BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANGALORE
Dated this the 29th of October 2010
PRESENT
SMT. ASHA SHETTY : PRESIDENT
SMT.LAVANYA M. RAI : MEMBER
SRI. ARUN KUMAR K. : MEMBER
COMPLAINT NO.47/2010
(Admitted on 06.02.2010)
Smt.K.S.Yashodha,
Aged about 69 years,
Wo. Late K.V. Sadashiva Rao,
Karikala House,
Pambethadi Village,
Karikala Post,
Sullia Taluk, Dakshina Kannada. …….. COMPLAINANT
(Advocate for the Complainant: Sri.Keshava B.V.)
VERSUS
1. The Chief Executive Officer,
Yashaswini Trust,
Room No.607, 6th Floor, 3rd Gate,
M.S. Building, Dr.Ambedkar Street,
Bangalore – 560 001.
(Advocate for Opposite Party No.1: Sri.Thimmayya P.)
2. The Chief Officer,
Father Muller’s Medical College and Hospital,
Fr.Muller Road, Kankanady,
Mangalore – 575 002.
(Advocate for Opposite Party No.2: Smt.Manjula N.A)
3. The Assistant Registrar,
Co-operative Societies Puttur,
Puttur, Dakshina Kannada.
(Opposite Party No.3: Exparte).
4. The Chief Executive Officer,
Pambethady Agricultural Co-operative Bank,
Pambethady Village, Karikala Post,
Sullia Taluk, Dakshina Kannada. ……. OPPOSITE PARTIES
(Advocate for the Opposite Party No.4: Sri.Kishore B.K)
***************
ORDER DELIVERED BY PRESIDENT SMT. ASHA SHETTY:
1. This complaint is filed under Section 12 of the Consumer Protection Act alleging deficiency in service against the Opposite Parties claiming certain reliefs.
The brief facts of the case are as under:
Complainant is the member of Yashaswini Co-operative Farmers Health Care Scheme with the 4th Opposite Party on 25.9.2009 for the year 2009-10. The 4th Opposite Party issued a receipt No.963 dated 25.9.2009.
It is stated that, due to severe chest pain Complainant was admitted to 2nd Opposite Party on 24.10.2009 to Emergency Care Unit. The Complainant informed the 2nd Opposite Party for eligibility of the benefits under Yashaswini Co-operative Farmers Health Care Scheme. The 2nd Opposite Party has treated the Complainant as an inpatient for Angiogram from 24.10.2009 to 28.10.2009. It is stated that, the 2nd Opposite Party refused to treat the Complainant under the above scheme and the Complainant contacted 4th Opposite Party for immediate help, 4th Opposite Party refused to make necessary arrangements. Finally Complainant forced to pay an amount of Rs.30,403/- as per bill dated 28.10.2009. The Opposite Parties neither given service nor paid the charges claimed by 2nd Opposite Party. It is contended that, the service rendered by the Opposite Parties suffers from deficiencies. Finally, Complainant has issued Lawyer’s notice on 16.11.2009 to the Opposite Parties but the Opposite Parties not complied the same, hence the above is filed under Section 12 of the Consumer Protection Act 1986 (herein after referred to as ‘the Act’) seeking direction from this Forum to the Opposite Parties to pay Rs.30,403/- and also claimed Rs.2,25,000/- as damages, compensation and cost of the proceedings.
2. Version notice served to the Opposite Parties by RPAD. Opposite Party No.1, 2 and 4 appeared through their counsel filed separate version.
Opposite Party No.3 despite of serving notice neither appeared nor contested the case till this date. Hence we have proceeded exparte as against the Opposite Party No.3. The acknowledgement placed before the FORA marked as court document No.1.
Opposite Party No.1 admitted that, the Complainant is a member of the Yashaswini Co-operative Farmers Health Care Scheme of the 1st Opposite Party. It is stated that, in order to avail the benefits of the Yashaswini Scheme, the member has to follow the procedure prescribed under the scheme but the Complainant failed to follow the procedures prescribed under the scheme. It is stated that, this Opposite Party not received any details of the treatment and bill pertaining to the Complainant as alleged by her. Hence the question of payment does not arise and there is no negligence or deficiency.
It is further stated that, as per the procedure of the Yashaswini Co-operative Farmers Health Care Scheme, the member should inform and submit the membership card to the network hospital before admitting the hospital. The network hospitals after treatments sending the bills to FHPL for considering it. After verifying the bills recommending the same for the 1st Opposite Party trust. The trust is passing the bill in its meeting and sending the bill amount to FHPL account. The FHPL send the bill amount through cheque or D.D to the concerned network hospitals. The Complainant without informing that, she is the member of Yashaswini Co-operative Farmers Health Care Scheme and undergone alleged treatment with 2nd Opposite Party and paid the bill amounts. Hence the Complainant is not entitled for the benefits because she had not followed the procedure. It is contended that there is no deficiency on the part of the 1st Opposite Party.
