BEFORE THE  STATE CONSUMER DISPUTES REDRESSAL COMMISSION

OF TELANGANA : AT HYDERABAD

CC NO.208 OF 2015

Between

Mrs Manda Nirmala Kumari W/o Arthur Mose

Aged 53 years, Occ: Pvt Service R/o H.No.6-3-1140/F1

BS Maqta, Begumpet, Hyderabad

                                                                                      …Complainant

          A N D

1. The Senior state Medical Commissioner

Employees State Insurance Corporation

Old Gandhi Medical College, Basheerbagh

2. The Senior State Medical Commissioner

Employees State Insurance Corporation

108, Panchadeep Bhavan, Joshi Marg,

Lower Parel, Mumbai

3. The Medical Commissioner

Employees State Insurance Corporation

CIG Margh, New Delhi

                                                                                      … Opposite parties

Counsel for the Complainants :         Sri  G.Tirupathi Reddy

Counsel for the Opp. parties    :         Sri William Burra

QUORUM             :

HON’BLE SRI JUSTICE B.N.RAO NALLA, PRESIDENT

&

SRI PATIL VITHAL RAO, MEMBER

WEDNESDAY THE SIXTH DAY OF SEPTEMBER

TWO THOUSAND SEVENTEEN

Oral Order : (per Hon’ble Sri Justice B.N.Rao Nalla, Hon’ble President)

***

          The complaint is filed u/s 17(1)(a) of C.P.Act  seeking direction to the opposite parties to pay a sum of Rs.75,00,000/- with interest, compensation and costs.  

2.                The brief facts as set out in the complaint is working in a private hospital in Hyderabad as nurse and she is the member of the Employees State Insurance Corporation as her employer had been contributing tot the insurance and the medical insurance benefit is applicable to the entire family members of the complainant.  While so, the daughter of the complainant late Shanthi Ayani, aged 25 years, suffered from frequent fever and cough in the year 2011 and she was treated in various hospitals in Hyderabad for the said treatment the ESIC has made payments to the local hospitals.  Though the complainant spent considerable amounts for the treatment of her daughter she was not recovered fully well and on sequent analysis it was diagnosed that she was suffering from blood cancer.  After several tests at Hyderabad, Christian Medical College, Vellore and a Tata Memorial Centre, Mumbai, it was suggested that the daughter of the complainant  has to undergo Bone Marrow Transplantation (BMS).   Tata Memorial centre, Mumbai has given an estimation of Rs.50 lakhs for the cost of treatment of Bone Marrow Transplantation.  The complainant  applied to the opposite party no.1 for required assistance for treatment of her  daughter.  The opposite party no.1 has issued a letter of credit to the Tata Memorial Centre vide letter dated 20.11.2012 but on presentation of the same  Tata Memorial Centre has asked to deposit the amount prior to commencement of treatment.  The complainant has informed the same to the opposite party no.2 and opposite party no.2 also issued another letter of credit for treatment of BMS vide letter dated 18.04.2013 marking a copy to the opposite partyno.1.   opposite party no.2 in turn written to the Medical Commissioner, ESIC, New Delhi, which is the opposite party no.1 for approval to deposit the estimated amount with Tata Memorial Centre, Mumbai. 

3.                 Opposite party no.3 has not given any approval in time and the complainant had approached the opposite party no.1 for necessary approvals to deposit the required amount with Tata Memorial Centre, Mumbai for treatment  but no approval has been granted.  In fact opposite party no.2 ordered enquiry into the complainant’s contribution when the daughter of the complainant was seriously ill and in the enquiry it was found that the case of the complainant is genuine.   The complainant also addressed representations dated 21.09.2013 and 01.10.2013 to the Hon’ble Prime Minister and the National Human Rights Commission, Delhi. 

4.                 In the meantime, as the health of the complainant’s daughter became serious the complainant has filed WP No.29570 of 2013 before the Hon’ble High Court seeking a direction to the opposite parties to release the advance amount to Tata Memorial Centre, Mumbai for treatment of her daughter.  The High Court by its WPMP No.36729 of 2013 dated 10.10.2013 granted interim direction directing the opposite parties to approve and sanction the advance amounts for the treatment of her daughter.  On 12.10.2013 the complainant got issued a notice to the opposite parties  informing them to comply the orders of the High Court immediately.    But the opposite parties intentionally ignored to comply with the order of the High Court  resulting which her daughter could not undergo suggested treatment at Tata Memorial Centre, Mumbai and as such she was forced to admit in Apollo Hospital for chemotherapy on 21.10.2013 and while undergoing the treatment she died on 21.11.2013.  Subsequently, the complainant has filed contempt case in CC No.2152 of 2013 against the opposite parties for willful disobedience of the order of the High Court and the same is still pending. 

