BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT MANGALORE
Dated this the 23rd August 2010
COMPLAINT NO.83/2010
(Admitted on 09.03.2010)
PRESENT: 1. Smt. Asha Shetty, President
2.Smt.Lavanya M. Rai, Member
BETWEEN:
Sri. M.Thimmappa Shetty,
Aged about 71 years,
So. Late Vasu Shetty,
Mandadiguthu, Athrikaribettu Village,
Mangalore Taluk,
Dakshina Kannada. …….. COMPLAINANT
(Advocate for the Complainant: Sri.K.Sridhara Rao).
VERSUS
1. The Secretary,
Vijaya Raithara Seva Sahakari Bank Ltd.
And Yashaswini Co operation
Farmers Health Care Scheme,
Mulki, Dakshina Kannada.
(Opposite Party No.1: Exparte).
2. The Dean,
K.M.C. Hospital,
Ambedkar Circle,
Mangalore. ……. OPPOSITE PARTIES
(Advocate for the Opposite Party No.2: Sri.K.S. Bhat).
***************
ORDER DELIVERED BY PRESIDENT SMT. ASHA SHETTY:
1. The facts of the complaint in brief are as follows:
This complaint is filed under Section 12 of the Consumer Protection Act alleging deficiency in service against the Opposite Parties claiming certain reliefs.
The Complainant filed the above Complaint stating that, he is an agriculturist and also a member of Vijaya Raithara Seva Sahakari Bank Ltd., Mulky i.e., Opposite Party No.1 and the said society is running “Yashaswini Health Insurance Scheme” for the benefit of the farmers. The Opposite Party No.1 collecting premium from the members and issuing Yashaswini Card to the members for getting medical benefits from the associated hospitals which includes K.M.C. Hospital, Mangalore i.e., Opposite Party No.2.
It is stated that, the Complainant had become the member/card holder of Yashaswini Health Scheme under Opposite Party No.1 by paying prescribed premium of Rs.150/-. The 1st Opposite Party issued an identity card to the Complainant, wherein, the Complainant and his son Mallikarkjuna Shetty are shown as family members who are entitled for the insurance benefits.
That being the position, on 9.6.2009 the Complainant got himself admitted to the KMC Hospital for treatment and operation of Prostrate gland and hydrocele. The Complainant had deposited Rs.10,000/- at the time of getting admitted to the hospital and also shown his Yashaswini identity card for getting insurance coverage. It is stated that, at the time of discharge from the hospital i.e., on 16.06.2009 the hospital authorities insisted the Complainant to pay complete hospital bill i.e., Rs.27,000/-. The Opposite Party No.2 not given deduction/reimbursement under the Health Insurance Scheme. And further it is contended that, inspite of taking several times, the hospital authorities and society not considered the claim of the Complainant. Hence the Complainant issued a legal notice dated 18.01.2010, despite of that, the Opposite Party not paid the amount and hence the above Complaint is filed by the Complainant before this Forum under Section 12 of the Consumer Protection Act 1986 (herein after referred to as ‘the Act’) seeking direction from this Forum to the Opposite Party No.2 to pay back the medical bill amount collected from the Complainant i.e., Rs.27,000/- and also directing the Opposite Party No.2 to pay Rs.15,000/- as compensation and cost of the proceedings.
2. Version notice served to the Opposite Parties by RPAD. Opposite Party No.1 despite of serving notice neither appeared nor contested the case till this date. Hence we have proceeded exparte as against the Opposite Party No.1. The acknowledgement placed before the FORA marked as court document No.1.
Opposite Party No.2 appeared through their counsel filed version and took a contention that, the Complaint is bad for non-joinder of necessary parties i.e., Yashaswini Co-operative Farmers Health Care Scheme. It is stated that, Yashaswini Co-operative Farmers Health Care Scheme, No.45, Millers Road, Vasanth Nagar, Bangalore had empanelled Opposite Party No.2 hospital for Yashaswini Co-operative Farmers Health Care Scheme as their network hospital vide their letter dated 09.12.2008 for the period upto 31.05.2009. It is submitted that, the above said agreement was subsequently renewed vide their letter dated 21.08.2009 for further period. It is stated that, the Complainant was admitted on 09.06.2009 as an emergent case with a Complaint of difficulty in passing urine. On the same day he underwent cystoscopy and also surgery for Hydrocele. It is stated that, at the time of admission the Complainant had not furnished the details of the membership with Yashaswini Scheme and the same has been furnished on 10.06.2009. The Opposite Party hospital has applied for pre-authorization but the above said authority replied that, as per the Yashasvini Trust order, all family members should become the members of Yashaswini Scheme, hence pre-authorization cannot be issued. It is stated that, since the above authority not considered the claim of the Complainant, there is no other option the Opposite Party collected the amount from the Complainant and contended that there is no deficiency on their part and prayed for dismissal of the Complaint.
3. In view of the above said facts, the points now that arise for our consideration in this case are as under:
- Whether the Complaint is bad for non-joinder of necessary parties?
