Chandigarh

StateCommission

A/91/2020

Health and Family Welfare department - Complainant(s)

Versus

S. Jagtar Singh - Opp.Party(s)

Brijesh Singh Kanwar Adv.

28 Feb 2022

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

Appeal No.	:	91 of 2020
Date of Institution	:	26.06.2020
Date of Decision	:	28.02.2022

 

Director, Health & Family Welfare, Punjab Parivar Kalyan Bhawan, Sector 34-A, Chandigarh.

 ……Appellant/opposite party no.2

V e r s u s

1. S.Jagtar Singh s/o Harchand Singh age 60 years R/o H.No.248/1, Sector 41-A, Chandigarh
2. Gurpreet Singh s/o Jagtar Singh R/o H.No.248/1, Sector 41-A, Chandigarh.

….Respondents no.1 and 2/complainants

3. Oriental Insurance Co. Ltd., SCO No.109-111, Surendra Building, Sector 17-D, Chandigarh 160017, through its Incharge/Manger.
4. Regional Manager, M.D. India Health Insurance TPA Private Limited, Max-Pro Info Park, D-38, 1^st Floor, Industrial Area, Phase-I, Mohali  (Pb.) 160056.
5. Land Mark Hospital Site No.1 & 2, Sector 33-C, Chandigarh through Dr. Vikas Goyal, consultant Surgeon (PMC-300740).

…..Respondents

6. State of Punjab through its Principal Secretary Health Mini Civil Secretariat, Sector 9, Chandigarh

BEFORE:              JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT.

                             MRS.PADMA PANDEY, MEMBER.

                             MR.RAJESH K. ARYA, MEMBER.

 

Present through Video Conferencing:-

                            

                             Sh.Rajeshwar Singh Kanwar, Advocate for the appellant.

                             Sh.Anil N. Shukla, Advocate for the respondents no.1 and 2.

                             Sh.J.P. Nahar, Advocate for respondents no.3 and 4.

                             Sh.Munish Kapila, Advocate for respondent no.5.

                             None for respondent no.6.

 

PER JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT

                   This appeal has been filed by opposite party no.2-Director Director, Health & Family Welfare (in short the appellant), feeling aggrieved by the order dated 30.09.2017 passed by the District Consumer Disputes Redressal Commission-I, U.T., Chandigarh (in short the District Commission), whereby the consumer complaint bearing no.436 of 2017 filed by the complainants-respondents no.1 and 2 was partly allowed in the following manner:-

“ …..In view of the above discussion, the present consumer complaint succeeds and the same is accordingly partly allowed. OPs 1 to 4 are directed as under :-

1. OPs 3 & 4 to pay the amount of Rs.36,034/- to the complainants alongwith interest @ 9% per annum from the date of repudiation till realization.
2. OPs 1 & 2 to pay the amount of Rs.24280-8480 = Rs.15,800/- to the complainants alongwith interest @ 9% per annum from the date of repudiation till realization.
3. OPs 1 & 2 to pay an amount of 15,000/- to the complainants as compensation for causing mental agony and harassment to them. Similarly OPs 3 & 4 shall also pay an amount of Rs.15,000/- to the complainants as compensation for causing mental agony and harassment to the complainants.
4. OPs 1 & 2 to pay Rs.5,000/- to the complainants as costs of litigation.  OPs 3 & 4 shall also pay an amount of Rs.5,000/- to the complainants as cost of litigation. 

This order be complied with by the respective OPs within thirty days from the date of receipt of its certified copy, failing which, they shall make the payment of the amounts mentioned at Sr.No.(i) to (iii) above, with interest @ 12% per annum from the date of this order, till realization, apart from compliance of direction at Sr.No.(iv) above.

 Since, no deficiency in service has been proved qua OP-5, therefore, the consumer complaint against it stands dismissed leaving the parties to bear their own costs. ”.