5.                 The case of the complainant is that had the opposite parties released the required amount in time the daughter of the complainant would have survived.  The negligent and irresponsible attitude of the opposite parties resulted in death of the complainant’s daughter which amounts to deficiency of service on the part of the opposite parties.   Hence the complainant filed this complaint seeking directions to the opposite parties as stated in para no.1 supra.

6.                 The opposite parties filed their written version resisting the case and contended that the Employees’ State Insurance Act, 1948 is a Social Security legislation that provides for medical care and cash benefits in the contingencies of Sickness, Maternity, Disablement and Death due to Employment Injury to workers employed in shops, hotels, restaurants, cinemas including preview theatres, road motor transport undertakings newspaper establishments, educational and medical institutions covered under ESI Act, 1948 and drawing monthly wages upto Rs.15,000/- per month.  The ESI scheme is financed by the contributions raised from the Employers and Employees covered under ESI Scheme.  The ESI Corporation is a corporate body established under the provisions of ESI Act for the administration of the ESI Scheme in accordance with the Provisions of the Act.     ESI Scheme is a government scheme meant for organized sector workmen.  Its main object is social security and not the insurance.  The insured persons and their dependents are given medical care through a net work of ESI dispensaries and hospitals.  The Super Specialty treatment is provided through empanelled Private/Government Hospitals.  The daughter of the complainant was initially treated for Blood Cancer “ AML” but the disease relapsed.  So the Oncologist at ESI Hospital Sananthnagar advised for Allogeneic Stem cell Transplantation.  He has also referred the patient at Tata Memorial Centre where the said treatment was available.  Since Tata Memorial Centre Mumbai was empanelled with senor State Medical Commissioner, Mumbai she was referred by senior State Medical Commissioner, Hyderabad vide letter dated 20.11.2012 to M/s Tata Memorial Centre, Mumbai through Sr. State Medical Commissioner Mumbai.  Accordingly she was examined at Tata Memorial Centre and an estimate for Rs.50,75,000/- was given and the center had also asked for advance payment of the said amount form ESI Corporation.  The Senior State Medical Commissioner, Mumbai vide letter dated 17.01.2013 has forwarded the estimate to the Medical Commissioner ESI, New Delhi for its approval and the  opposite party no.3 vide its letter dated 05.04.2013 directed Sr. State Medical Commissioner Mumbai to take necessary action to provide treatment as per the ESI Norms.  Senior State Medical Commissioner, Mumbai has issued an approval letter for referring the patient to the Tata Memorial centre, Mumbai for Allogeneic Stem cell Transplant on 18.04.2013 and the said reference was valid upto 30.06.2013.  The Senior State Medical Commissioner, Mumbai thereafter requested for sanction of advance to Tata Memorial centre, Mumbai by enclosing estimate form in respect of the patient which was received by opposite party no.3 on 02.07.2013.  The Senior State Medical Commissioner, Mumbai has also issued approval letter again on 08.07.2013 and the same was valid upto 31.12.2013. 

7.                 While the matter was being examined at the opposite party no.3 some doubts arisen regarding the very entitlement of the complainant for the benefits under the ESI Act.  Therefore on 31.07.203, the Senior state Medical Commissioner, Hyderabad was advised by opposite party no.3 to get the case investigated for checking the eligibility criteria.  The case was got investigated by the local Social Security Officer who confirmed the eligibility of the Insured Woman.  The Investigation report of the Social Security Officer was sent to opposite party no.3 on 07.08.2013 and the opposite party no.3 not satisfied with the said reply and had directed the Senior State Medical Commissioner, Hyderabad to get the case investigated again by Vigilance (South Zone).  The Deputy Director Vigilance (South Zone) submitted his report on 16.08.2013 expressing his doubt about the coverage of insured woman who was drawing a gross wages of Rs.15,000/- p.m. from April 2011 onwards without any increase in the emoluments.  It was further reported by the Vigilance that i) Rs.15,000/- is the upper limit for coverage under ESI from May 2010 onwards and hence any increase in salary will make the insured woman out of coverage, and ii) as stated by Smt Nirmala Kumari to Vigilance that she came to know the diagnosis of cancer to her daughter during January 2011.  This is also confirmed by medical records.  It was also stated that combined reading of above aspects suggests that it is an act on the part of the employer to ensure continuous ESI coverage to the insured woman and thereby make the insured woman and her family membrs eligible for medical and other beneifts under ESI Act. The Vigilance (South Zone) report has been forwarded to opposite party no.3 which was received at opposite party no.3 on 22.08.2013.  The Deputy Director (Vig.SZ) in his report has stated that employer had registered insured woman in 2009 itself after the code number was issued to the employer by the Regional office and the employer entered her details in ESI Corporation portal in 2011 during migration process.  As per records insured woman was covered from October 2008 onwards and had gone out of coverage due to increase of her salary from April, 2009 to April, 2010 in view of the increase in ceiling limit w.e.f 01.05.2010.  She was again covered from May, 2010 as her salary was less as compared to the enhanced ceiling limit of Rs.15,000/-.  The employer has not increased the complainant, insured woman’s salary from April 2011 while other employees were given periodical increments.  Hence it was apprehended that the complainant and her employer colluded to continue to avail benefits under the ESI Scheme, more particularly for the treatment of the cancer patient.

