP took Rs. 71,272/- in total towards hospitalization charges which was less than Rs. 1 Lakh and it was also argued that on the date of admission, if a patient comes with the New Health Scheme Card  complying with the other instructions, in that event,  the patient would have got the benefit of Cash Less Option up to Rs.1,00,000/- and here in this case, the hospital charges incurred by the patient was much less than Rs.1,00,000/- i.e. Rs. 71,272/-. Ld. Advocate for the OP drew out attention to the Guidelines for receiving medical treatment and settlement of claims under the West Bengal Health Scheme, 2008, while receiving medical treatment in recognized hospital/diagnostic center and give a photo-copy of the Identity Card to the hospital/diagnostic center. But in the present case, the complainants could not produce any document to show that they have shown health scheme identity with photocopy of the identity card to the OP  and Point No. 4 of the Guideline discloses, “ Inform your office within  three days of commencement of indoor medical attendance and treatment “. Even in this event, the complainant could not produce any document to show that they have informed the office of the Patient within three days of commencement of indoor medical attendance and treatment. The complainant alleged that the OP has drawn general bill which is over-billing and unnecessary procedures. But the Guidelines No. 12 discloses, “In case of over-billing and/or unnecessary procedures if done by a Health Care Organization, bring the same to the notice of the Hospital Authority within 15 days of discharge”.

In the instant case, the patient was discharged on 16.10.2014 but no paper is forthcoming to us to show that the complainants’ party informed the matter as per Guidelines No. 12 i.e. within 15 days of discharge, rather, the complainant filed an application on 13.10.2015 long after the discharge. The OP rightly pointed out that on 13.10.2015 long after the discharge of the patient and payment of the said bill, the complainant submitted an application and as the law does not permit, the OP felt no necessity to act in accordance with the said application. The guidelines for receiving medical treatment and settlement of claims under the West Bengal Health Scheme, 2008 does not permit the OP to issue D-2 Form without the limitation period.

            Under the above facts and circumstance of the case, we are of opinion that the complainants have failed to prove the case i.e. deficiency in service of the OP.

            As a result, the case fails.

            Hence, it is

                                                          O R D E R E D

That the Consumer Complaint No. 152/2016 be and the same is dismissed on contest but without any cost.

            Let a copy of this order be given to the parties on free of cost.

     Dictated & corrected by me.

                      President

     D.C.D.R.C , Purba Bardhaman.

               Member                                             Member                                             President

     D.C.D.R.C , Purba Bardhaman.   D.C.D.R.C, Purba Bardhaman.           D.C.D.R.C , Purba Bardhaman.