| Final Order / Judgement | DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION CAMP COURT AT LUDHIANA RBT/Consumer Complaint No.218 of 2018 Date of institution: 03.04.2018 Date of Decision: 19.05.2022 Manjit Singh son of Sh. Harbhajan Singh, resident of House No.1, Baba Nand Singh Nagar, Phullanwal, Ludhiana ….Complainant Versus
- SPS Hospitals, (A unit of SJS Healthcare Limited) Sherpur Chowk, GT Road, Ludhiana, through its Managing Director
- M/s Star Health and Allied Insurance Company Limited, 2716, 1st Floor, Gagan Complex, Backside Majestic Park Plaza Hotel, Gurdev Nagar, Pakhowal Road, Ludhiana 141001
……..Opposite Parties Complaint under Consumer Protection Act Quorum: Shri Ranjit Singh, President. Mrs. Ranvir Kaur, Member Present: Sh. Rishabh Gupta, Adv. for complainant Sh. RK Bhandari, Advocate, for OP1 Sh. Rajeev Abhi, Adv. For OP2
Order dictated by :- Shri Ranjit Singh, President Order The present order of ours will dispose of the above complaint filed under Consumer Protection Act, received by way of transfer from District Consumer Disputes Redressal Commission, Ludhiana by the complainant against the Opposite Parties on the ground that the complainant had fall at home because of which he had pain in the right shoulder and could not lift weight with his right arm. He was admitted in the hospital of the OP1 where he was operated for rotator cuff and bankart repair and implants were also placed. The OP1 had raised a bill dated 20.10.2017 for Rs.1,57,881.87P for the treatment of the complainant. The complainant was medically insured from pro forma opposite party No.2 which was a cashless insurance. The Proforma opposite party No.2 had paid Rs.1,28,762/- to the OP1 and deducted Rs.29,120/- which was paid by the complainant to the OP1. It is further alleged that the proforma OP2 had deducted Rs.11,920/- for the implants as the opposite party No.1 had failed to provide the bill for the implants. The complainant had approached the OP1 a number of terms times and requested them to issue the bill for the implants. After persistent efforts, the OP1 had issued a letter to the complainant stating that they are unable to issue any bill for the implant as they had purchased the implants in bulk and it is not possible to provide single implant bill. The total cost of the implant was Rs.59,600/- but as per the policy of the OP2 only 80% amount is payable if the invoice is not produced. As the OP1 had failed to issue the invoice therefore out of Rs.59,600/- only 80% i.e. Rs.47,680/- was paid by the OP2 to OP1 and Rs.11,920/- was paid by the complainant from his own pocket. Hence, this complaint. Vide instant complaint, the complainant has sought the following reliefs:- - To provide the bill of the implants or in the alternative to pay Rs.11,920/- i.e. the cost of the implants to the complainant
- To pay Rs.50,000/- as compensation to the complainant in the interest of justice.
- To pay Rs.20,000/- as litigation expenses.
- Any other relief to which the complainant is found entitled to be also granted to the complainant in the interest of justice.
- Upon notice, the O.P. No.1 has filed written reply taking preliminary objections; that the present complaint is not maintainable; that the Hon’ble Commission has no jurisdiction to entertain and decide the matter in issue as the complainant has sought recovery of specific amount and has also sought mandate despite the fact that no such relief is available to him; that there is no deficiency in service on the part of the answering OP; that complainant has deliberately and intentionally shown complete disregard towards the sanctity and dignity of the judicial process and has not only concealed the material facts from this Hon’ble Commission; that the present complaint is false, frivolous, baseless and vexatious; that the complaint is hit by the mandatory provision of Section 28-A of Consumer Protection Act as the mandatory pre requisite notice has not been served on the opposite party by the complainant before filing the complaint. On merits, it is stated that the opposite party No.1 had rightly raised the bill No.IPCR18/3514 dated 20.10.2017 for Rs.1,57,881.87p for the treatment of the complainant. The bill gives complete particulars of the treatment meted out to the patient/complainant including consultation fee, radiologist, bed charges, laboratory charges, medicines, consumables, orthopaedics, implants stores etc. the complainant was medically insured from OP2 vide policy No.P/161114/01/2017/010316 a cashless insurance. OP No.2 had paid Rs.1,28,762/- to the OP1 and deducted Rs.29,120/- which was paid by the complainant to the OP1. It is further stated that OP1 is not required to issue additional bill for implants for Rs.11,920/- as the amount of Rs.59,600/- charged for implants finds due mentioned in the in patient bill issued by the OP1 in the name of the complainant patient Manjit Singh. The complainant had been informed by the OP1 that additional bill for implants for Rs.11920/- cannot be issued by it as the amount of Rs.59600/- charged for implants finds due mention in the in-patient bill issued by the OP1 in the name of the complainant and it is not possible to provide single implant bill. Rest of the allegations leveled by the complainant against the answering OP have been denied and prayed for dismissal the present complaint.