8.                 It was further submitted that while the matter stood thus the complainant filed WP No.29570 of 2013 before the Hon’ble High Court of A.P. and the High Court was pleased to pass an interim order dated 10.10.2013 in WPMP NO.36729 of 2013 directing the opposite parties to immediately approve and sanction the advance amount as per the entitlement of the complainant for treatment of her daughter at Tata Memorial Centre, Mumbai.  The order of High Court was forwarded to the opposite party no.3 and the opposite party no.3 has directed the Regional Director, AP, Hyderabad vide letter dated 21.10.2013 to get the case investigated and the Regional Director has got the case reinvestigated and submitted the same to opposite party no.3 on 29.10.2013 in which the Regional Director has opined that no fraud or malafide intention of the employer regarding the coverage of the insured woman.  Finally after long correspondence between the opposite parties, the opposite party no.3 on 03.12.2013 has sanctioned required amount in respect of the daughter of the complainant.  Immediately on receipt of cheque form Accounts Branch, The Deputy Director (Admn) Senior State Medical Commissioner, Hyderabad has contacted the counsel and as per his telephonic advice contacted the father of the deceased patient to come and collect the cheque to avoid further loss of time.  Father of the deceased patient has informed that he would come on 09.12.2013 to collect the cheque, however he did not turn up.  On 11.12.2013 a daily report of Social Security Officer (Legal) was received duly informing the death of the daughter of the complainant on 21.11.2013 itself. On 12.12.2013 it was learnt from the counsel that a contempt petition was filed before the High Court on 11.12.2013 itself and the same was informed to the Medical Commissioner on the same day.  There was no intentional delay on the part of ESIC.

9.                 The deceased dependent of the complainant was given the required treatment by the Corporation in its hospital as well as in tie-up hospitals.  In fact an amount of Rs.48,84,085 was already spent on her treatment at Apollo Hospitals, Jubilee Hills’ Hyderabad by the ESI Corporation.  During the process of sanction of advance a necessity was felt to verify the entitlement/eligibility of insured woman for availing ESI Scheme Benefit.  Once the doubt about the eligibility was cleared, the amount of Rs.50.75 lakhs was sanctioned as advance in the name of M/s Tata Memorial Centre, Mumbai.  The opposite parties were not aware that she was admitted in Apollo Hospital Jubilee Hills for Chemotherapy treatment on 21.10.2013 and that she expired on 21.11.2013.  It was only due to the procedural aspects involved between offices of three states in the matter.  Hence, the opposite parties prayed for dismissal of the complaint. 

10.              The complainant in proof of her case filed her affidavit and   got Exs.A1 to A14 marked while on behalf of the opposite parties, opposite party no.2  filed his  affidavit evidence and got Exs.B1 to B16 marked.

11.                  Counsel for the complainant present and was heard.  No representation for the opposite parties.  Both parties have filed their respective written arguments.    

12.              The points that arises for consideration are :

(1)  Whether the opposite parties have committed
           deficiency in service in not sanctioning the amount in time?

(2)   Whether the Complainant is entitled to the relief sought for?

