Haryana

Yamunanagar

CC/1249/2012

Sony S/o Surjeet - Complainant(s)

Versus

Tilak Raj Chhabra Memorial Hospital - Opp.Party(s)

G.S.MAnipur

02 Jan 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

                                                                                          Complaint No. 1249 of 2012.

                                                                                          Date of institution: 04.12.2012      

                                                                                          Date of decision: 02.01.2017

 

Sony aged about 20years son of Surjeet resident of Village  Sankhera, Tehsil Chhachhrauli, District Yamuna Nagar.

 

              …Complainant.

                                                            Versus

1. Tilak Raj Chhabra Memorial Hospital, Bilaspur Byepass Road, Jagadhri, through Dr. Sanjeev Chhabra.
2. Deputy Commissioner, Nodal Officer, under National Health Insurance Schme, Yamuna Nagar.
3. Insurance Company (particulars to be disclosed by respondents No.1 & 2.).

 

                                                                                                                    ...Respondents

BEFORE:         SH. ASHOK KUMAR GARG…………….. PRESIDENT.

                         SH. S.C.SHARMA………………………….MEMBER.

 

Present:           Sh. G.S.Manipur, Advocate for complainant.

                         Sh. Sushil Garg, Advocate, for respondent No.1.

                         None for respondent No.2.

 

ORDER

 

1                          The present complaint has been filed under section 12 of the Consumer Protection Act, 1986.

2.                     Brief facts of the present complaint, as alleged by the complainant, are that the Government of India had flouted a scheme known as National Health Insurance Scheme for the economically poor people. Under this scheme, a smart card was issued to the father of the complainant and under the scheme, the father of the complainant and his other four members including the complainant was covered and in case of hospitalization of any member of the family, the expenses upto Rs. 30,000/- were to be paid to the concerned hospital through smart card and no charges were required to be paid in cash by the complainant or his family members. The premium of the policy has been paid by the Government of India. The complainant is having the ration card under category of BPL and the smart card was issued in the name of the father of the complainant. The complainant is beneficiary under the scheme and the beneficiary also comes under the definition of consumer. The complainant had fallen from the bicycle and sustained injuries on his head and both jaw and complainant was taken to Civil Hospital, Jagadhri from where he was referred to PGI Chandigarh. However, the family members of the complainant took the complainant in respondent No. 1 Hospital (hereinafter referred as OP No.1) and admitted there. The OP No.1 Hospital is mentioned in the list of panel Hospital at serial No.36,under the aforesaid scheme. The complainant remained admitted in Op No.1 Hospital w.e.f. 12.04.2012 to 20.04.2012. At the time of admission, OP No.1 told to the family members of the complainant that total expenses of the treatment approximately comes to Rs. 50,000/-. The father of the complainant stated that they are not having this much amount upon which the Op No.1 asked the father of complainant to arrange Rs. 50,000/- and assured the father of the complainant that later on the OP will fill the form under the aforesaid scheme and thereafter the complainant will get refunded the amount of Rs. 30,000/- as per scheme. Thereafter, the father of the complainant arranged Rs. 50,000/- after mortgaging his plot and under the compelling circumstances, the father of the complainant paid a sum of Rs. 50,000/- to the OP No.1. The OP No.1 acted illegally by pressurizing the father of the complainant to pay the aforesaid amount whereas against smart card, no payment was required to be made to Op No.1 upto Rs. 30,000/- as provided under the scheme. The Op No.1 called the Dr. Nageshwar Iyer for conducting the operation of Jaw of the complainant and Dr. Iyer also received a sum of Rs. 2500/- from the complainant and Dr. Kamboj also received a sum of Rs. 3,000/- for giving Anesthesia, but the OP No.1 has not issued the bill regarding the aforesaid amount. The complainant was discharged from the hospital of Op No.1 on 20.04.2012 and thereafter many times he visited the OP No.1 Hospital and requested him to fulfill the promise and to get refunded the amount of Rs. 30,000/- as per aforesaid scheme but the OP No.1 postponed the matter on one pretext or the other. Thereafter, the complainant got issued a legal notice to the OP No.1 through his counsel on 25.06.2012 but till today the Op No.1 did not bother to reply the said notice and also did not bother to comply with the terms and conditions of the notice. The OP No.1 is liable to refund the amount of Rs. 30,000/- which was received by him from the complainant illegally. Lastly prayed for directing the OPs No. 2 & 3 to pay a sum of Rs. 30,000/- on account of expenses of treatment under the National Health Insurance Scheme alongwith interest and also to pay compensation as well as litigation expenses. Hence, this complaint.

