By Sri. Gururaj Member:-<br /> <br /> This is a complaint filed U/s. 12 of Consumer Protection Act by the complainants- (1) Smt. Meenakshi W/o. Sharanabasava (2) Sri. H. Veeranagouda S/o. Virupanagouda against the three Respondents (1) The Chief Secretary Government of Karnataka Co-operative Department MS Building 2nd Stage 6th Floor, Bangalore (2) The Chief Executive Officer FHPL Yashwini Co-operative Formers Health Scheme MS Building, Bangalore (3 The General Manager RAPM & PCS Ltd., Raichur. <br /> <br /> At the time of hearing on admission of this complaint, the L.C. for the complainant has filed memo for not pressing the complaint against the Respondent NO-1 hence Respondent NO-1 has been deleted from the complaint and Respondent NO-2 & Respondent NO-3 have been re-numbered Respondent NO- 1 & 2. The brief facts of the complaint are as under:<br /> The complainant No-1 is the daughter of complainant NO-2 the complainant No-2 is the agriculturist. For the benefit of his family he has become a member of the Yashashwini Co-operative Farmers Health Scheme through Raichur Agriculture Producing Marketing and Processing Co-operative society, Raichur. The complainant No-1 being the daughter of complainant NO-2 she has also obtained membership under the said health scheme along with her father. The Respondents have assured to the members of the said scheme to reimburse hospital expenses in-respect of surgeries or medical treatment for different diseases if any member took treatment from the network hospital of Respondents. It is the case of the complainant that being influenced by the Respondent scheme complainant No- 1 & 2 have registered themselves as members under the Yashashwini Scheme and paid an amount of Rs. 130/- towards subscription fees as required under the scheme and same has been renewed for the period of 2007-08 by paying renewal fees of Rs. 130/- vide Receipt No. 4184206 dt. 16-04-07. Further they have contended that, the marriage of complainant No-1 was held on 24-01-07 with one Dr. Sharanabasava and after that she has become pregnant and faced with unforeseen health problem at the time of gestation period. She consulted Respondents penal hospital doctor- Dr. T.Chandrika. This doctor diagnosed that the complainant NO-1 was suffering from “ Prime with meconeum stained having with foetam distress with two right loops of cord around neck” lower segment formed having thick meconium stained. A live female child delivered by vertex presentation. Further she treated by employing lower segment scicessarian section under spiral anasthea on 03-01-08. The complainant NO-1 has taken treatment for (6) days from 02-01-08 to 07-01-08 as an in-patient and further one-month treatment as an out-patient. For the above treatment she has spent Rs. 30,000/- towards surgery, medicine and conveyance charges etc., It is the case of the complainant that after discharge of the complainant No-1 from the hospital she met with Respondent No-2 for getting benefit under the scheme and submitted application along with discharge card and subscriptions for reimbursement of the expenses incurred for the treatment, but the Respondent NO-2 refused to disburse the expenditure amount by giving false and un-called reasons as she was not the main member nor she is a dependent to main member, since she is married and enrolled on her father’s name. This reason shown by the Respondent NO-2 is illegal and against the terms of the policy. After the refusal by the Respondent NO-2 the complainants approached the Deputy Registrar of Co-operative Society Raichur. In-turn the DRCS Raichur recommended to disburse the benefit to the complainant, which is legally the complainant No-2 is entitled. But none of the Respondents have taken steps to disbursement of amount to the complainants.<br /> It is the case of the complainants that as per clarification/rules vide Memorandum No. CO.5.CLS07 dt. 12-09-07 the complainant No-1 is entitled to receive the benefit under the scheme because her date of enrolment is 16-04-07, her marriage date is 27-01-07. The delivery has been taken place within one year from the date of marriage or within the date of enrolment. It is further submitted that the claim of the complainants is genuine one. If the genuine claim of the complainants is denied the very purpose of obtaining the policy by becoming member in the scheme is useless and no purpose will be served by introducing the scheme. The complainant NO-1 is the real daughter of complainant NO-2. Being daughter of main member she is entitled