ORDER

The present Revision Petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 (the “Act”) against order dated 21.07.2017, passed by the learned State Consumer Disputes Redressal Commission, Punjab (‘State Commission’) in First Appeal No.546 of 2017. In the impugned order, the Appeal by Petitioner (OP-3) was dismissed, thereby, upholding the District Consumer Dispute Redressal Forum, Amritsar (“District Forum”) order in CC No.217 of 2016 dated 12.06.2017, wherein the Complainant’s complaint was allowed.

2. For convenience, the parties in the present matter are referred to as per the Complaint before District Forum. ‘Care Well Hospital’ (Petitioner herein) is referred to as the ‘OP-3’, whereas ‘Mr. Anil Arora’ (Respondent 1 herein), ‘National Insurance Company Ltd’ (Respondent 2 herein) and ‘Park Mediclaim TPA Pvt. Ltd.’ (Respondent 3 herein) are referred to as ‘Complainant’, ‘OP-1’ and ‘OP-2’ respectively.

3. The brief facts of the case, as per the complainant, are that he obtained a Mediclaim policy No.401209/48/15/8500000355 dated 23.6.2015 paying a premium of Rs.23,259. The policy provided medical coverage of Rs.3,00,000 for himself and Rs.2,00,000 for his wife from 26.06.2015 to 25.06.2016. Since the complainant had not filed any claims for over 4 years, Rs.60,000 cover had accumulated, thereby increasing his coverage to Rs.3,60,000. The complainant fell ill on 08.09.2015 and was admitted to OP-3 Hospital, wherein he and his relatives were assured that he would be covered under the cashless treatment package of OP-1 insurance company. The complainant was informed by OP-3 that he needed to undergo PTCA and was briefed about the PTCA package and cashless treatment. Subsequently, he proceeded with the treatment from OP-3. However, at the time of discharge, he was required to pay Rs.2,71,579 to OP-3. It is the case of the complainant that he approached OP-1, who instructed him to deposit the amount with OP-3 and assured him that the same would be reimbursed. Accordingly, complainant paid Rs.2,71,579 to OP-3. OP-1 later replied to his email, stating that OP-3 was still on their panel and that the claim would be settled as per the PPN (Preferred Provider Network), advising him to make a representation before OP-2. The complainant then made a representation to OP-2, but OP-1 only issued an RTGS payment of Rs.1,71,579, which was Rs.1,00,000/- short. Despite further representations to OP-2, there was no resolution. The complainant filed consumer complaint No.217 of 2016 seeking payment of the remaining amount, compensation and litigation cost etc.

4. In reply before the District Forum, OP-1 denied the case of the complainant and contended that the contract of insurance was subject to its terms and conditions of the policy and there was no procedure for any oral sanction of cashless treatment to any policy holder. It had already settled the claim of the complainant as per terms and conditions of the policy. OP-2 did not opt to put in appearance despite service, as such it was ordered to be proceeded against ex-parte. In reply, OP-3 denied that Sandeep Kapoor assured and told the complainant and his relatives that they were under the panel of OP-1 and would provide cashless treatment to him. OP-3 conveyed its inability for the cashless treatment and the same was immediately told to the representatives of the complainant on 09.09.2015. It was denied that any assurance for cashless treatment was given to the complainant.

5. The learned District Forum vide Order dated 12.06.2017, allowed the complaint with the following reason /findings:

“This fact that the hospital is enlisted on the panel of the opposite party is proved as the complainant has placed on record User Guide Book in which name of the opposite party No.3 hospital has been mentioned. But even then the cashless treatment of the complainant has been denied by opposite party No.3. As such the complainant has to pay the treatment expenditure to the