IMPORTANT POINT
Free treatment in enlisted hospital not to be repudiated simply, thus adjudication afresh directed.

ORDER

Dr. S.M. Kantikar, Member.—The present Revision Petition is against the impugned Order dated 10.06.2014 passed by the Punjab State Consumer Disputes Redressal Commission, Chandigarh (hereinafter referred to as the “State Commission”) whereby the First Appeal filed by Petitioner was dismissed and the Order dated 25.04.2012 passed by the District Consumer Disputes Redressal Forum, Faridkot (hereinafter referred to as the “District Forum”) was upheld, while inter alia upholding that there was nothing on record to show that the Petitioner was not an enlisted hospital under the Scheme and the act of Petitioner amounting to fleecing the patients.

2. For the convenience, the Parties are referred to the positions as stated in the Original Complaint filed before the District Forum.

3. Brief facts of the case are that the Complainant Darshan Singh was a member of The Chand Bhan Multipurpose Cooperative Agriculture Service Society Ltd – the Opposite Party No.4 (hereinafter referred to as the ‘Society’). He got himself insured with ICICI Lombard, Health Insurance (the Opposite Party No. 2) under the Scheme named “Bhai Ghanya Sehat Sewa Scheme” (hereinafter referred to as the “Scheme”) vide Policy No. 4016/00004117. The Scheme was valid for the period 01.02.2010 to 31.01.2011. Under the Scheme, the insured Complainant was entitled to get free treatment in empaneled hospitals. For some spinal cord problems, from 30.05.2010 to 11.06.2010 Complainant was admitted in Amandeep Hospital – the Petitioner / the Opposite Party No. 3 and spent Rs. 3,50,000/-. The complainant alleged that at the time of admission the Petitioner /Opposite Party No.3 had promised that it would give all the benefits under the Scheme and later on refused to give those benefits. Also the Insurance Company the Opposite Party No. 2 did not reimburse the treatment expenses. Being aggrieved, the Complainant filed a Complaint against the Opposite Parties i.e. Insurance Company, the Hospital and the Co-op Society.

4. The Hospital/ Opposite Party No. 3 filed a Written Version and denied the allegations. It was contended that the hospital was a partner hospital with Bhai Ghanya Sehat Sewa Scheme up to 30.09.2009 only. Thereafter, the Opposite Party No. 3 never signed any fresh MOU with concerned authorities for the new scheme which commenced from 01.02.2010 till 31.01.2011. The Complainant was admitted during that period; therefore the Opposite Party No. 3 was not liable to give cashless facility to the Complainant.

5. The Opposite Parties No.1 and 2 have neither appeared nor filed any reply despite service of notice. The District Forum, after hearing the Complainant and the Opposite Parties Nos. 3 & 4 passed an ex-parte order against the Opposite Parties Nos. 1 & 2. District Forum ordered the Opposite Party No. 3 to refund Rs. 1,50,000/- to the Complainant on account of medical treatment and Rs. 30,000/- as compensation on account of mental agony within 30 days from the date of receipt of the copy of the order. It observed:

11. We have perused the evidence adduced by the complainant, by the opposite party No. 3 in this regard. Nowhere it has come on record that on the day of admission of the patient on the day of complainant having fallen ill i.e 26.4.2010 and thereafter having undertaken various investigations and treatment etc. The complainant was admitted in the hospital of the opposite party No. 3 on 3.5.2010 to 11.6.2010. Thus, from 3.5.2010 to 11.6.2010 is the period which is very important for us to know whether the hospital i.e opposite party No. 3 was the enlisted hospital or not. Nothing has come on record to prove the stand of the opposite party No. 3 i.e it was not a enlisted hospital. On the contrary, the counsel for the complainant in order to assist the Forum has taken out the print from the Internet showing the list of cashless hospitals in District Amritsar under Bhai Ghanyha Sehat Sewa Scheme and name of the hospital still exist as an empaneled hospital