BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANGALORE
Dated this the 27th MAY 2017
PRESENT
SRI VISHWESHWARA BHAT D : HON’BLE PRESIDENT
SMT. LAVANYA M. RAI : HON’BLE MEMBER
ORDERS IN
C.C.No.392/2016
(Admitted on 06.12.2016)
Mr. Vincent Saldanha,
S/o Stephen Saldanha,
Aged about 64 years,
Kadur House, Chelur,
Bantwal Taluk, D.K.
….. COMPLAINANT
(Advocate for the Complainant: Sri ADB)
VERSUS
1. The Asst. Manager,
YCFHS (Yashaswini Co operative)
Farmers Health Care Scheme) Project,
MD India Health Care Net Work,
No.8, 9th Cross, Wison Garden,
Bengaluru Pin 560 027.
2. Mr. Santhosh,
Convenor,
District Registrar of Co op Society,
Janatha Bazar Building,
G.H.S Road,
Mangaluru 575 001
…..........OPPOSITE PARTIES
(Advocate for the Opposite Party No.1: In person)
(Opposite Party No.2: Ex parte)
ORDER DELIVERED BY HON’BLE PRESIDENT
SRI VISHWESHWARA BHAT D:
The above complaint filed under Section 12 of the Consumer Protection Act by the complainant against opposite parties alleging deficiency in service claiming certain reliefs.
The brief facts of the case are as under:
The complainant claims he was founder member of Chelur Milk Producers Co operative Society Ltd, Bantwal Taluk had subscribed to Health Care Project envisaged by opposite party No.1 by paying Rs.500 towards premium for the year 2014-15 as per receipt No.300 dated 12.8.2014. In first week of March 2013 he suffered from a severe chest pain and it was diagnosed to be the IHD.Acute IWMI, Atherosclerotic triple vessel coronary artery disease, S/P PTCA to RCA, PTCA to LCD & LCx and was constrained to undergo immediate angioplasty at Father Muller Medical College Mangalore on 29.3.2015. Enquiry was made by complainant with opposite party No.2 about the benefit opposite party No.2 declined to give full benefit available to complainant and informed that it could be paid only once. The doctor of the patient stated that there may be another procedure for the same disease. The bill for the treatment charge of Rs.1,40,568 and opposite party company paid only Rs.6,500 to complainant under the scheme and balance was paid by the complainant himself and underwent treatment for 20.4.2015 to 23.4.2015 and incurred the heavy treatment expenditure. On request made under the scheme opposite party company had paid only Rs.1,00,000 against the hospital bill amounting Rs.2,08,368. The complainant himself came to know company had hiked the revised benefit rate under the various scheme and up to Rs.2,00,000 in respect of the angioplasty treatment from 75,000 to 1,20,000 and in case need arises for second time treatment benefit it will be extended to Rs.2,00,000 as per official gazette dated 23.04.2015. As such seek payment of the balance Rs.93,500 from opposite party No.2 which was declined. Alleging deficiency in service in not making payment seeks remedy mentioned in the complaint.
2. On notice on behalf opposite party No.1 Mr. Dixith Sarvotham, Co ordinator of opposite party No.1 appeared and sought time to file version. However he had presented a vakalat which was not signed by any advocate. As such on 26.04.2017 the vakalat was returned to the said Mr. Dixith Sarvotham later opposite party No.1 remained absent.
3. In support of the above complaint Mr. Vincent Saldanha filed affidavit evidence as CW1 and produced documents got marked at Ex.C1 to C9 as detailed in the annexure here below. On behalf of the opposite parties not filed any affidavit evidence.
4. In view of the above said facts, the points for consideration in the case are:
- Whether the Complainant is a consumer and the dispute between the parties?
- If so, whether the Complainant is entitled for any of the reliefs claimed?
- What order?
The learned counsels for complainant filed notes of arguments. We have considered entire case filed on record including evidence tendered by parties. Our findings on the points are as under follows:
Point No. (i) : Affirmative
Point No. (ii) : Affirmative
Point No. (iii) : As per the final order.
