DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR
Complaint no. 470
Instituted on: 14.09.2017
Decided on: 05.02.2018
Bharpur Singh aged 56 years son of Jagir Singh resident of Guru Nanak Colony, Opposite Govt. College, Malerkotla, District Sangrur.
…. Complainant.
Versus
1. The Mohammad Nagar Multipurpose Agricultural Service Society, Village Mohammad Nagar ( Bhaini Khurd), Tehsil Malerkotla, District Sangrur through its Secretary.
2. Bhai Ghanhya Sehat Sewa Scheme, Bhai Ghanhya Trust through its Chairman 17, Bays Building Sector 17, Chandigarh.
3. ICICI Lombard General Insurance Company Limited, SCO No.174-175, Sector -9 Chandigarh through its Divisional Manager.
4. ICICI Lombard Health Insurance Regd. Office, ICICI Bank Towers, Bandra Kurla Complex Bansara East Mumbai through its Divisional Manager.
5. M.D. India Health Care Services ( TPA) Private Limited through its MD Mohali Tower, Ist Floor, Plot No.F-539 , Phase -8B, Industrial Area, Airport Road, Mohali, Punjab. ….Opposite parties.
FOR THE COMPLAINANT: Shri Mohd. Izhar, Advocate
FOR OPP. PARTIES No.1&2 : Shri S.S.Ratol, Advocate
FOR OPP. PARTIES No.3to 5 : Shri G.S.Sibia, Advocate.
Quorum
Sukhpal Singh Gill, President
Sarita Garg, Presiding Member
Vinod Kumar Gulati, Member
ORDER:
Sukhpal Singh Gill, President
1. Bharpur Singh, complainant has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that he obtained the services of OPs by getting himself insured under Bhai Ghanhya Sehat Sewa Scheme launched by Punjab Govt. in associated with the OPs no. 3 and 4 . On 13.12.2016, the complainant emergently became unconscious and got admitted in Hero DMC Heart Institute, Hospital Ludhiana where he remained admitted from 13.12.2016 to 24.12.2016. The complainant showed his card issued by the OPs no.2 to 5 and requested for cashless facility but after admission the official of the hospital asked the complainant to pay the charges and to claim from the OPs later on. Thereafter the complainant submitted the hospital and medicine bills with OP no.1 but till today no claim was paid to him. Thus, alleging deficiency in service on the part of OPs, the complainant has sought following reliefs:-
i) OPs be directed to pay Rs.1,13,250 spent on the treatment and on transportation charges ,
ii) OPs be directed to pay to the complainant a sum of Rs.50,000/- on account mental agony and harassment,
iii) OPs be directed to pay Rs.30000/- as litigation expenses.
2. In reply filed by OPs no.1and 2, it is stated that Bhai Ghanhya Trust is a registered Trust and the scheme is meant for providing cashless services to the members and employees of the eligible Cooperative Societies and Cooperative Department Punjab and their families across the State of Punjab and Chandigarh who shall be covered under the Scheme for a period of one year from the date of commencement of the scheme in an approved network hospital and on reimbursement basis in a Government hospital under the Scheme. The OPs no.1 and 2 is neither a service provider or a claim settling authority under the scheme nor received any claim/ request for settlement of the same from the complainant.
3. In reply filed by the OPs no.3 to 5, it is submitted that complainant neither visited the office of OPs no.3 to 5 nor intimated the OPs no.3 to 5 regarding his admission in the said hospital nor submitted any document with the OPs no.3 to 5 as has been alleged in the complaint. Thus, there is no deficiency in service on the part of the OPs no.3 to 5.
4. The complainant has tendered documents Ex.C-1 to Ex.C-62 and closed evidence. On the other hand, OPs have tendered documents Ex.OPs no.1&2/1 to Ex.OPs no.1 and 2/3 and Ex.OPs no.3 to 5/1 to Ex.OPs no.3 to 5/2 and closed evidence.
5. It is the case of the complainant that he submitted the hospital and medicine bills with the OP no.1 who further told the complainant to approach OPs no. 2 to 5 and thereafter he approached the OPs no.3 and 4 and submitted photo copies of the said bills but till today nothing has been done in favour of the complainant. On the other hand, OPs no.3 to 5 have specifically stated in their written reply that complainant neither visited their office nor intimated them regarding his admission in the said hospital nor submitted any document with them regarding his claim.
6. Without touching the case on merits and from the perusal of the entire file we find that the complainant has not produced any document which show that he ever submitted the alleged bills with the OPs . Moreover, he has not produced on record any evidence which could show that he lodged the claim with the OPs. So, we feel that it would be better if first of all the complainant is directed to lodge the claim with the OPs alongwith required documents. Accordingly, the complainant is directed to lodge the claim with the OPs alongwith required documents within 15 days and thereafter OPs are directed to settle/ decide the claim of the complainant within 30 days from the receipt of claim form alongwith other required documents. However, the complainant shall be at liberty to approach the Forum again he is not satisfied with the decision of the OPs regarding his claim. A copy of the order be supplied to the parties free of charge. File be consigned to records in due course.
Announced
February 5, 2018
(Vinod Kumar Gulati) (SaritaGarg) (Sukhpal Singh Gill)
Member Member President