2.           Following are the facts narrated in the consumer complaint, by the District Commission in the impugned order:-

“………., complainant No.1 retired from the service of OP-1 on 31.5.2016 and complainant No.2 happens to be his son and dependent and has been nominated under the health insurance policy applicable to the employees of Govt. of Punjab vide circulars dated 13.9.1995, 1.9.2000, 1.2.2005 and 24.6.2010.  His case is, OPs 1 & 2 had authorised OP-3 to release the claim received from the retired Govt. employees payable by insurer/OP-4. His further case is, the wholly dependent son of complainant No.1 i.e. complainant No.2 was treated in the empanelled hospital of OPs 1 & 2 i.e. OP-5 for a disease known as “Pilonidal Sinus” on 4.10.2016.  Operation had to be done and despite insurance, on being bill raised by OP-5 of Rs.36,034/- the same was paid. Surgery was done in emergency.  On bill being submitted, OPs 1 to 3 had been raising objections as to why it was paid in advance to OP-5 as it was a cashless policy.  His further case is, again on 10.1.2017, treatment was taken from the empanelled hospital and on bill being raised of Rs.24,280/-, same was paid by complainant. On claim despite being submitted, the amount of these bills was not reimbursed by OPs 1 to 4 respectively……..”.

 

3.           The District Commission noted down the following replies, given by opposite parties no.1, 3, 4 and 5:-

“……OP-1 contested the consumer complaint and filed reply.  Its line of defence is confined to the fact, it was a cashless policy and the amount was paid by OPs 1 & 2 to the insurer/OP-4. Under these circumstances, cash ought not to have been paid by the complainant per terms and conditions of the policy.

OPs 3 & 4 filed their joint written reply and their claim is, complainant is not their consumer; insurance was provided on payment being made by OPs 1 & 2 for indemnification of the treatment charges of the employees/retired employees of OPs 1 & 2.  Further case is, insurance policy with OPs 1 & 2 had expired on 31.10.2016 and the treatment taken on 10.1.2017, of which bill was raised of Rs.24,280/-, is not liable to be indemnified by OPs 3 & 4 while the first bill from 4.10.2016 to 5.10.2016 on being raised was not to be paid by them to OP-5 as it was a cashless policy per terms and conditions of the agreement.

OP-5 filed its separate written reply and opposed the consumer complaint, but, admitted complainant No.2 was hospitalized firstly from 4.10.2016 to 5.10.2016 for which Rs.36,034/- was paid by complainant No.1 to OP-5 and of second treatment  taken on 10.1.2017 bill of Rs.24,280/- was raised was paid.  Its case is, the card of the insurer i.e. OPs 3 & 4 was not shown, therefore, the amount was received. On these lines, the cause is sought to be defended…..”

4.           Despite deemed service, none put in appearance on behalf of opposite party no.2 (now appellant before this Commission), as a result whereof it was proceeded against exparte vide order dated 24.07.2017, by the District Commission
5.           In the rejoinders filed, the complainants reiterated all the averments contained in their complaint and controverted those contained in written version filed by the contesting opposite parties.
6.           The contesting parties led evidence by way of affidavits and numerous documents before the District Commission.
7.           The District Commission after hearing the contesting parties and on going through the material available on record partly allowed the consumer complaint, in the manner stated above.
8.           Hence this appeal.        
9.           We have heard the contesting parties and gone through the material available on the record; including the written arguments, very carefully.
10.           Before going into the merits of this case, it is pertinent to mention here that from the letter dated 14.11.2019 (at page 5 of this appeal file) it is evident that the Insurance Company-respondents no.3 and 4/opposite parties no.3 and 4 have made payment of Rs.64,513/- vide demand draft no.020758 dated 14.11.2019 to the complainants/respondents no.1 and 2,  in line with the impugned order, which fact has not been disputed by the complainants/respondents no.1 and 2
11.            This appeal has been filed by the appellant, on limited ground i.e. with regard to the reimbursement of entire amount of second bill of Rs.24,280/- paid by the complainants/respondents no.1 and 2 to the empanelled Hospital, for the treatment taken by complainant no.2 on 10.01.2017.  It has been vehemently contended by Counsel for the appellant that since the appellant is a State Department under the agies of Health and Family Welfare, Punjab, the claim of respondents no.1 and 2 falls under the State Services (Medical Attendant Rules), CS MA Rules, 1940, which is beyond the scope of Consumer Protection Act and as such, the District Commission  fell into a grave error in allowing the consumer complaint and directing the appellant to make payment of entire amount of Rs.24,280/- to respondents no.1 and 2.

