INDERJIT AGGARWAL Vs. CENTRAL GOVERNMENT HEALTH SCHEME

JUDGEMENT

(1.) THIS is an appeal against order of District Consumer Disputes Redressal Forum -I, U.T., Chandigarh (for short hereinafter to be referred as District Forum) dated 1.10.2008 passed in Complaint case No. 248 of 2008, Sh. Inderjit Aggarwal v. Central Government Health Scheme.

(2.) BRIEFLY stated the case of the complainant is consequent to his retirement, he took a Health Policy from OP and the same was renewed every year. It was averred by the complainant that as per the said policy, he was entitled to get free medical treatment from approved hospitals along with medicines and in case of treatment being taken from any other hospitals, the amount spent on the treatment was to be reimbursed to him. As per the complainant, he was not supplied the copy of terms and conditions of the policy by the OP in spite of making number of requests. The case of the complainant is that in August 2005, he got his wife namely Promilla Aggarwal treated for her knees replacement at Nehru Hospital, P.G.I., Chandigarh and an amount of Rs. 2,56,216 was spent for the same. It was averred that despite allowing the claimed amount of Rs. 2,56,216 OP only paid a sum of Rs. 1,88,631 vide cheque Ex.C -5 and the said amount was accepted by the complainant on the assurance of officials of OP that rest of the money would be released shortly. The allegation of the complainant is that OP did not release the remaining amount of the claim till date in spite of several letters and visits, which amounted to deficiency in service on its part. However, the OP did not make the payment of balance amount. The next allegation of the complainant is that he, after consultation with the doctors of Govt. Medical College, Sector 32, Chandigarh, who advised him surgery and putting a new eye lense, got his eye operated for Cataract and he spent an amount of Rs. 17,680 for the purchase of lense including miscellaneous expenses. Thereafter, the complainant filed his claim totalling Rs. 22,162 with the OP for the Cataract operation including other charges but OP allowed claim of Rs. 5,268, which amount was accepted by the complainant under protest. Alleging non -payment of balance amounts of both the claim of Rs. 2,56,216 and Rs. 22,162 as deficiency in service and unfair trade practice on the part of OP, the complainant had filed the present complaint

(3.) THE version of OP is that payments for both the claims to the complainant were made as per admissible rates and instructions of Govt. of India, Ministry of Health and Family Welfare, New Delhi (Exhibits OP -1 and OP -3) duly covered under the decision of Hon ble Apex Court vide Ex.OP -1 -A for reimbursement of implants. Pleading no deficiency in service and unfair trade practice on its part, OP prayed for dismissal of the complaint.