3.                     Upon notice, OPs No.1 & 2 appeared and filed its written statement separately. OP No.1 filed its written statement by taking some preliminary objections such as complaint is wholly misconceived, groundless, frivolous, vexatious and scurrilous which is unsustainable in the eyes of law as the same is cooked up and has been filed without justified reason/cause against the OP No.1; no specific, scientific and justified allegations with regard to negligence or deficiency in providing services has been made by the complainant against the OP No.1 and the complainant has totally failed to explain “ as to how the respondent No.1 was negligent”; no cause of action has arisen to file the present complaint; complaint is not maintainable under the provisions of Consumer Protection Act; This Forum has no jurisdiction to entertain and decide the present complaint and on merit it has been admitted that a scheme as National Health Insurance for economically poor people has been launched by the Government of Haryana to provide medical facility, duly covered under the same, through the hospitals as empanelled time to time by the Govt. of Haryana. It has been further mentioned that at the time of admission, the complainant show his BPL Card upon which the OP No.1 doctor stated that now the Hospital of Op No.1 is not on the panel of pertaining to the abovesaid Government Scheme, after 01.02.2012 and advised the complainant to got his treatment somewhere else from other hospital or PGI, Chandigarh but the complainant and his family members insisted the OP No.1 doctor to provide the medical treatment and at the instance of complainant, the OP No.1 doctor provided the medical treatment and received only R. 27,200/- being the hospital charges and there is no negligence and deficiency in service on the part of OP No.1 Doctor and lastly prayed for dismissal of complaint.

4.                     OP No.2 filed its written statement by taking some preliminary objections such as complaint is not maintainable in the present form qua the OP No.2. In the present case the dispute, if any, is between the complainant and Op No.1 Hospital. Moreover, Op No.2 is not Nodal Officer under Rashtriya Swasthya Beema Yojna and specific Nodal Officer has been appointed in this scheme. There is no consumer dispute between the complainant and the OP No.2  as the complainant did not hire any services against payment. As such the complainant does not fall in the category of consumer under the provisions of section 2(1)(d) of the Consumer Protection Act,1986; this Forum has got no jurisdiction to entertain and hear the present complaint; no locus standi to file the present complaint, no cause of action in favour of the complainant; the complaint is false and frivolous to the very knowledge of the complainant and has been filed just to harass the OP No.2 and the same is liable to be dismissed and on merit it has been submitted that the OP No.1 was not on the panel of hospitals under the RSBY Scheme at the relevant time when the complainant suffered alleged injuries. As such, the complainant is not entitled to claim any amount which he had incurred and paid to Op No.1 Hospital. Lastly, prayed for dismissal of complaint against Op No.2.

5.                     In support of the case, learned counsel for the complainant tendered into evidence affidavit of complainant as Annexure CW/A and documents such as Photo copy of OPD Card of General Hospital, Jagadhri as Annexure C-1, Photo copy of medical bills of Tilakraj Chhabra Memorial Hospital as Annexure C-2, Photo copy of C.E.C.T. report of Dr. Pardeep’s Tahlan as Annexure C-3, Photo copy of Prescription slips of Dr. Tilak Raj Chhabra as Annexure C-4 and C-5, Photo copy of prescription slip of Savitri Krishan Memorial as Annexure C-6, Photo copy of Credit Card of Rashtriya Swasthya Bima Yojna as Annexure C-7, Photo copy of ration card as Annexure C-8, Photo copy of postal receipt as Annexure C-9, Photo copy of legal notice dated 25.06.2012 as Annexure C-10, Photo copies of cash memo issued by Pahwa Medicos as Annexure C-11 to C-14 and closed the evidence on behalf of complainant.