Opposite Party No.2 hospital submits that, it is Charitable Co-Operative Farmers Institution and recognized network hospital under the Yashaswini Health Scheme. There is no direct contract between the Complainant and this Opposite Party. This Opposite Party is not aware whether the Complainant is a member of 4th Opposite Party. It is stated that, the Complainant came to this Opposite Party on 24.10.2009 with the complaint of chest pain and treated conservatively. Thereafter discharged on 28.10.2009. At the time of admitting the Complainant nor her attenders/daughter informed this Opposite Party that the Complainant is the beneficiary under the Yashaswini Scheme. Hence the Complainant was admitted as general patient and received an amount of Rs.30,403/-. After the discharge, the Complainant’s daughter approached this Opposite Party on 31.10.2009, at that time Opposite Party explained the rules and regulations to be followed by the beneficiaries to avail the benefit under the scheme and contended that there is no deficiency and prayed for dismissal of the complaint.
Opposite Party No.4 admitted that, the Complainant had paid the premium to Yashaswini Co-operative Farmers Health Care Scheme and became the member of the said society and this Opposite Party has nothing to do with the liability to pay – reimburse the expenditure incurred on her health as per the said scheme. It is stated that, this Opposite Party is not aware of any ailment, period of treatment and not contacted this Opposite Party for immediate help and contended that there is no deficiency on the part of this Opposite Party 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 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, Smt.K.S.Yashodha (CW1) filed affidavit reiterating what has been stated in the complaint and answered the interrogatories served on her. Ex C1 to C7 were marked for the Complainant as listed in the annexure. One Sri.Poovappa (RW1), Chief Executive Officer of the Opposite Party No.1, one Rev.Fr.Patrick Rodrigues (RW2) – Director of the 2nd Opposite Party, one Sri.A.V.Bhat (RW3) – Chief Executive Officer of the Opposite Party No.4 filed counter affidavits and answered the interrogatories served on them. Ex R1 and R2 were marked for the Opposite Parties 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 this Forum and answer the points are as follows:
Point No.(i): Affirmative.
Point No.(ii) & (iii): As per the final order.
Reasons
5. Point No. (i) to (iii):
In the instant case, it is admitted that, the Complainant is a member of the Yashaswini Co-operative Farmers Health Care Scheme with the 4th Opposite Party on 25.09.2009 for the year 2009-10. The Opposite Party No.4 has issued a receipt for the same as per receipt No.963 dated 29.05.2009 as per Ex C3. It is also admitted that, the Complainant was admitted to the 2nd Opposite Party on 24.10.2009 to emergency care unit. The 2nd Opposite Party has treated the Complainant as an inpatient for Angiogram from 24.10.2009 to 28.10.2009. The Complainant has paid the hospital charge of Rs.30,403/- as per bill dated 28.10.2009.
According to the Complainant, the Opposite Parties failed to reimburse the medical expenses despite she being a member of the Yashaswini Co-operative Farmers Health Care Scheme. It is stated that, the Complainant informed the 2nd Opposite Party that she is eligible for benefits under Yashaswini Co-operative Farmers Health Care Scheme. Even though the 2nd Opposite Party refused to treat the Complainant under Health Care Scheme, the Complainant contacted the 4th Opposite Party for immediate help with regard to the demands of the 2nd Opposite Party through telephone but the Opposite Party No.4 refused to make necessary arrangements and finally the Complainant has forced to pay the entire amount of Rs.30,403/- and the Opposite Parties committed deficiency of service.
The Opposite Party No.2 i.e., hospital contended that, the Complainant not informed that she is a member of the Yashaswini Co-operative Farmers Health Care Scheme and she is eligible for benefits under the scheme. Since she had not informed the Opposite Parties collected the bill amount and discharged from the hospital. On 31.10.2009 the Complainant approached the hospital at that time the hospital explained the rules and regulations to be followed by the beneficiaries to avail the benefits under the scheme. Since the Complainant was already discharged on 28.10.2009 the Complainant is not able to get the benefits under Yashaswini Scheme as per the Rules and Regulations.
Rest of the Opposite Parties contended that, the Complainant not followed the procedures prescribed under the scheme, unless and until the members has not followed the procedures prescribed under the scheme, this Opposite Party is not liable to pay any amount to the members herein the Complainant.
In the instant case, the Complainant filed evidence by way of affidavit and produced Ex C1 to C7. Opposite Parties also filed evidence by way of affidavit and produced Ex R1 and R2.
On scrutiny of the oral as well as documentary evidence available on the file, we find that, admittedly the Complainant was the member of the Yashaswini Co-operative Farmers Health Care Scheme and at the time of the admission of the hospital the membership of the Complainant was in force. The Opposite Party No.2 i.e., the hospital in their version para No.5 stated that, the Complainant came to their hospital on 24.10.2009 with the complaint of chest pain and was admitted in ICCU and was treated conservatively and Angiogram was done and thereafter on 28.10.2009 she was discharged. Since the Complainant came with a complaint of chest pain was admitted in ICCU that means, it is a case of emergency and at the time of admission the Opposite Parties cannot expect from the Complainant to inform the same. The hospital ought to have asked the Complainant before making a bill. It is admitted that, the 2nd Opposite Party has treated the Complainant as an inpatient for Angiogram from 24.10.2009 to 28.10.2009.