- In reply, the learned counsel for the OP2 has filed written reply taking preliminary objections; that the present complaint is barred under section 26 of the Consumer Protection Act; that the averments made in the complaint are hereby denied except those that are admitted hereunder and the complainant is put to strict proof thereof; that the complainant is not a consumer as defined under the Consumer Protection Act; that this Hon’ble Commission has no jurisdiction to try and decide the present complaint since complicated question of law and facts are involved which require elaborate evidence both oral and documentary and it is only civil court of competent jurisdiction who can try and decide the present complaint. On merits, it is stated that the only relief claimed is only against the OP1. No relief has been claimed against OP2 as is evident from the averments in the claim petition as well as the relief para of the complaint. The OP1 is only made a performa opposite party No.2 as mentioned in para No.4 and Para No.7 of the complaint. The claim of the complainant already stands settled and paid for a sum of Rs.1,28,762/- in full and final settlement of claim and accepted by the complainant in full and final settlement of his claim. Thus, alleging no deficiency in service on the part of answering OP.
- The complainant has tendered various documents in the shape of evidence. On the other hand, the OPs have also tendered various documents in the shape of evidence.
- We have heard learned counsel for the parties at considerable length and have also examined the record of the case.
- It is pertinent to mention that as per the complainant he has suffered a loss of Rs.11920/- due to non issuance of separate bill incurred by him on implants, the same being requirement of OP2 for its payment. The defence of OP1 is that the said amount of Rs.11920/- finds mention in the consolidated/detailed bill of the amount of Rs.59600/-. OP1 has further declined to issue separate bill due to technical reasons.
- In the circumstances of the case denial by the OP1 to issue separate bill, required by the complainant to claim it from OP2 on technical grounds is not justified. In the circumstances of the case OP1 is directed to issue separate bill of Rs.11920/- of the amount incurred by the complainant as per requirement of the policy by OP2.
- Further OP2 is directed to not to deny the said payment, otherwise payable on the ground of delay taken while perusing the present complaint.
- OP1 will facilitate, by issuing relevant separate bill the payment of Rs.11,920./- by OP2, who is liable to pay the said amount of Rs.11920/- along with interest @ 9% per annum on the said amount, since the date it became payable along with other insurance money already paid , till its actual payment. Further complainant is also entitled Rs.25,000/- as compensation on account of mental agony and physical harassment and Rs.11,000/- as litigation expenses paid by the OP1 to the complainant. The OP2 is also directed to reimburse the amount of Rs.11920/- to te complainant after receiving the bill of the said amount. Free certified copies of this order be sent to the parties, as per rules. The file be sent back to the District Consumer Commission, Ludhiana, for consigning the same to the record room.
Announced May 19, 2022 (Ranjit Singh) President (Ranvir Kaur) Member CC No.218 of 2018 Present: Sh. Rishabh Gupta, Adv. for complainant Sh. RK Bhandari, Advocate, for OP1 Sh. Rajeev Abhi, Adv. For OP2 Arguments completed. Vide our separate detailed order of today, the complaint stands allowed. Free certified copies of this order be sent to the parties, as per rules. The file be sent back to the District Consumer Commission, Ludhiana, for consigning the same to the record room. May,19 2022 (Ranjit Singh) (Ranvir Kaur) | |