to receive the package rate for the above surgery at Rs. 5,000/- as per norms. Therefore she is entitled for above amount and also Rs. 20,000/- which was spent for medical expenses, conveyance charges, food and nourishment etc., Due to non-disbursement of package amount for the surgery both the complainant have got mental torture and agony. The Respondents have illegally refused to disburse the surgery package amount, which shows clearly negligence and deficiency on the part of the Respondent. Therefore both the Respondents are jointly severally liable to reimburse the surgery package of Rs. 5,000/-, and to pay expenses towards medical conveyance food and nourishment Rs. 20,000/-, damages Rs. 20,000/- and cost of litigation Rs. 10,000/- totally in all 55,000/-.<br /> <br /> 2. In response to service of notice Respondents No-1 & 2 appeared through their respective counsels. Respondent NO-1 has filed written version contending that the complainants have registered themselves as members under the scheme and paid the subscription amount of Rs. 130/- for coverage of their risks and renewed their membership for the period 2007-08 by paying subscription on 16-04-07. The marriage of the complainant NO-1 took place on 24-01-07 with one Dr. Sharanabasava of Javalagera village, so they have denied about the membership of complainant No-1 with the complainant No-2’s family and they have also contended that the complainant NO-1 by suppressing the marriage matter with Dr. Sharanabasava held on 24-01-07, renewed her membership. Immediately after her marriage complainant No-1 will become the member of her husband’s family therefore the complainant No-1 is no more a member of the complainant No-2’s family hence she is not entitled to claim the benefit under the scheme. It is also denied about the spending of Rs. 30,000/- by the complainants towards surgery medicine & conveyance charges, as they were un-aware about the treatment taken by the complainant NO-1 and doctor one who gave treatment. Complainant NO-1 was neither main member nor dependent to the main member, since she has married and served her relationship with complainant NO-2’ family. Even after the marriage also she has enrolled on her father’s name by suppressing her husband’s name. So the Respondent No-1 was justified in denying the claim of the complainants. As such the claim of the complainants that the Respondent No-1 has given false, un-called reasons or illegal against the terms of policy are all baseless. If at all the complainant NO-1 wants to avail the benefit of the scheme she ought to have enrolled herself in the family of her husband. In this regard Co-operative Department of Government of Karnataka has issued Circular on 07-12-07 and as per the class-4 of the said circular she is not entitled to claim the benefit under the scheme. The Karnataka Government Secretariat Co-operation Department has issued a circular on 12-09-07 clarifying regarding the married daughter and under what circumstances she is entitled to claim the benefits. Further this Respondent contended that the clarification/Rules vide Memorandum No. CO.5.CLS07 dt. 12-09-07 by this order the Karnataka Government Secretariat Co-operation Department has clearly clarified that married daughter means she is not the daughter of original family but she becomes the member of her husband’s family so she is not entitled to claim the benefit. Further she is not entitled to claim the exemption mentioned at Para-1, 2 & 3 in the said circular as such complainant NO-1 is not entitled to claim the benefit under the Yeshasvini scheme. This Respondent NO-1 further contended that, though the complainant NO-1 is the daughter of complainant NO-2, her relation with that family were severed, the movement she marries. So she becomes the family member of her husband and has denied the rate of surgery, nourishment charges as false. Hence question of paying compensation does not arise. As such there is no deficiency of service as claimed and has prayed this Forum to dismiss the complaint by awarding exemplary cost against the complainants.