Decided on August 19,2010

Sanjivni Trust Appellant


- (1.)THIS order will dispose of three appeals, namely, First Appeal No.1268 of 2007 (ICICI Lombard General Insurance Company Limited v. Baljeet Singh @ Balgeet Singh and others), First Appeal No.1244 of 2008 (Sanjivni Trust (Regd.) v. Baljeet Singh @ Balgeet Singh and others) and First Appeal No.98 of 2009 (MedSave Healthcare Limited v. Baljeet Singh @ Balgeet Singh and others) as all these appeals arise out of the same order dated 11.4.2007 passed by the District Consumer Disputes Redressal Forum, Ferozepur (in short District Forum ). The facts are taken from First Appeal No.1244 of 2008 and the parties would be referred by their status in this appeal.
(2.)BALJEET Singh @ Balgeet Singh respondent No.1 (in short the claimant ) was a Member of the Karma Cooperative Agricultural Service Society Limited, respondent No.5 (in short the Society ). The claimant was a beneficiary under the Sanjivni Healthcare scheme initiated by Sanjivni Trust (Regd.) appellant (in short the appellant Trust ) for cashless health hospitalization in the network hospitals on the basis of an identity card issued by MedSave Health Care Limited, respondent Nos. 2, 3 and 7 (in short MedSave ). The claimant was allotted card No.86010500009572A against policy no.4016/0000968 valid for the period from 31.3.2006 to 30.3.2007 as he was having account No.628 -160 in the Society.
(3.)IT was further pleaded that the claimant fell ill in the third week of December 2006. He got himself admitted in Dayanand Medical College and Hospital, Ludhiana (in short DMC ) on 18.12.2006 where he remained admitted upto 24.1.2007 for medical treatment. DMC was a provider hospital. The First Appeal No.1244 of 2008. claimant had informed the appellant Trust and respondents No.2 to 7 about his illness and admission in the provider hospital. All the relevant documents were supplied to them and the appellant Trust and respondent No.2 to 7 were requested to issue an authorization letter for cashless medical treatment under the Scheme. The appellant Trust and respondents No.2 to 7 had refused to issue the authorization letter on the false allegations that the claimant was chronic alcoholic and opium addict vide letter dated 19.12.2006. The claimant had spent an amount of Rs.2,16,231/ - on his medical treatment. Hence the complaint for the insurance claim. Compensation and costs were also prayed.
The Society respondent No.5 and the Deputy Registrar, Cooperative Societies respondent No.6 filed the written statement. It was admitted that the claimant was a Member of the Society respondent No.5 and he was entitled to medical reimbursement. It was denied if there was any deficiency in service on the part of respondents No.5 and 6. Dismissal of the complaint was prayed.

Click here to view full judgement.
Copyright © Regent Computronics Pvt.Ltd.