Mohinder Signh v. State Of Punjab & ORS

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IN THE HIGH COURT OF PUNJAB AND HARYANA AT

CHANDIGARH CM-3688-CWP-2019 in/and CWP-24781-2016 Date of decision: - 08.03.2019 Mohinder Singh ....Petitioner

Versus

State of Punjab and others .....Respondents CORAM : HON'BLE MR. JUSTICE HARSIMRAN SINGH SETHI Present:- Ms. Sonia G. Singh, Advocate, for the applicant-petitioner.

Ms. Deepali Puri Sandhu, Additional Advocate General, Pb. Mr. Arun Walia, Senior Advocate with Mr. Vikrampreet Singh, Advocate and Mr. Gitish Bhardwaj, Advocate for respondent No.3.

**** HARSIMRAN SINGH SETHI , J. (ORAL) CM-3688-CWP-2019 Present application has been filed on behalf of applicantpetitioner to place on record replication to the written statement filed on behalf of respondent No.3.

Copy of the application has already been supplied to opposite counsel.

In view of the averments made in the application, the same is

-2allowed. Replication is taken on record, subject to all just exceptions. CM stands allowed.

CWP-24781-2016 In the present writ petition, the grievance raised by the petitioner is that the medical reimbursement is not being allowed to the petitioner in respect of the treatment which the wife of the petitioner had undertaken and for which the bills have already been submitted with the respondents starting from March, 2016 till August, 2016. Before the matter could be heard on merits, learned Senior counsel appearing on behalf of respondent No.3 has raised a preliminary objection that under the policy, in respect of which the present reimbursement claim has been made by the petitioner, there is a Dispute Resolution Committee, where the petitioner should have raised his grievance for the grant of reimbursement of the medical bills.

Counsel for the respondents states that under para 24 of the said policy, there is a District Level Grievance Redressal Committee which has been formed and if not satisfied with the decision of the District Level Grievance Redressal Committee, the petitioner has to approach the State Level Committee. The relevant objection as raised by the respondents in the reply is as under:- "1.

-3with the validity, interpretation, implementation or alleged breach of any provision of the scheme, it will be settled in the following way:

a) Dispute between Beneficiary and Health Care Provider/Care Provider and the TPA/Insurance Company:

1. District Level Grievance Redressal Committee. Grievance Redressal Committee shall be set up in each District for all possible Redressal of grievance of beneficiaries/Health provider by the Insurer. The Committee will constitute following member: - i) Deputy Commissioner, ii) Civil Surgeon iii) Deputy Medical Commissioner iv) Representative of Insurance Company v) Representative of TPA The Committee will resolve the Grievance within 30 days from the date of receiving the application. Any party, if not satisfied with the decision of the committee, can reach to the State Level Committee."

In view of the above condition, the present civil writ petition is liable to be dismissed."

In view of the said objection, counsel for the petitioner apprehends that there might be an issue with regard to the limitation, which might be taken by the respondents, if the petitioner approaches the respondents under Section 24 of the Policy at this stage. Learned Senior counsel appearing on behalf of the respondents assures that no such objection will be taken in case the petitioner approaches the authorities under Section 24 of the Policy and the case will be decided on merits.

Keeping in view the above, counsel for the petitioner states that she be allowed to withdraw the present writ petition with a liberty to

-4the petitioner to approach the appropriate authorities under the Policy for the redressal of his grievance at the first instance. ( HARSIMRAN SINGH SETHI ) March 08, 2019 JUDGE naresh.k Whether reasoned/speaking?

Yes Whether reportable?

Yes