<br /> <br /> 3. The Respondent NO-2 has filed his written version contending that the complainants have unnecessarily brought this Respondent before this Forum as there is no deficiency in service or negligent etc., on their part and also this Respondent not comes under the purview of the said act in the present case. On this count itself the complaint of the complainant is liable to be dismissed with cost. It is further contended that the complainant NO-1 got admitted in Balanku Hospital, Raichur after one year from the date of her marriage, she become the member of Yashashwini Scheme after four months from the date of marriage by that she was the member of her husband family. She might be a member of Yashashwini Scheme but she looses her right since she became the member of her husband’s family and more over she admitted for treatment and operation for delivery after the lapse of one year. A daughter who married and residing in-laws house is entitled to get the benefit only within one year of her father. There is no deficiency in service on the part of this Respondent hence he is not responsible for the claim of complainant. If the Forum comes to the conclusion that the complainant are entitled to receive the benefits under the scheme, then burden may be shifted against the Respondent NO-1. Further contended that this Respondent, issue the membership receipt to the members only as per the guidelines and instructions of the Respondent NO-1. Hence the Respondent No-1 is sole responsible to answer the claim of the complainants. Therefore the complaint against this Respondent is fit to be dismissed with the cost. <br /> <br /> 4. During the course of enquiry the complainant No-1 has filed her sworn affidavit by way of examination-in-chief reiterating the averments of her complaint and she has got marked (9) documents as Ex.P-1 to Ex.P-9. In rebuttal the Respondent NO-1 has filed sworn affidavit of Shivaranga Rama Nayak, Chief Executive Officer, Yeshasvini Co-operative Farmers Health Scheme M.S. Building Bangalore for Respondent No-1. Similarly Respondent NO-2 Sri. Lingappa General Manger, R.A.P.M.C. Raichur has filed sworn affidavit by way of examination-in-chief on behalf of the Respondent No-2. The Respondent No- 1 & 2 have not filed any documents. Hence no documents were marked on their behalf.<br /> <br /> 5. Heard the arguments of L.C. for respective parties. The following points arise for our consideration and determination:<br /> <br /> 1. Whether the complainants prove deficiency in service by the Respondents in not settling their claim as alleged.?<br /> <br /> 2. Whether the complainant is entitled for the reliefs sought for.?<br /> <br /> <br /> 6. Our finding on the above points are as under:-<br /> <br /> 1. In the affirmative. 2. As per final order for the following <br /> <br /> REASONS<br /> <br /> POINT NO.1:-<br /> <br /> 7. There is no dispute that complainant NO-2 is the father of complainant NO-1 and complainant No- 1 & 2 are the members of the Yashashwini Scheme, which was floated by the Respondents and they have renewed their names for the year 2007-08. It is also not in dispute that the marriage of the complainant No-1 took place on 24-01-07 with one Dr. Sharanabasava. The complainants have produced in all (9) documents they are: Ex.P-1 is Receipt No. 3957 dt. 16-04-07 for having paid Rs. 130/- towards renewal fees. Ex.P-2 is Letter dt. 05-01-08 written by the DRCS Raichur to the Respondent NO-1 to take necessary action in-respect of claim of the complainant No-1. Ex.P-3 is Birth certificate dt. 10-01-08 issued by the Balanku Hospital Raichur. Ex.P-4 is Letter of the Respondent dt 7-01-08. Ex P 5 & Ex.P-6 are the two circulars dt. 12-09-07 & 07-12-07 issued by the Secretary, Karnataka Government Secretariat Co-operation Department Bangalore. Ex.P-7 is the Discharge Card issued by the Balanku Hospital Raichur. Ex.P-8 is Detailed list of Surgery package rates and Ex.P-9 is Wedding Card of complainant NO-1.<br /> <br /> 8. The case of the complainants is that the complainants are the members of the Yashashwini Scheme and they have renewed their names by paying Rs. 130/- on 16-04-07, since they are the members they are entitled to claim the medical expenses for their treatment and operations from the Respondents. It is also the case of the complainants that the complainant NO-1 has admitted in the Balanku Hospital for her unforeseen problems at the time of gestation period and under gone for operation of L.S.C.S. and took treatment for (6) days from 02-01-08 to 07-01-08 as in-patient and one month as a out-patient. It is also the case of the complainant No-1 that, since she is the member of Yashashwini scheme she is entitled to claim Rs. 5,000/- as per the package rates towards surgery and Rs. 20,000/- towards medical expenses conveyance charges etc., and Rs. 20,000/- towards mental torture for non-settling her claim by Respondents and Rs. 10,000/- in-respect of cost of this litigation. But the case of