- Whether the Complainant proves that the Opposite Parties committed deficiency in service?
- If so, whether the Complainant is entitled for the reliefs claimed?
- What order?
4. In support of the complaint, Mr.Thimmappa Shetty (CW1) filed affidavit reiterating what has been stated in the complaint and answered the interrogatories served on him. The Complainant produced 10 (ten) documents as listed in the annexure. One Mrs.Sangeetha Shetty (RW1), Team Member of the Opposite Party No.2 filed counter affidavit and answered the interrogatories served on her. Ex R1 to R8 were marked for the Opposite Party No.2 as listed in the annexure. Both parties produced notes of arguments.
We have considered the notes/oral arguments submitted by the learned counsels and also considered the materials that was placed before the Hon'ble Forum and answer the points are as follows:
Point No.(i): Negative.
Point No.(ii) to (iv): As per the final order.
Reasons
5. Point No. (i) to (iv):
In the instant case, the Opposite Party No.1 despite of receiving version notice not appeared nor contested the case of the Complainant. The entire evidence placed on record reveals that, the Complainant is an agriculturist and also a member of the Yashaswini Health Insurance Scheme and the Opposite Party No.1 issued an identity card bearing No.0209143 to the Complainant (as per document No.4). It is also could be seen on record that, the Complainant got admitted the hospital i.e., Opposite Party No.2 as an emergent case with a Complaint of difficulty in passing urine and bilateral scrotal swelling (Hydrocele) and on the same day he underwent cystoscopy and also surgery for Hydrocele and discharged on 16.06.2009 (as per document No.7). The Opposite Party No.2 being a network hospital forwarded the claim of the Complainant to the Yashaswini Trust situated at Bangalore who had empanelled Opposite Party No.2 as their network hospital but the said trust not considered the claim of the Complainant also could be seen on record (as per Ex R1). Under that circumstances, the Complainant cannot find deficiency on the part of the Opposite Party No.2 in this case.
However, we find that, the Complainant ought to have made the Yashaswini Co-operative Farmers Health Care Scheme Trust as a necessary party to this proceedings. Because, the above trust has repudiated the claim of the Complainant. Moreover, the Opposite Party No.2 took a contention in their version that the Complaint is bad for non-joinder of necessary party. Atleast after receipt of the version, the Complainant ought to have taken steps for impleading the trust as a necessary party to this proceedings. No such attempt was made by the Complainant in this case till this date. Hence, we are of the considered opinion that, the Complaint is bad for non-joinder of necessary party i.e., Yashaswini Co-operative Farmers Health Care Scheme Trust in this case. Hence, the Complaint deserves to be dismissed. No order as to costs.
6. In the result, we pass the following:
ORDER
The complaint is dismissed. No order as to costs.
The copy of this order as per the statutory requirements be forwarded to the parties free of charge and therefore the file be consigned to record.
(Page No.1 to 6 dictated to the Stenographer typed by her, revised and pronounced in the open court on this the 23rd day of August 2010.)
PRESIDENT MEMBER
ANNEXURE
Witnesses examined on behalf of the Complainant:
CW1 – Mr.Thimmappa Shetty – Complainant.
Documents produced on behalf of the Complainant:
Doc. No.1 – 15.05.2009: Notarized copy of the receipt issued by Opposite Party No.1.
Doc. No.2 and 3 - 30.05.2009 & 03.06.2009: Notarized copy of the receipts issued by Opposite Party No.1.
Doc. No.4 – 09.02.2009: Identity card and self declaration.
Doc. No.5 – 26.06.2009: Letter issued by the Opposite Party No.1.
Doc. No.6 – 06.10.2009: Complaint copy to Deputy Registrar of Co-operative Societies, DK Mangalore.
Doc. No.7 – 12.06.2009, 15.06.2009 & 16.06.2009: Medical bills of KMC, Mangalore.
Doc. No.8 – 18.01.2010: Copy of the Lawyer’s notice with 2 acknowledgements.
Doc. No.9 – 26.01.2010: Reply of the Opposite Party No.1.
Doc. No.10 – 17.02.2010: Reply by the Opposite Party No.2.
Witnesses examined on behalf of the Opposite Party No.1:
RW1 – Mrs.Sangeetha Shetty, Team Member of the Opposite Party No.2.
Documents produced on behalf of the Opposite Party No.1:
Ex R1 – 09.12.2008: Letter of empanelment of Opposite Party hospital by FHPL enclosing terms and conditions.
Ex R2 – 21.08.2009: Renewal letter by FHPL.
Ex R3 - : Response by FHPL seeking few details.
Ex R4 – : Reply by FHPL rejecting the E-claim of the Complainant.
Ex R5 - : Continuation of the above reply.
Ex R6 - : Membership details of the Complainant at Yashaswini Co-operative Farmers Health Trust/ FHPL.
Ex R7 - : Scanned image of receipt of payment uploaded on to the website.
Ex R8 - : Compact – Disc containing images.
Dated:23.08.2010 PRESIDENT