It is a well known that, the above scheme is introduced by the Government to the poor farmers who can avail the benefits under the above scheme. Under that circumstances, it is the bounden duty of the Opposite Parties to provide/produce the terms and conditions along with the receipt to avail the benefits or to make the farmers to approach the concerned hospitals. It is not sufficient just issuing a receipt. As we know, majority of the farmers are not educated and not well-versed with the terms and conditions of the policies introduced by the Government until and unless the printed terms and conditions and other details/policy provided to them and explained the language known to them. In the absence of any such disclosures either in the I.D. card or in the beneficiary receipt or in the brochure, it is very difficult for the beneficiaries go in search of the hospitals as well as other details when they are fell ill.
Since the membership of the Complainant is admitted and the Complainant was admitted to the hospital as an emergency and it is also admitted that, she was kept in ICCU, under such condition the hospital authority cannot expect that the Complainant should inform the hospital with regard to the Yashaswini Health Care Scheme. The Opposite Party being a one of the network hospital, it is the bounden duty of the hospital to enquire with the patients whether they are eligible for Yashaswini Health Scheme. In the instant case, though the hospital admitted that they are one of the network hospital under the Yashaswini Health Scheme but raised a defence stating that the Complainant has not informed to the hospital authorities which cannot be acceptable. No prudent person will hide the membership of the Yashaswini Health Scheme if really the hospital authority enquired with the Complainant. Apart from that, the receipt issued by the Opposite Party No.4 also do not disclose the details of the network hospitals under such circumstances, we hold that the Complainant is a member of the Yashaswini Health Scheme, she is entitled for the medical reimbursement which she has already spent as per Ex C5 i.e., Rs.30,403/-. Just because the Complainant not followed the procedure the genuine claim of the Complainant cannot be rejected. The procedure adopted by the Trust or the other Opposite Parties just to avoid the false claim and not otherwise. In the instant case, the claim of the Complainant is genuine and there is a cogent/material evidence on record that, she had admitted to the Opposite Party No.2 hospital as an emergent case and spent Rs.30,403/- as per Ex C5 and there is no doubt with regard to the claim of the Complainant. Therefore, we direct the Opposite Party No.1 and 4 to pay Rs.30,403/- to the Complainant along with interest at 9% p.a. from 28.10.2009 (i.e., the date of discharge from the hospital) till the date of payment and also pay Rs.1,000/- as cost of the litigation expenses. Payment shall be made within 30 days from the date of this order.
Complaint against Opposite Party No.2 and 3 is hereby dismissed.
6. In the result, we pass the following:
ORDER
The complaint is partly allowed. Opposite Party No.1 and 4 are directed to pay Rs.30,403/- (Rupees thirty thousand four hundred and three only) to the Complainant along with interest at 9% p.a. from 28.10.2009 (i.e., the date of discharge from the hospital) till the date of payment and also pay Rs.1,000/- (Rupees one thousand only) as cost of the litigation expenses. Payment shall be made within 30 days from the date of this order.
Complaint against Opposite Party No.2 and 3 is hereby dismissed.
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 12 dictated to the Stenographer typed by her, revised and pronounced in the open court on this the 29th day of October 2010.)
PRESIDENT
MEMBER MEMBER
ANNEXURE
Witnesses examined on behalf of the Complainant:
CW1 – Smt.K.S.Yashodha – Complainant.
Documents produced on behalf of the Complainant:
Ex C1 – : Copy of the identity card.
Ex C2 – : Copy of the ration card.
Ex C3 – 29.05.2009: Copy of the receipt issued by Pambethady V.S.S. Bank Ltd.
Ex C4 – 28.10.2009: Receipt issued by Fr.Muller Medical College & Hospital for Rs.16,353/-.
Ex C5 – 28.10.2009: Bill issued by Fr.Muller Medical College & Hospital for Rs.16,353/-.
Ex C6 – 24.10.2009: Bill issued by Fr.Muller Medical College & Hospital.
Ex C7 – 16.11.2009: Lawyer’s notice sent to the Opposite Parties on behalf of the Complainant along with postal acknowledgements.
Witnesses examined on behalf of the Opposite Parties:
RW1 – Sri.Poovappa, Chief Executive Officer of the Opposite Party No.1.
RW2 – Rev.Fr.Patrick Rodrigues – Director of the 2nd Opposite Party.
RW3 – Sri.A.V.Bhat – Chief Executive Officer of the Opposite Party No.4.
Documents produced on behalf of the Opposite Party No.2:
Ex R1 – : Self attested copy of Yashasvini Scheme OP/IP register book.
Ex R2 – 02.06.2005: Notification No.CO.107.CLS 2005 issued by the Government of Karnataka.
Dated:29.10.2010 PRESIDENT