6.                     On the other hand, counsel for Op No.1 tendered into evidence affidavit of Dr. Sanjeev Chhabra as Annexure RW/A and documents such as Photo copy of letter dated 01.02.2012 for suspension/ de-empanelment of hospital of Tilak Raj Chhabra Memorial Hospital, Jagadhri as Annexure R-1, Photo copy of reply to show cause cum suspension notice by ICICI as Annexure R-2 and closed the evidence on behalf of Op No.1 doctor.

7.                     OP No.2 failed to tender any evidence despite availing so many opportunities with last, hence, evidence of Op No.2 was closed by court order dated 26.0-9.2016.

8.                     We have heard the counsels of both the parties and have gone through the pleadings as well as documents placed on the file very carefully and minutely.

9.                     The only grievances of the complainant is that due to fall from the bicycle he sustained injuries on his head and both jaw and he was firstly taken to the Civil Hospital, Jagadhri from where he was referred to the PGI, Chandigarh. However, the family members of the complainant took him in the hospital of OP No.1 at Yamuna Nagar and he spent Rs. 30,000/- on his treatment, as the complainant belongs to the BPL family and was having a smart card, so, he requested to the Op No.1 to refund the amount of Rs. 30,000/- spent on his treatment by showing the smart card but the Op No.1 flatly refused to refund the same.

10.                   Whereas on the other hand, learned counsel for OP No.1 argued at length that at the time of admission, the complainant had shown his BPL card upon which the OP No.1 stated that now the hospital of OP No.1 was not on empanel pertaining to the above Government R.S.B.Y. Scheme after 01.02.2012 and advised the complainant to get his treatment somewhere else from other hospitals or PGI Chandigarh but the complainant and his family members insisted the OP No.1 Doctor to provide the medical treatment at their own cost and expenses. So, at the instance of the complainant, the OP doctor provided medical treatment and received Rs. 27,200/- being the hospital charges. Hence, there was no deficiency in service or unfair trade practice on the part of OP No.1 Doctor. Learned counsel for the OP No.1 draw our attention towards the letter dated 01.02.2012 issued by the ICICI Lombard Insurance Company (Annexure R-1) vide which the hospital of OP No.1 was de-empanelled and further draw our attention towards the reply of this letter Annexure R-2. Learned counsel for the Op No.1 further argued that as the hospital of the OP No.1 was not on the empanelment of the insurance company, hence, there was no question to treat the complainant free of costs because the OP No.1 Doctor cannot claim the amount from the OP Insurance Company as per Government Scheme due to de-empanelment.

11.                   We have perused the Bill Annexure C-2 dated 13.06.2012 vide which the complainant has paid Rs. 27,200/- to the Op No.1 doctor but the present complaint has been filed on 04.12.2012 i.e. after a period of 6 months. When the complainant was having smart card then why he made the payment to Op No.1 and did not lodge his protest/ complaint before any Nodal Officer during that period. Furthermore, the complainant has not placed on file any such document or cogent evidence that at the time of admission, OP No.1 Doctor did not tell him that his hospital was not on the panel. The complainant remained admitted in the hospital of OP No.1 Hospital from 12.04.2012 and discharged on 20.12.2012 but during that period he never approached to any Nodal Officer or any Higher Authority with the complaint that Op No.1 Doctor for not giving treatment free of costs as per Government RSBY Scheme. Meaning thereby that complainant was having knowledge or was told by Op No.1 Doctor that his hospital had already been de-empanelled. Upon which the complainant obtained the treatment at his own sweet will without availing the facility of the Scheme RSBY of Government of Haryana on the smart card and later on he cannot claim the amount paid to the Op No.1 doctor. It is also not the case of the complainant that after making the payment to the Op No.1 Doctor, he ever lodged any claim or made any complaint to the Higher Authority or Insurance Company.

12.                   In the circumstances noted above, we are of the considered view that there is no deficiency in service or unfair trade practice on the part of the OP No.1 Doctor. Further, the complainant has also failed to prove any allegation against the OP No.2 i.e Nodal Officer. Hence, we have no option except to dismiss the present complaint qua Op No.2 also

13.                   Resultantly, we find no merit in the present complaint and the same is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced in open court. 02.01.2017.

 

                        (S.C.SHARMA)                                    (ASHOK KUMAR GARG)

                        MEMBER                                             PRESIDENT

                                                                                       D.C.D.R.F,YAMUNANAGAR