Date of Filing: 27.06.2018
Date of Order: 19.01.2021
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION – I, HYDERABAD
P r e s e n t
HON’BLE Sri P.VIJENDER, B.Sc. L.L.B., PRESIDENT
HON’BLE Sri K.RAM MOHAN, B.Sc. M.A L.L.B., MEMBER
On this the Tuesday the 19th day of January, 2021
C.C.No. 273 /2018
Between
R.B. Khanna S/o Late R.D. Khanna,
Age 53 years, Occ: Asst Sub Inspector
Of police, Sultan Bazar PS,
R/o H.No. 23-5-848,Opp. Sudha Theatre,
Shah-Ali-Hunda, Hyderabad. TS
….Complainant
And
- The Director General of Police,
Telangana State
Opp. Ravindra Bharathi,
Lakadi-ka-pul, Hyderabad – 500004
- The Inspector General of Police,
(Welfare),
Telangana State,
Office of the Director General of Police,
Telangana State,
Opp. Ravindra Bharathi,
Lakadi-ka-pul, Hyderabad - 500004
… Opposite Parties
Counsel for the Complainant : PIP
Counsel for the Opposite parties No.1 & 2 : Mr. I.V. Radhakrishna Murthy
O R D E R
(By Sri P.VIJENDER, B.Sc. L.L.B., PRESIDENT on behalf of the Bench)
1. This Complaint is filed U/s 12 of Consumer Protection Act 1986 alleging deficiency of service on the part of opposite parties the complainants case in brief is that as a Assistant Sub Inspector of Police , he joined in the welfare scheme introduced by opposite party No.1 under the name and style of Arogya Bhadratha launched on 24.11.1998 vide circular memo No. L&O/M5/4710/98. The authorities of the said scheme had an agreement with Messers Family Health Plan Ltd for providing medical facilities and identified some hospitals to meet the requirement all facilities for the family members of the persons enrolled with the scheme An amount of Rs. 125/- was compulsory deducted from January 1999 from the salaries of the members and later by a memo dated 09.07.1999 this subscription amount was increased to Rs. 40/- per month which was further increased by a memorandum dated 14.03.2000 to Rs. 90/- per month. In the year 2003 Messers Good Health Plan Ltd was appointed as 3rd party administrators of the scheme. The complainant and his family members were made as members in the year 2004 and the trust board increased the celling limit of expenditure from Rs. 5,00,000/- to Rs 8,00,000/- by a memo dated 28.01.2004.
2. The complainant Wife suffered with Heart problem and severe dental issue. When he approached Government Area Hospital Nampally for dental treatment she was referred to a Government recognized referral hospital as a treatment for it was not available at Area Hospital Nampally. Hence the complainant visited Sowjanya Dental Hospital for treatment which was commenced on 12.07.2017. In the said hospital an estimation was given at Rs. 1,00,000/- as a Teeth of the patient was decayed and was advised for extraction , Root Canals and Crowns. Out of estimated amount of Rs. 1,00,000/-, Rs. 30,000/- is the subsidy given under Arogya Bhadratha Scheme and balance amount of Rs. 70,000/- was paid by the complainant. Hence the complainant made a representation to opposite party No.1 on 19.07.2017 for grant all facilities under the scheme but same was rejected on 25.07.2017.
3. The opposite parties have deducted Rs. 90/- per month from the complainant salary from 1998 -99 and regularly imposing restrictions on the treatment availed for the employees and their family members As a result of it, the complainant suffered mentally. Hence the present complaint for a direction to the opposite parties to pay a sum of Rs. 2,00,000/- as compensation for causing mental agony , hardship and serious inconvenience by rejecting request for grant of medical facilities to his wife to the full extent and a further direction to consider his wife dental treatment expenses fully under Arogya Bhadratha Scheme.
4. The substance of the contest of the opposite parties in the counters is that, in the year 1998, the Police Department introduced welfare measure under the name and style of Arogya Bhadratha Scheme for supporting members of the scheme in medical necessitates. Under the said scheme the medical necessities of members as well as their dependents was proposed to cover. Initially the agreed amount for enrolling amount was Rs. 25/- per month and deduction were made compulsorily. Thereafter the amount of deduction was increased to Rs. 40/-p.m and presently Rs. 90/-p.m and expenditure under the scheme was also increased from Rs. 5,00,000/- to Rs. 8,00,000/-during one financial year.
