Charanjit Singh, President;
1 The present complaint has been received from the District Consumer Disputes Redressal Commission Amritsar by the order of the Hon’ble State Consumer Disputes Redressal Commission Punjab, Chandigarh for its disposal.
2 The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 12 and 13 against the opposite party on the allegations that complainant is doctor general Practitioner and practicing at the address given at the headnote of the complainant along with his wife Ms. Preeti Arora who is looking after the GYNE Patients. They took the professional indemnity policy vide policy No. 2333200-2008174 from the opposite party and used to make regular premium for renewal each and every year hence, the complainant became the consumer qua the opposite party as the complainant got the aforesaid policy for his own benefit. The complainant paid the requisite amount towards premium to the opposite party in this respect. On 5.7.2016 District Consumer Disputes Redresal Forum now Commission Amritsar allowed / decided a complaint titled as Vijay Kumar Vs M.P. Arora Maternity and general Hospital and others vide order dated 5.7.2016 copy of order is enclosed with the observations that complainant is entitled to compensation to the tune of Rs. three Lacs from opposite parties No. 1 to 3 i.e. M.P. Aora Hospital, Dr. Madan Arora and Ms. Preeti Arora. Compliance of this order be made within 30 days of receipt of copy of order failing which awarded amount shall carry interest @ 6% p.a. from the date of filing the complaint until full and final recovery. Since opposite parties No. 1 to 3 were admittedly under insurance cover during the relevant time, therefore, they could seek indemnification of the claim from the opposite party No. 4 i.e. the Oriental Insurance Company who was also a opposite party No. 4 in the above titled complaint after firstly paying the compensation. The said amount of Rs. 3 Lacs was paid by opposite party Nos. 1 to 3 as directed by the commission with the right of indemnification of the claim from opposite party No. 4 i.e. the Oriental Insurance Company. In view of the aforesaid orders dated 5.7.2016 the consumer Forum now Commission complainant lodged the claim with opposite party regarding this fact and also informed orally on the phone to the concerned insurance office of the same along with copy of order but the opposite party deliberately did not work out anything and has been delaying the things and not reimbursed the claim to the complainant for the reasons best known to them, refused the genuine claim/ reimbursement to the complainant and the complainant also tried to convince them and submitted all the documents related to insurance and order. He further gave a reminders personally calling them to release his reimbursement/ claim but the opposite party did not listen to the complainant tried to avoid to reimburse the claim therefore, opposite party has failed to provide any service. By not refunding of amount of Rs. 3 Lacs by the opposite party early shows the malafide intention and deficiency, negligence on the part of the opposite party and clear deficiency of service. The complainant has suffered from mental pain agony and harassment at the hands of opposite party and the opposite party has shown its negligence and deficiency in services on its part. The complainant has prayed that the opposite party may kindly be directed to reimburse the claim amount of Rs. 3 Lacs which has been deposited by the complainant to comply the orders of this commission at the earliest and prayed Rs. 50,000/- as compensation and Rs. 20,000/- being the charges of the present complaint
3 After formal admission of the complaint, notice was issued to Opposite Party and opposite party appeared through counsel and filed written version and contested the complaint by interailia pleadings that earlier this commission fixed liability against M.P. Arora Maternity and General Hospital, Dr. Madan Arora C/o M.P. Arora Maternity & General Hospital and Dr. Preeti Arora C/o M.P. Arora Maternity & General Hospital in equal shares vide order dated 5.7.2016 holding that they were negligent in performing their duties. Oriental Insurance Co. Ltd. was also made party and specific objection was taken in the written version filed by it that no relevant policies have been supplied to the Insurance Co. The preliminary liability was fixed against the opposite parties No. 1 to 3 in equal shares by the District Consumer Forum(now Commission) Amritsar. In the light of Doctors Indemnity Policy, it was ordered that after making payment to the complainant, they have right to approach the Insurance Co for reimbursement of the amount as per the policy issued by it. On receipt of information regarding payment made by the said hospital , demand was raised for a sum of Rs. 3,00,000/- for which query was made regarding existence of Doctor M.P. Arora as well as policy obtained in the name of M.P Arora Maternity & General Hospital as well as policy for the relevant period issued to Dr. Preeti Arora. However no response was given to the Insurance Company and as such again the competent authority himself discussed the matter with the said Hospital and Mr. Madan Arora attended the said matter. The following enquiries/ documents were required from Mr. Madan Arora:-
(i) Whether there is any doctor by the name M.P. Arora in whose name the policy has been obtained as Doctors Indemnity Policy ?