the Respondent is that by suppressing her marriage matter complainant No-1 renewed her name and after marriage she has lost her membership with family membership of her father. Immediately after marriage she will get the membership of her husband accordingly she has became the member of her husbands family, if at all she wants to claim any benefits under her father’s membership she has to claim within one year from the date of her marriage. It is also their case that complainant NO-1 admitted for her treatment and operation for delivery after the lapse of one year therefore she is not entitled to claim any benefit under the scheme. Hence they are not responsible for the claim made by the complainants.<br /> <br /> 7. From the close perusal of the pleadings of the parties first crucial question will arise for our consideration is whether the complainant No-1 is admitted to the hospital within one year from the date of renewal of her name under the scheme or not and then secondly whether the complainant is the family members of her father or not during her treatment. From the close perusal of Ex.P-1 the Receipt for having paid the renewal fees and Ex.P-9 Wedding Card, it appears that the marriage of complainant NO-1 with Dr. Sharanabasava was held on 24-01-07 and date of renewal of her name under the scheme is on 16-04-07 from this it is very clear that within a span of four months of her marriage, her name has been renewed. Similarly from the close perusal of the Discharge Card & Birth Certificate i.e, Ex.P-7 & Ex.P-3 it appears that the complainant No-1 was admitted in the Balanku Hospital on 02-01-08 and discharged from the hospital on 07-01-08. The Ex.P-3 Birth Certificate discloses the date of delivery as 03-01-08. If we made comparison of these Ex.P-3 & Ex.P-7 with the Ex.P-9 it appears that the date of admission in hospital, date of delivery, treatment and operation are within span of one year from the date of marriage as contended by the complainants. Therefore the answer for the first question is in favour of the complainant. From this we find no substances in the defence of Respondents particularly the defence of Respondent NO-2 as contended in Para-7 of the written version that “after lapse of one year the complainant No-1 was admitted in the hospital for treatment and for delivery etc., as false and baseless”. Hence we hold that the rejection of the claim of the complainants on one of this reason by the Respondents holds no good. Similarly if we come to the second question whether the complainant NO-1 is the family member of her father or not during the course of her treatment? For this we perused the Ex.P-5 the circular issued by the Secretary Karnataka Government Secretariat Co-operative Department and we found that the Para-3 of said Ex.P-5 which reads as under:-<br /> “AiÀıÀ²é¤ AiÉÆÃd£ÉAiÀÄ ¥sÀ¯Á£ÀĨsÀ«UÀ¼À£ÀÄß ªÀµÀð«r £ÉÆAzÁĸÀĪÀÅ¢®èªÁzÀÝjAzÀ JzÀÄgÁUÀ§ºÀÄzÁzÀ ¸ÀªÀĸÉåAiÀÄ£ÀÄß §UɺÀj¸À®Ä AiÉÆÃd£ÉAiÀÄ ¸Ë®¨sÀåªÀ£ÀÄß ªÀÄzÀĪÉAiÀiÁzÀ ªÀÄUÀ¼ÀÄ vÀAzÉAiÀÄ PÀÄlÄA§zÀ ¸ÀzÀ¸Àå¼ÁV, ªÀÄzÀĪÉAiÀiÁzÀ ªÉÆzÀ® ªÀµÀð ªÀiÁvÀæ ¥ÀqÉAiÀÄ®Ä DºÀð¼ÁUÀÄvÁÛ¼É.”<br /> <br /> From this it is very clear that only for the first year a married daughter is entitled to get the membership of her father’s family and during the said first year of her marriage she is entitled to claim the benefits under the scheme. But the Respondents have contended that subsequently after this circular at Ex.P-5, another circular with some modification at Ex.P-6 has been issued on 07-12-07 and as per Para-4 of the said circular, a married daughter is not entitled for claim of her fathers family immediately after her marriage and after marriage she will become the member of the husbands family. The said circular is also made available before the Forum by the complainant and the same has been marked at Ex.P-6. From the close perusal of Ex.P-6, no doubt it appears that the married women will loose her membership of her fathers family soon after her marriage, but this circular is made applicable only from the year 2008-09, as could be seen in Para-3 which reads as under:-<br /> <br /> “G¯ÉèÃRzÀ°è £ÀªÀÄÆ¢¹zÀ ¸ÀÄvÉÆÛ¯ÉUÀ¼À°èAiÀÄ AiÀıÀ²é¤ AiÉÆÃd£ÉAiÀÄ ¸Ë®¨sÀåªÀ£ÀÄß ºÉaÑ£À ¥ÀæªÀiÁtzÀ°è UÁæ«ÄÃt ¸ÀºÀPÁjUÀ½UÉ MzÀV¸ÀĪÀ zÀÈÖÄAzÀ PÉ®ªÀÅ ªÀiÁ¥ÁðqÀÄUÀ¼À£ÀÄß ªÀiÁqÀ¯ÁVvÀÄÛ CzÉà GzÉÝñÀ¢AzÀ 2008-09 £Éà ¸Á°UÉ F PɼÀUÉ £ÀªÀÄÆ¢¹zÀ ªÀiÁ¥ÁðqÀÄUÀ¼À£ÀÄß ªÀiÁrzÀÄÝ CªÀÅUÀ¼À£ÀÄß ¸ÀjAiÀiÁV w½zÀÄPÉÆAqÀÄ C£ÀĵÁÖ£ÀzÀ°è vÀgÀ¨ÉÃPÁVzÉ. EªÀÅUÀ¼À ¥Àæw ¸ÀºÀPÁj ¸ÀAWÀzÀ ¸ÀzÀ¸ÀåjUÉ vÀ®Ä¥ÀĪÀAvÉ £ÉÆÃrPÉƼÀî¨ÉÃPÁUÀÄvÀÛzÉ.” <br /> <br /> From this it is very clear that, no