5. complainants wife underwent treatment for dental decease and he made a representation with the opposite parties on 19.07.2017 for grant of medical facilities to his wife but said request was rejected as the prescribed upper limit of Rs. 30,000/- as permitted under G.O.Ms.No. 105HM&FW(Ki) dt. 09.04.2007 was already accepted by Bhadratha and further amount cannot be paid. Under the said G.O. the maximum amount for dental treatment payable is only Rs. 30,000/- for three spells. The Claim of the complainant that on account of refusal of his request he suffered mentally and entitled for grant of compensation is false. The complainant is making claim against Arogya Bhadratha but same is not added as party to the present complaint and opposite parties have nothing to do with his claim. The services of Messer Good Health Plan Pvt Ltd were terminated in the year 2009 and 2 medical advisers were appointed to give coverage to Lison with the hospitals and to scrutinize the bills in accordance with the tariff prescribed by the Government under G.O.M.S No. 74HM&FW(Ki) dt. 15.03.2005 and also G.O.M.S.No. 105HM& FW(Ki) dt. 09.04.2007. Hence the present complaint is deserved to be dismissed with costs.
6. In the enquiry complainant filed his evidence affidavit reiterating the material contents of complaint and denied the stand of the opposite parties in their counters. He has got exhibited 22 documents to support his claim. For the opposite parties the evidence affidavit of one Gopal Reddy stated to be secretary Arogya Bhadratha is got filed and the substance of the affidavit is in line with the stand taken in the counters filed for them Eight (8) documents are exhibited for the opposite parties.
7. The complainant has got filed written arguments and made oral submissions. On a consideration of material brought on the record the following points have emerged for consideration.
- Whether the complainant is entitled for a direction to the opposite parties to consider to provide the financial assistance for meeting the entire expenditure of his Wife dental treatment. ?
- Whether complaint is entitled for the compensation claimed.?
- To What relief.?
Point No.1:-
Material facts relating to floating of a scheme claim known as Arogya Bhadratha for supporting members of the scheme and their Family member’s and collecting for Rs. 25/- per month from the persons who agreed to enroll as members and subsequent enhancement to Rs. 40/- per month and again to Rs. 90/- per months has been Admitted by the opposite parties in the counters itself. It is also admitted by the opposite parties that the medical expenditure under the said scheme has been increased from time to time form Rs. 5,00,000/- to Rs. 8,00,000/- during one financial year to the members. It is further agreed that the complainant wife underwent for treatment of dental decease and to meet the total expenditure required for it. He made a representation with the opposite parties on 19.07.2017 but same was rejected on the ground that as per the Government G.O dated 15.03.2005 and 09.04.2007 the complainant exceeded the tariff prescribed for dental treatment. Under Ex.A1 memo dt. 24.11.1993 by which the Director General and Inspector of Police introduced Arogya Bhadratha Scheme there is no reference of prescribed limit for extending the financial aid for treatment of members enrolled under the scheme. As already said the opposite parties have categorically stated in the counters that that deduction of contribution by the members was made a compulsory from the salaries. In the circular memorandum dt. 14.03.2000 under Ex.A4 also no financial limit is prescribed under this scheme in providing medical facilities to the enrolled members. The subsequent memos and circulars relating to the Arogya Bhadratha Scheme floated by the department there is no reference of the Government G.Os under which the requests of the complainant for the payment of the entire amount paid for treatment is refused under Ex.A8 circular memorandum dt. 28.01.2004, the celling limit for medical expenditure for a family was increased from Rs. 5,00,000/- to Rs. 8,00,000/- in a financial year with immediate effect by the press release dt. 07.03.2018. Under Ex.A9 the Arogya Bhadratha Scheme for police personal and their dependent’s are entitled to under go dental treatment with cashless facilities.
