STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH.

Date of institution : 17.06.2021 Reserved On : 05.07.2022 Date of decision : 13.07.2022

1. The Oriental Insurance Company Ltd., Regional Office, S.C.O.

No.109, 110, 111, Surindera Building, Sector 17-D, Chandigarh, through its Regional Manager.

2. M.D. India Healthcare Services (TPA) Pvt. Ltd. (Punjab Government Employees and Pensioners Health Insurance Scheme (PGEPHIS), MD India Health Insurance TPA Pvt. Ltd., Maxpro Info Park, D-38, Industrial Area, Phase-1, through its Authorized Representative, Mohali.

Now through its Authorized Signatory Gurupdesh Kaur, Manager, The Oriental Insurance Company Ltd., Regional Office, SCO No.109-111, Sector 17-D, Chandigarh.

….Appellants/Opposite Parties No.1 & 2 Versus

1. Santokh Singh s/o Sh. Gangu, R/o B-IX-49/63, New Hardyal Nagar, P.O. Shekhey Pind, Hoshiarpur (Jandu Singha) Road, Jalandhar, Punjab.

….Respondent/Complainant

2. SGL Superspeciality Charitable Hospital, Garha Road, Jalandhar.

….Respondent/Opposite Party No.3 First Appeal under Section 41 of the Consumer Protection Act, 2019 against the order dated 27.04.2021 passed by the District Consumer Disputes Redressal Commission, Jalandhar.

Quorum:-

Hon’ble Mrs. Justice Daya Chaudhary, President Mr. Rajinder Kumar Goyal, Member Mrs. Urvashi Agnihotri, Member.

1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No

2) To be referred to the Reporters or not? Yes/No

3) Whether judgment should be reported in the Digest? Yes/No Present:-

For the appellants : Sh. J.P. Nahar, Advocate For respondent No.1 : Sh. Varun Goyal, Advocate For respondent No.2 : None.

JUSTICE DAYA CHAUDHARY, PRESIDENT Appellants/opposite parties No.1 & 2 i.e. Oriental Insurance Company Ltd. and another have filed the present appeal under Section 41 of the Consumer Protection Act, 2019 to challenge the impugned order dated 27.04.2021 passed by the District Consumer Disputes Redressal Commission, Jalandhar (in short, “the District Commission”), whereby the complaint filed by respondent No.1/complainant was allowed and a direction was issued to the appellants/opposite parties No.1 & 2 to reimburse an amount of ₹6,38,476/-, which was spent by him on the treatment of his wife while remained admitted in various hospitals along with interest at the rate of 5% per annum from the date of filing of the complaint till its realization.

Respondent No.1/complainant was also held entitled for ₹8,000/- as compensation for causing mental harassment to him and also litigation expenses. The appellants/opposite parties No.1 & 2 were also directed to deposit an amount of ₹3,000/- as costs in the Consumer Legal Aid Account of the District Commission.

2. It would be apposite to mention here that hereinafter the parties will be referred, as have been arrayed before the District Commission.

3. Briefly the facts of the case as made out by respondent No.1/complainant in the complaint filed by him before the District Commission are that the complainant was employed in Punjab State Government and retired from the Irrigation Department, Shahpur Kandi. He along with his wife Chanan Kaur and grandson Sher Singh was insured under Cashless Health Insurance Scheme introduced by the Government of Punjab. It was the beneficial health insurance scheme called as ‘Punjab Government Employee’s & Pensioners Health Insurance Scheme” (hereinafter to be referred as “PGEPHIS”). The policy was issued and premium as consideration was paid by the State Government to cover the risk under the said Scheme. One ID Card No.MD 150987255998 was issued by the opposite parties. The wife of the complainant fell ill and was got admitted in the hospital on 23.06.2016 for treatment as Indoor Patient. Thereafter also, she remained admitted in different hospitals on different occasions, like DMC, Ludhiaana, Vedanta Hospital, Jalandhar and Patel Hospital, Jalandhar. In all the said hospitals, the medical expenses amount was paid by the complainant.

4. Notic