Central Mumbai District Commission Holds Shushrusha Citizens Co-Operative Hospital Liable For Deficiency In Service

Brief facts of the case:

Mr. Prafullchandra Kantilal Ladhani (“Deceased”) was admitted to Shushrusha Citizens Co-Operative Hospital Ltd. (“Hospital”), Dadar, on the 19th of November 2017. He held a Group Insurance Policy issued by M/s Star Health & Allied Insurance Co. Ltd. (“Insurance Company”), which provided coverage for a sum assured of ₹5 lakh. Tragically, the deceased passed away while under hospital care on the 26th of November 2017. While paying the bill, the deceased’s son, Jitendra Ladhani (“Complainant”) found that the final hospital bill included markup charges amounting to ₹24,000, which were associated with the provision of cashless hospitalization services for the deceased.

The Complainant contended that the imposition of the ₹24,000 markup charges in the hospital's bill was unjustified and incorrect. He further alleged that the hospital's actions amounted to deficient service and unfair trade practices, as they failed to provide adequate justification for these charges. Consequently, the complainant initiated legal proceedings by filing a consumer complaint in the Central Mumbai District Consumer Disputes Redressal Commission (“District Commission”). His complaint sought various remedies, including the refund of the ₹24,000 markup charges, reimbursement of the deposit balance of ₹29,286 held by the hospital, coverage of legal expenses, and an award of punitive damages.

The Hospital Ltd. put forth the argument that the complainant's father had been admitted to the hospital as a non-institutional patient (credit patient). They claimed that the complainant was fully aware of the existence of a 15% mark-up fee associated with such admissions. According to their stance, if the complainant had reservations regarding the mark-up charges, he should have raised objections at the time of admission.

Observations by the Court:

The District Commission acknowledged that the deceased, the father of the complainant, had been admitted to the Hospital on November 19, 2017, and, at the time of admission, the Complainant had deposited ₹40,000 with the hospital to avail medical services for his father. The District Commission noted that the complainant's father held a Group Insurance Policy with the insurance company and the hospital had included ₹24,000 in the bill as mark-up charges for cashless hospitalization services, which the complainant disputed as incorrect. Notably, the District Commission observed that just two days after the admission, the insurance company had authorized ₹10,000 for cashless treatment, suggesting that the hospital was well aware of the complainant's entitlement to cashless medical facilities as per the insurance policy.

Consequently, the District Commission held the hospital liable for deficiency in service and unfair trade practice for imposing the 15% mark-up charges. Therefore, the bench directed the hospital to refund ₹24,000 to the complainant with 6% interest from the date of filing the complaint. Additionally, the hospital was directed to pay ₹5,000 as compensation for mental agony suffered by the complainant and ₹3,000 as litigation costs.

Case: Jitendra Prafull Ladhani vs. Dean, Shushrusha Citizens Co-operative Hospital Limited

Case No.: CC/19/12

Advocate for the Complainant: In person

Advocate for the Respondent: Adv. Anand Patwardhan for OP no.1 and Adv. Balaji Umate for OP no.2.

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