By. Sri. P. Raveendran, Member:-
Brief of the complaint:- The complainant has filed an application for joining in Rashtriya Swasthya Bhima Yojana Samagra health Insurance introduced by state and Central government. During August 2010 the opposite parties officials came to his residence and accepted Rs.30/- towards the registration charge and part of insurance policy. They have taken his photos and finger prints after 15 days. The members of kudumbasree has issued a smart card to the complainant. In the smart card the photo is that of the complainant but the name and age noted in the smart card is different. That differences bring notice to the kudumbasree members and as per their advise he went to the office of the opposite party No.1. At that time opposite party No.1 told that the change of name and age is not a problem they will take the details entered in the digit market in gold colour so the complainant returned. It is learned that the opposite party No.1 collected the balance amount from state and Central government during December 2010. Due to illness to eyes he was treated at Comtrust Hospital Calicut and under went an operation on 13.12.2010. At that time he contacted the help line of opposite party No.1 situated at the hospital. Since the detail in his smart card is different they declined to accept the smart card and give amount. So the complainant forced to pay an amount of Rs.6,041 incurred for the treatment. After accepting the amount from the complainant issuing smart card without full details and denying insurance policy is a deficiency of service on the part of the opposite party. Hence it is prayed that to give direction to opposite party No.1 to pay an amount of Rs.6,041/- along with 18% interest from 13.12.2010 and also prayed to give direction to pay an amount of Rs.25,000/- towards cost and compensation of this litigation.
2. Opposite Party No.1 appeared and filed their version. In the version he stated that RSBY scheme provides the coverage for meeting the expense of hospitalization for medical and surgical procedures to the enrolled BPL families up to Rs.30,000/- per family per year. The provider will identify the beneficiary on the basis of smart card issued to them as per RSBY Scheme. The card has a chip with details of name, age, relationship with head of the family and photograph of the rest of the family members enrolled for the benefit under the scheme. The finger prints are captured and saved in the chip for all the enrolled beneficiaries in a family. As soon as a beneficiary went to the hospital for medical attention, he will have to produce smart card issued to the RSBY counter. The card will then fed to card reader No.1 MHC card reader will fed in the card reader No.2 as soon as this card is inserted to the reader it will ask for user ID and password and MHC pin number. Upon inserting the same transaction software will open. Now the beneficiary card details can be read by clicking on the option which will be provided in the transaction software and also finger print verification can be done of the relevant finger as mentioned in the card. Once the finger print verification is successfully completed the registration, blocking and transaction process can be accomplished. Once the identity of the beneficiary is established by verifying the finger print of the patient through the smart card following procedure shall be followed for providing the health care facility under package rates. It has seen that the patient is admitted for covered procedure and package for such intervention is available, Beneficiary has balance in his account, at the time of discharge final entry shall be made on the smart card after verification of patient's finger print to complete transaction. The service have to be provided to the beneficiary based on smart card and finger print authorization and the issue of the smart card including the project involving smart card envisages the need for the necessary hardware and software installation. The opposite party submitted that the claim was newly introduced through out India at a stretch and due to some software problem some mistakes happened in the name portion of the smart card. The persons will be identified through the finger print. The name of the beneficiary was mistakenly noted due to software mistake beyond the control of this opposite party and not due to any willful default. There is no deficiency of service on the part of the opposite party. If the complainant is furnishing the original records of treatments including original bills this opposite party is ready to consider the claim as per terms and conditions of the policy. The complainant is not entitled to get Rs.25,000/- towards the compensation. Hence it is prayed to disallow the petition with cost.
3. On considering the complaint and version the following points are to be considered:-
1. Is there any deficiency in service on the part of opposite parties?
2. Relief and Cost.
4. Point No.1:- It is admitted by opposite party that the name of the beneficiary was mistakenly noted due to software mistake. He further stated that the persons will be identified through finger print. In this case Ext.A2 series and Ext.A4 shows that the complainant has paid an amount of Rs.5,943 at Comtrust Hospital Calicut. Ext.A3 shows that the complainant under went an operation on 13.12.2010. Issuing the smart card without full details and denying expenses met by the complainant is deficiency of services on the part of the opposite party No.1. Point No.1 is decided accordingly.
5. Point No.2 :- Exts.A2 and A4 shows that the complainant has spent Rs.5,941/- and he paid that amount on 13.12.2010. So he is entitled to get that amount from opposite party No.1 with interest at the rate of 10% from 30.05.2011 till the payment is made. He is also entitled to get Rs.2,000/- towards cost and compensation. Point No.2 is decided accordingly.
In the result the complaint is partly allowed and opposite party No.1 is directed to pay an amount of Rs.5,941/- (Rupees Five Thousand Nine Hundred and Forty One Only) with 10% interest from 30.05.2011 till the payment is made. He is also directed to pay an amount of Rs.2,000/- (Rupees Two Thousand Only) towards cost and compensation. This Order is to be complied within 30 days from the date of receipt of this Order.
Pronounced in Open Forum on this the day of 13th April 2012.
Date of Filing:30.05.2011.