In the light of this specifics provisions and regularization it is not open to the opposite parties to reject the claim of complainant to provide treatment facility of his wife and said rejection is in violation scheme guidelines that too after deducting monthly subscriptions from his salary compulsorily. Accordingly point is answered in favour of complainant.
Point No.2:-
The rejection of the complainants representation to provide complete dental treatment to his wife under the Arogya Bhadratha scheme is not in terms of guidelines of the said scheme and by rejecting it opposite parties caused any amount of inconvenience to the complainant. Hence he is entitled for the compensation. Accordingly point is answered.
Point No.3
In the result, the complaint is allowed in part directing the opposite parties to reimburse the entire amount spent by the complainant for Dental treatment of his wife with interest @ 9% p.a from the date of rejection to the date of payment. The opposite parties further directed to pay a sum of Rs. 25,000/- as compensation for causing inconvenience to him. The opposite parties further liable to pay a sum of Rs. 10,000/- towards costs of this complaint.
Time for compliance 45 days from the date of service of this order.
Dictated to steno, transcribed and typed by him, pronounced by us on this 19th the day of January, 2021.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
WITNESS EXAMINED
NIL
Exhibits filed on behalf of the Complainant:
Ex.A1– Copy of Memo No. L&O/M5/4710/98 - dt.24.11.1998.
Ex.A2 – Copy of Memo No. L&O/M5/4710/98-99 – dt.09.01.1999.
Ex.A3 - Copy of Memo No. L&O/M5/4710/99 – dt.09.07.1999.
Ex.A4 – Copy of Circular Memo.No. 002/ABS /2000 – dt. 14.03.2000.
Ex.A5- Copy of Circular Memo.No. 015/ABS/2003 – dt.18.01.2003.
Ex.A6- Copy of Good Health Insurance TPA dt. 07.04.2018.
Ex.A7- Copy of Health Card vide No. 42734 - dt.12.10.2016.
Ex.A8- Copy of Circular Memo. No 31/ABS/2003 – dt.28.01.2004.
Ex.A9- Copy of press release (A.B in Hyderabad – dt. 07.03.2018.
Ex.A10- Copy of Physician / Cardiologist Consent – dt. 06.09.2015.
Ex.A11- Copy of O.P Ticket Government hospital – dt 17.12.2012.
Ex.A12- Copy of Pamplet of Sowjanya Dental Hospital.
Ex.A13- Copy of Estimation of Dental Hospital – dt. 12.07.2017.
Ex.A14- Copy of Representation to DGP – dt.19.07.2017.
Ex.A15- Copy of Representation to IGP(Welfare) – dt.19.07.2017.
Ex.A16- Copy of rejection letter of A.B – Dt.25.07.2017.
Ex.A17- Copy of Annexure “D” of circular.
Ex.A18- Copy of G.O.Ms No. 105 - Dt.09.04.2017.
Ex.A19- Copy of G.O.Ms.No. 174 – dt. 01.11.2013.
Ex.A20- Copy of Circular memo No. ABS/32/2003 – dt. 21.03.2003.
Ex.A21- Copy of G.O.Ms.No. 74 – dt. 15.03.2005.
Ex.A22- Copy of Circular of “Bhadratha” - dt. 01.03.2014.
Exhibits filed on behalf of the Opposite parties:
Ex.B1 – Copy of para wise remarks dt. 03.08.2018.
Ex.B2– Copy of Circular memorandum No. 31/ABS/2003 dt.
28.01.2004.
Ex.B3 - Copy of circular memorandum No. 33/ABS/2004 dt. 26.04.2004.
Ex.B4 – Copy of letter to the counsel dt. 10.10.2018.
Ex.B5- Copy of G.O.Ms.No. 74 issued by Health & Family Welfare (K1)
Department dt. 15.03.2005.
Ex.B6- Copy of G.O.Ms.No. 105 issued by Health & Family Welfare (K1)
Department dt. 09.04.2007.
Ex.B7- Copy of the complainant is not eligible for further treatment letter
dt. 25.07.2017
Ex.B8- Copy of Para wise letter and photocopy dt. 21.08.2018
MEMBER PRESIDENT