doubt, some changes have been made in the earlier circular i.e, Ex.P-5 but it is also very clear that effect of those changes which are made in Ex.P-6 are for the period of 2008-09 but not for the year 2007-08 thus we hold that the Ex.P-5 is the relevant circular to the case of the complainant and so the circular dt. 07-12-07 i.e, Ex.P-6 will not effect the case of the complainant because complainants renewed their membership under the Yeshasvini Scheme on 16-04-07 for the year 2007-08. The date of marriage of complainant NO-1 is 24-01-07. The date of admission for treatment for delivery and operation is on 02-01-08 and date of discharge is 07-01-08. From these dates it is very clear that every thing has been happened during the period of 2007-08 but not in the period of 2008-09. So viewed from all the angles, it appears that the Ex.P-6 i.e, circular issued on 07-12-07 is no way concerned to the facts of the complainants case. On the contrary Ex.P-5 circular is applicable to the present case. This Ex.P-5 clearly goes to show that the complainant NO-1 was the member of her father’s family during the period of her treatment but not the member of her husbands family though she got married with Dr. Sharanabasava within the meaning of Para-3 of the Ex.P-5. Therefore we hold that the contentions of the Respondent in this regard is nothing but contrary to their own circulars. It is worthwhile to note that the said circular which are marked at Ex.P-5 & Ex.P-6 have been issued by the Chairman of the Yeshasvini Co-operative Farmers Health Care Trust are very much clear in understanding the conditions of Yeshasvini scheme and its purposes. Even the Deputy Registrar of Co-operative Society Raichur District through his letter dt. 05-01-08 addressed to Bharathi Maradi Manager, FHPL & Respondent No-1 under Ex.P-2 has opined and recommended the entertainment of the claim by the complainants, this letter interalia reads thus:-<br /> “ -----------------------------------------------------¥ÀæAiÀÄÄPÀÛ G¯ÉèÃRzÀ ¸ÀgÀPÁgÀzÀ ¸ÀÄvÉÆÛïÉAiÀÄ£ÀéAiÀÄ ²æêÀÄw «ÄãÁQë. «. EªÀgÀÄ AiÀıÀ²é¤ AiÉÆÃd£ÉAiÀÄ ¸Ë®¨sÀå ¥ÀqÉAiÀÄ®Ä DºÀðgÁVgÀÄvÁÛgÉ.___________________”<br /> <br /> J¸ï.r.<br /> ¸ÀgÀPÁgÀ ¸ÀAWÀUÀ¼À ¤§AzsÀPÀgÀÄ<br /> gÁAiÀÄZÀÆgÀÄ f¯Éè. <br /> <br /> It appears that without going through the said circular and the letter of DRCS at Ex.P-2 the Respondents have denied the claim of the complainants, this would goes to show that Respondents are not deligent in dealing the matter and have committed deficiency in service as rightly argued by L.C. for complainants. Therefore for above said reasons and discussions we hold that the complainant has proved the negligence and deficiency in service by the Respondents. Hence Point NO-1 is answered in the affirmative. <br /> POINT NO.2:-<br /> <br /> 8. The complainants have claimed Rs. 5,000/- towards surgery package and Rs. 20,000/- towards medical, conveyance food and nourishment, Rs. 20,000/- towards damages and Rs. 10,000/- cost of litigation in all they have claimed Rs. 55,000/- against the Respondents. So far as the first relief is concerned, we have referred the Ex.P-8 i.e, surgery package rate and come to the conclusion that the complainants No-1 is entitled to receive Rs. 5,000/- Having regard to the facts and circumstances of the case as discussed above in Point No-1, we feel it just and proper to award in-respect of medical expenses, conveyance food and nourishment, damages and cost of litigation, a global compensation of Rs. 10,000/- Therefore in all we have awarded Rs. 15,000/- against the Respondents. In this view of the matter we pass the following order:<br /> <br /> ORDER<br /> <br /> The complaint of the complainants is allowed in part <br /> <br /> The Respondents are jointly and severally shall pay Rs. 15,000/- towards surgery package, medical expenses, conveyance food and nourishments damages and cost of the proceedings.<br /> <br /> The Respondents shall comply this order within a period of six weeks from the date of receipt of copy of this order.<br /> <br /> Office to furnish certified copy of this order to both the parties forth with free of cost.<br /> (With the permission of the President, Sri. Gururaj Member dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 31-12-08)<br /> <br /> Sd/-<br /> Sri. N.H. Savalagi,<br /> President,<br /> District Forum-Raichur.<br /> <br /> Sd/-<br /> Sri. Gururaj, Member,<br /> District Forum-Raichur.<br /> <br /> Sd/- <br /> Smt.Pratibha Rani Hiremath, <br /> Member. <br /> District Forum-Raichur.<br /> <br /> <br />