                   Thus, the limited question in this appeal is - whether respondent no.1 and his son-respondent no.2 (beneficiary of the Health Scheme of the State Government), would be a consumer under the provisions of the Consumer Protection Act or not?   It may be stated here that in numerous cases the Hon’ble Supreme Court has held that the jurisdiction of a consumer fora has to be construed liberally so as to bring many cases under it for their speedy disposal. In the case of M/s. Spring Meadows Hospital and Another v. Harjol Ahluwalia and Another, AIR 1998 SC 1801, it was held that the CP Act creates a framework for speedy disposal of consumer disputes and an attempt has been made to remove the existing evils of the ordinary system. The Act being a beneficial legislation should receive a liberal construction. In State of Karnataka v. Vishwabarathi House Building Co-op. Society and Others, AIR 2003 SC 1043, the Court speaking on the jurisdiction of the consumer fora held that the provisions of the said Act are required to be interpreted as broadly as possible and the fora under the CP Act have jurisdiction to entertain a complaint despite the fact that other courts/tribunals would also have jurisdiction to adjudicate upon the lis. These judgments have been cited with approval in paras 16 and 17 of the judgment in Secretary, Thirumurugan Cooperative Agricultural Credit Society v. M. Lalitha and Others, (2004) 1 SCC 305. The trend of the decisions aforesaid is that the jurisdiction of the consumer fora should not and would not be curtailed unless there is an express provision prohibiting the consumer fora to take up the matter which falls within the jurisdiction of civil court or any other platform of State Policies as established under some enactment. Thus, even if there are two different platforms available to entertain the dispute in regard to the same subject, the jurisdiction of the consumer fora would not be barred and the power of the consumer fora to adjudicate upon the dispute could not be negated. In this view of the matter, objection taken by the appellant in this regard stands rejected. Thus, it is held that the District Commission was right in entertaining the complaint out of which this appeal has arisen

12.           Now coming to the question regarding directions given by the District Commission to the appellant to reimburse the amount spent by the respondent no.1 on treatment of respondent no.2, i.e. Rs.24280-8480 = Rs.15,800/-; it may be stated here that the treatment taken by respondent no.2 has not been disputed. It has also not been disputed that respondent no.2 was entitled for reimbursement of the amount spent on his treatment under the health policy of the State Government, though it was to be borne by the appellant directly. However, the appellant has not denied the genuineness of the medical bills, issued by the empanelled Hospital. Thus, we are of the considered opinion that if the empanelled Hospital, in respect of treatment of respondent no.2, who (Hospital) was under the control of the appellant; insisted the respondents no.1 and 2 to pay the medical bills, despite the fact that the same was to be borne by the appellant, then the fault if any lies on the said hospital or the appellant, as it should have exercised control over their own empanelled hospital and not respondents no.1 and 2. 
13.           It is also coming out from the record that out of the total amount of Rs.24,280/- incurred upon the treatment of respondent no.2, only an amount of Rs.8,480/- had been sanctioned by the appellant. We are convinced with the findings of the District Commission that, no reasons have been assigned as to why only an amount of Rs.8,480/- out of the above amount of  Rs.24,280/-  was sanctioned by the appellant. It is not the case of the appellant that the respondents no.1 and 2 have gone beyond the limits permissible to them for treatment under the aforesaid Rules.   In the absence of any justification in that regard, by deducting substantial amount, referred to above, the appellant indulged into unfair trade practice and was also deficient in providing service to respondents no.1 and 2. ,
14.           In view of the above discussion, it is held that the impugned order passed by the District Commission, partly allowing the consumer complaint, being based on the correct appreciation of evidence and law on the point, does not suffer from any illegality or perversity, warranting the interference of this Commission and the same stands upheld.
15.           For the reasons recorded above, this appeal being devoid of merit must fail and the same stands dismissed with no order as to costs.
16.           Certified copies of this order be sent to the parties, free of charge.
17.           The concerned file be consigned to Record Room, after completion.

Pronounced

28.02.2022

Sd/-

 [JUSTICE RAJ SHEKHAR ATTRI]

PRESIDENT

 

Sd/-

 

(PADMA PANDEY)

          MEMBER

 

Sd/-

 

 (RAJESH K. ARYA)

MEMBER

Rg