Delhi High Court: A petition was filed by the petitioner challenging common judgement and order dated 19-05-2018 vide which the criminal revision petitions filed by the three respondents separately against the order of summoning them under Sections 342, 406, 420 and 120-B, were allowed and they were discharged in complaint case. Neena Bansal Krishna, J., held that there is no merit in the petition and upheld the order by ASJ that no criminal offence under Section 342, 420, 406, 34 and 120-B IPC was made out.
The petitioner, an advocate by profession, had been diagnosed with Cysticercosis and was advised surgical removal of the affected area in his right hand. He chose to undergo the surgery at Max Super Speciality Hospital, Saket (Max Hospital), a network hospital under his Cashless Health Insurance Policy issued by Max Bupa Health Insurance Company Ltd., a joint venture under Max India. The policy was valid from 28-08-2013 to 28-08-2014, and it promised cashless medical service at network hospitals. Max Hospital initially provided two estimates: ₹1,79,368 for a shared room and ₹2,20,316 for a single occupancy room. The petitioner chose the single (deluxe) room. He applied for pre-authorisation under his policy and was granted an initial approval of ₹75,000 on 05-10-2013, with assurance of further authorisation to follow.
Despite the cashless coverage, Max Hospital demanded advance deposit. The petitioner was admitted on 07-10-2013, and although the surgery was scheduled for 08-10-2013, he was compelled to deposit ₹1,45,000 (₹50,000 on 07-10-2013 and ₹95,000 on 08-10-2013) before the surgery was conducted. On 09-10-2013, the insurance company approved the total billed amount of ₹1,73,907 and confirmed direct payment to Max Hospital. However, Max Hospital claimed to have received only ₹1,04,080 from the insurer and retained ₹57,332 from the petitioner advance deposit. After accounting for discounts and adjustments, ₹87,668 was refunded to him.
Feeling cheated, the petitioner filed a private complaint under Sections 342, 406, 420 and 120-B IPC against hospital officials including Duty Manager and Patient Care Coordinator. His complaint asserted that the pre-deposit was entrusted to the hospital under the cashless policy but was wrongly retained. He further alleged wrongful confinement on 09-10-2013, as he was not discharged until 9:15 PM despite full approval from the insurer earlier that evening. An application under Section 156(3) CrPC was dismissed by the Magistrate, but summons was eventually issued under the IPC provisions after recording pre-summoning evidence. Aggrieved, the respondents challenged the summoning order before the Sessions Court through separate criminal revision petitions. The Additional Sessions Judge (ASJ) set aside the summoning orders, holding them to be grossly illegal and infirm. Challenging this, the petition filed the present petition under Section 482 CrPC before the Court seeking to quash the ASJ’s order and reinstate the summoning of the accused.
Counsel for the petitioner submitted that the hospital misappropriated entrusted funds by failing to refund the full advance deposit even after full coverage was approved. He was wrongfully confined on 09-10-2013 and only discharged at night due to deliberate delay in bill settlement. The acts were not isolated but reflected an institutional conspiracy involving several officials, thereby invoking criminal conspiracy, common intention, and abetment. He held a ‘Gold Policy’ with coverage up to ₹5 lakhs, and the hospital’s justification of difference in room category was baseless. The denial of refund and delayed discharge amounted to harassment and mala fide intention.
The Court observed that the essential element for summoning under criminal charges is the existence of a prima facie case, not proof of guilt. The entire transaction between the petitioner and the hospital was rooted in a commercial and procedural framework governed by insurance policies and medical practice. The hospital had provided the estimates for both shared and single rooms, and the petitioner voluntarily chose the higher category, thereby incurring additional cost. The advance deposit was demanded only because the insurer had sanctioned a partial amount initially, which did not constitute cheating or dishonest inducement. The balance amount was adjusted and refunded properly after due approval; the ₹ 57,332 difference was reasonably explained by higher room charges not covered under the standard policy.
The Court noted that the final approval from the insurance company was received only at 7:10 PM on 09-10-2013, and discharge at 9:15 PM did not amount to wrongful confinement. It was a procedural delay, not an intentional act of restraint. No entrustment or misappropriation was made out to justify invocation of Section 406 IPC. While acknowledging that procedural harassment in hospital discharges due to insurance delays is a common and unfortunate experience for patients, the Court clarified that such grievances may give rise to a civil claim or compensation for mental harassment but do not amount to criminal offences.
The Court remarked that it would be pertinent to record that such incidents of alleged harassment felt by the patients in settling their ‘Final Bills’, is not an untold story but is frequently suffered by the patients. Their harassment gets compounded by the fact that they come out of a trauma of an ailment under treatment but even for discharge, there are long drawn procedures for settling the bills with the ‘Insurance Company’. This harassment and mental trauma by the patients and their family members who are pushed to follow the matter with the Insurance Company for getting the requisite approvals which is riddled with delays at the end of the Insurance Companies, is well understandable. Much angst has been expressed on this system of getting the approvals from the Insurance Company at many forums and by the Courts, but such situation may be a ground for seeking compensation for mental harassment but does not tantamount to any criminal offence.
The Court concluded that no offences under Sections 342, 406, 420, 120-B, 34, 109 IPC were made out from the complaint or the evidence and the ASJ was correct in setting aside the summoning order as being illegal and unsustainable in law. The petition under Section 482 CrPC was found to be without merit and was accordingly dismissed. The Court strongly urged State and Central authorities, IRDA, and medical councils to address the systemic issues patients face during discharge and insurance claim processing and reiterated the need for a robust mechanism or charter to protect patients’ rights but clarified that these issues do not transform into criminal liability.
[Shashank Garg v. State, 2025 SCC OnLine Del 2455, decided on 17-04-2025]
Advocates who appeared in this case :
Mr. Nitin Mehta and Mr. Bhanu Sanoriya, Advocates for petitioner
Mr. Shoaib Haider, Ld. APP for the State. Mr. Anil Bhasin, Advocate for R-2 and R-3.
Buy Penal Code, 1860 HERE