(ii) Whether Dr. Madan Arora has obtained any policy in his individual name under the Doctors Indemnity Policy ?
(iii) Whether any insurance policy is existing in the name of Hospital because the doctors Indemnity Policy is not applicable to the Hospital and there is separate policy regarding indemnification of particular Hospital and its staff ?
(iv) That as per the policy of Dr. Preeti Arora supplied during the pendency of the said case is issued after the date of admission of the patient in the hospital, therefore, earlier policy for the relevant period is there. If so the same be supplied.
Although time of 2 to 3 days was requested by Dr. Madan Arora to supply the relevant information and documents but to no effect. As the statutory period for filing written version is expiring, therefore, for the time being written version is being filed by taking the objection that in the light of aforesaid information, no insurance policy is in the name of Hospital is existing nor the insurance policy of Dr. Preeti Arora for the earlier period i.e. covering the date of admission of the patient in the hospital has been supplied nor there is any doctor by name Mr. M.P. Arora in whose name Doctors Indemnity Policy has been obtained nor there is any policy in the name of Dr. Madan Arora. The opposite party is not liable to pay any portion of the amount allowed against the opposite parties No. 1 to 3 in the complaint No. 240 of 2008 decided on 5.7.2016. Even otherwise, now the present complaint for getting reimbursement has been filed on behalf of hospital only and not by the concerned doctors. if equal liability is considered as allowed by the Forum, then the proportionate liability of the hospital comes to Rs. 1,00,000/- i.e. 1/3rd of total amount of Rs. 3,00,000/-. As no other doctor has filed any petition for any reimbursement, therefore, remaining amount is not payable. Even amount of Rs. 1,00,000/- is only payable if the policy in the name of hospital for the relevant period covering date of occurrence is supplied. Amount of Rs. 50000/- as claimed on account of harassment suffered by the complainant Hospital is totally illegal and untenable in the eyes of law. As far as policy is concerned, there is only some number of the policy but neither any date nor any month or year has been mentioned nor it has been made clear that the said policy stands in whose favour. It was the duty of the complainant and other doctors to give intimation that they are going to satisfy the liability so that it should have been decided whether appeal should be filed by the concerned doctor or hospital authorities against the said order or not but the said procedure has not been followed. The opposite party has denied the other contents of the complaint and prayed for dismissal of the same.
4 To prove his case, the complainant has placed on record affidavit of Dr. Madan Arora Ex. CW1/A copy of the e-mail sent to insurance company Ex. C-1, copy of the letter to the Oriental Insurance Company Ex. C-2, copy of the order of Consumer Forum Amritsar dated 5.7.2016 Ex. C-3, copy of insurance policy Ex. C-4, copy of the receipt Ex. C-5 and closed the evidence. On the other hands, Ld. counsel for the opposite party has entered in evidence affidavit of Sh. Naresh Singla Sr. Div Manager of Opposite party Insurance Company Ex. OP/1, Certified copy of the insurance policy along with terms and conditions Ex. OP/2, copy of insurance policy in the name of Priti Arora issued by Oriental Insurance Co. Ltd. for the period 30.1.2008 to 29.1.2009 Ex. OP/3, copy of insurance policy in the name of Priti Arora by New India Assurance Company for the period of 30.1.2007 to 29.1.2008 Ex. OP/4 and closed the evidence.