REASONS
5. POINTS No. (i): Complainant having been subscribed to the scheme Yashaswini Co operative Farmers Health Care Scheme and paid Rs.500/ as per Ex.C2 the receipt dated 12.08.2014 with Ex.C3 the copy of the members of the society in question. It is clear he had subscribed to the scheme run by opposite party No.1 covering the health risk. The claim of complainant was not honoured in fullest extent towards payment of the medical expenditure of the hospitalization of the complainant. Hence there is not only relationship of consumer and service provider between the parties but also live dispute as contemplated under section 2 (1) (e) of the C P Act. Hence we answer point No.1 in the affirmative.
6. POINTS No. (ii): Ex.C4 is the discharge summary issued by Father Muller Medical College Hospital pertaining to complainant as per which he was admitted on 29.03.2015 and discharged on 1.4.2015 and Diagnosis is shown as IHD.Acute IWMI, Atherosclerotic triple vessel coronary artery disease, Culprit vessel PTCA to RCA, Plan PTCA to LAD & LCx. Mention made at Ex.C6 for the same period discharge total bill of Rs.1,40,568 of which Yashaswini Approved is show as Rs.6,500 and the advance of Rs. 1,34,068. Ex.C7 is the discharge summary bill copy bill date/ discharge show as 23.4.15 at 12:47 and it mentions the IP No as 545549 which is pertaining to Ex.C5 another discharge summary dated showing 23.4.2015 with diagnosis copy.
7. Opposite party has not challenged the claim made by complainant. Hence it is clear that opposite party did not pay the amount demanded by the complainant under legal notice dated 04.06.2015 for payment of Rs.93,500/ under the scheme. Hence complainant proved deficiency in service on the part of opposite party. Hence we answer point No.2 in the affirmative.
POINTS No. (iii): Wherefore the following
ORDER
The complaint is allowed. Opposite party No.1 is directed to pay Rs.93,500/ (Rupees Ninety Three thousand Five hundred only) to complainant.
2. Opposite party No.1 shall also pay cost of this complaint fixed at Rs.5,000/ (Rupees Five thousand only) to complainant.
3. In case of failure of opposite party to comply with this order within 30 days opposite party shall pay interest on the above sum at the rate of 9% per annum from the date of complaint till the date of payment.
Copy of this order as per statutory requirements, be forwarded to the parties free of cost and file shall be consigned to record room.
(Page No.1 to 6 directly typed by steno on computer system to the dictation of President revised and pronounced in the open court on this the 27th May 2017)
MEMBER PRESIDENT
(LAVANYA M. RAI) (VISHWESHWARA BHAT D)
D.K. District Consumer Forum D.K. District Consumer Forum
Mangalore. Mangalore.
ANNEXURE
Witnesses examined on behalf of the Complainant:
CW1 Mr. Vincent Saldanha
Documents marked on behalf of the Complainant:
Ex.C1: Notarized copy of the policy issued by the OP
Ex.C2: Receipt No 300 dated 12.08.2014 issued by the Society for being received the renewal of Subscription for the period August 2014 to July 2015
Ex.C3: Notarised copy of the membership card of the Complainant to show that he had the membership of Chelur Milk Producers Co operative Society
Ex.C4: Discharge summary of Father Mullers Hospital for the period of 29.03.2015 to 01.04.2015
Ex.C5: Discharge summary of Father Mullers Hospital for the period of 20.04.2015 to 23.04.2015
Ex.C6: Hospital bill of Father Mullers Hospital for the period Of 29.03.2015 to 2.04.2015 for Rs.1,40,568.00
Ex.C7: Hospital bill of Father Mullers Hospital for the period of 20.04.2015 to 23.04.2015 for Rs.2,08,368.00
Ex.C8: Copy of the legal notice dated 4.6.2015 sent to both the opposite parties
Ex.C9: The original Udayavani Daily Newspaper dated 27.04.2015 Containing the paper publication about the Govt Notification regarding the revise.
Witnesses examined on behalf of the Opposite Parties:
Nil
Documents marked on behalf of the Opposite Parties:
Nil
Dated: 27.5.2017 PRESIDENT