5 We have heard the Ld. counsel for the parties and have gone through the record on the file.
6 The combined and harmonious reading of documents and pleadings is going to prove that on 5.7.2016 District Consumer Disputes Redresal Commission Amritsar allowed / decided a complaint titled as “Vijay Kumar Vs M.P. Arora Maternity and General Hospital and others” vide order dated 5.7.2016 whereby it was observed that complainant is entitled for compensation to the tune of Rs. three Lakhs from opposite parties No. 1 to 3 i.e. M.P. Aora Hospital, Dr. Madan Arora and Ms. Preeti Arora. Since opposite parties No. 1 to 3 were admittedly under insurance cover for the relevant time, therefore, they could seek indemnification of the claim from the opposite party No. 4 i.e. the Oriental Insurance Company who was also a opposite party No. 4 in the above titled complaint after firstly paying the compensation. The order of district Consumer Disputes Redressal Commission was duly complied by the opposite parties/ complainant in the present case. The complainant admittedly, has taken professional indemnity policy bearing No. 233300 from the opposite party. The complainant has placed on record a policy of Dr. M.P. Arora thereby he has obtained this policy by paying the premium to the tune of Rs. 450/-. In continuation to this policy bearing No. 233300, the hospital i.e. named as M.P. Arora Maternity and General Hospital was obtained by paying the premium to the tune of Rs. 11,651/- whereby eight number of doctors were covered as well as six number of qualified employees and four number of unqualified employees were covered and this policy was valid from from 26.10.2007 to 25.10.2008. Meaning thereby at the time of incidence, the complainant was duly covered under the insurance policy. However, the opposite party has taken the objection that earlier this commission fixed the liability against M.P. Arora Maternity and General Hospital, Dr. Madan Arora and Dr. Preeti Arora c/o M.P. Arora Maternity and General Hospital in equal shares. But the complainant has not supplied the relevant policy to the insurance company. The policy of Dr. Preeti Arora which was supplied during the pendency of this case has been issued after the date of admission of the patient in the hospital. Further the opposite party has taken the objection that the present complaint for getting reimbursement has been filed on behalf of hospital only and not by the concerned doctors. If equal liability is considered as allowed by the commission, then the proportionate liability of the hospital comes to the tune of Rs. 1 Lac . But we are not agree with the opposite party. This complaint has been filed on behalf of M.P. Arora Maternity and General Hospital through Dr. Madan Arora and the policy bearing No. 233300 which is placed on record and which was duly valid from 26.10.2007 to 25.10.2008 and it is in the name of Dr. M.P. Arora. The other policy in continuation of same number i.e. 233300 is in the name of M.P. Arora Maternity and General Hospital Amritsar which duly covers the eight numbers of doctors, which clearly shows that the hospital i.e. M.P. Arora Maternity and General Hospital Amritsar, Dr. M.P. Arora and Dr. Preeti Arora are covered under the professional indemnity policy issued by oriental India Insurance Company Ltd. The opposite party has taken the objection that the policy of Dr. Preeti Arora which was placed on record of New India Assurance Company Ltd. was after the incidence. But in the commission Dr. Madan Arora proprietor of M.P. Arora Maternity and General Hospital Amritsar suffered the statement on 20.7.2021 that he only relied upon the professional indemnity policy of the OIC with policy Number 233300 and which covers the period from 26.10.2007 to 25.10.2008. The said policy is a relevant policy which covers M.P. Arora Maternity and General Hospital Amritsar along with eight other doctors He also stated that inadvertently the complainant filed another copy of policy in the name of Dr. Preeti Arora which is not relevant to the present case.
7 Admittedly, Dr. M.P. Arora, Dr. Preeti Arora and Hospital i.e. M.P. Arora Maternity and General Hospital Amritsar are under the insurance cover as per the policy placed on record. Dr. Preeti Malhotra is also under covered the said policy as the eight number of doctors are insured under the professional indemnity policy. There is no question arises that in the eight number of doctors Dr. Preeti Malhotra was not covered as she is one of the important doctor of Hospital and she is family member of Dr. Madan Arora and this the same policy which is proved and established in the previous complaint in which the award was allowed.
8 For foregoing reasons, it is established on record that policy bearing No. 233300 of Dr. M.P. Arora and in continuation to this policy, hospital i.e. M.P. Arora Maternity and General Hospital Amritsar is also under the insurance cover plus Dr. Preeti Malhotra is also covered under this policy in the eight number of doctors. As such, the opposite party is liable to indemnify the complainant and while not releasing the genuine claim of the complainant, it amounts to deficiency in service and unfair trade practice on the part of the opposite party.
9 In view of the above discussion, the present complaint is allowed and the opposite party is directed to make the payment of Rs. 3 Lakhs to the complainant. The complainant has also been harassed by the opposite party for a long time, as such, the complainant is also entitled to Rs. 15,000/- as compensation on account of harassment and mental agony and Rs 10,000/- as litigation expenses. Opposite Party is directed to comply with the order within one month from the date of receipt of copy of the order, failing which the complainant is entitled to interest @ 9% per annum, on the awarded amount, from the date of filing the present complaint till its realisation. Copy of order be supplied by the District Consumer Disputes Redressal Commission, Amritsar as per rules. File be sent back to the District Consumer Disputes Redressal Commission, Amritsar.
Announced in Open Commission
15.11.2022