13.              Point No.1                     The case of   the complainant is that she is working in a private hospital in Hyderabad as nurse and she is the member of the Employees State Insurance Corporation as her employer had been contributing to the insurance and the medical insurance benefit is applicable to the entire family members of the complainant.  While so, the complainant has come to know that her daughter was suffering from blood cancer.  After several tests at Hyderabad, Christian Medical College, Vellore and a Tata Memorial Centre, Mumbai, it was suggested that the daughter of the complainant has to undergo Bone Marrow Transplantation (BMS).   Tata Memorial Centre, Mumbai has given an estimation of Rs.50 lakhs for the cost of treatment of Bone Marrow Transplantation and the complainant applied to the opposite party no.1 for required assistance for treatment of her daughter.   The opposite party no.1 has issued a letter of credit to the Tata Memorial Centre vide letter dated 20.11.2012 but on presentation of the same Tata Memorial Centre has asked to deposit the amount prior to commencement of treatment.   But the opposite party no.3 has not given any approval in time and instead   ordered enquiry into the complainant’s contribution when the daughter of the complainant was seriously ill and in the enquiry it was found that the case of the complainant is genuine.     The complainant alleged that as the health of the complainant’s daughter became serious the complainant has filed WP No.29570 of 2013 before the Hon’ble High Court seeking a direction to the opposite parties to release the advance amount to Tata Memorial Centre, Mumbai for treatment of her daughter but the opposite parties in spite of the direction from the High Court failed to sanction the required amount in time failing which the daughter of the complainant died.    She contended that   had the opposite parties released the required amount in time the daughter of the complainant would have survived.  The negligent and irresponsible attitude of the opposite parties resulted in death of the complainant’s daughter which amounts to deficiency of service on the part of the opposite parties.

14.               On the other hand it is the case of the opposite parties that the daughter of the complainant was initially treated for Blood Cancer “ AML” but the disease relapsed and so the Oncologist at ESI Hospital Sananthnagar advised for Allogeneic Stem cell Transplantation.     Accordingly she was examined at Tata Memorial Centre and an estimate for Rs.50.75 lakhs was given and the center had also asked for advance payment of the said amount form ESI Corporation.   Senior State Medical Commissioner, Mumbai has issued an approval letter for referring the patient to the Tata Memorial Centre, Mumbai for Allogeneic Stem cell Transplant  and requested opposite party no.3 for sanction of advance to Tata Memorial Centre, Mumbai by enclosing estimate form in respect of the patient.       In the meanwhile due to some doubts regarding eligibility criteria the  opposite party no.3   had directed the Senior State Medical Commissioner, Hyderabad to get the case investigated again by Vigilance (South Zone).  The Deputy Director Vigilance (South Zone) submitted his report on 16.08.2013 expressing his doubt about the coverage of insured woman who was drawing a gross wages of Rs.15,000/- p.m. from April 2011 onwards without any increase in the emoluments.    Hence it was apprehended that the complainant and her employer colluded to continue to avail benefits under the ESI Scheme, more particularly for the treatment of the cancer patient.           While the matter stood thus the complainant filed WP No.29570 of 2013 before the Hon’ble High Court of A.P.   and the High Court was pleased to pass an interim order dated 10.10.2013 in WPMP NO.36729 of 2013 directing the opposite parties to immediately approve and sanction the advance amount as per the entitlement of the complainant for treatment of her daughter at Tata Memorial Centre, Mumbai.  As per directions of the High Court the opposite party no.3   has directed the Regional Director, AP, Hyderabad vide letter dated 21.10.2013 to get the case investigated and the Regional Director has got the case reinvestigated and submitted the same to opposite party no.3 on 29.10.2013 in which the Regional Director has opined that no fraud or malafide intention of the employer regarding the coverage of the insured woman.   Accordingly, opposite party no.3    has sanctioned required amount in respect of the daughter of the complainant and  contacted the father of the deceased patient to come and collect the cheque to avoid further loss of time.  Father of the deceased patient has informed that he would come on 09.12.2013 to collect the cheque, however he did not turn up and later on 11.12.2013 a daily report of Social Security Officer (Legal) was received duly informing the death of the daughter of the complainant on 21.11.2013 itself.   The defence of the opposite parties is that the deceased dependent of the complainant was given the required treatment by the Corporation in its hospital as well as in tie-up hospitals by incurring expenditure of   Rs.48,84,085 on her treatment at Apollo Hospitals, Jubilee Hills’ Hyderabad by the ESI Corporation and pleaded that it was only due to delay in the procedural aspects involved between offices of three states in the matter. 

15.               Ex.A1 and Ex.B1 is the copy of letter of opposite party no.1 dated 20.11.2012 addressed to the Director, Tata Memorial Hospital, Mumbai requesting it to treat the deceased patient on credit basis and submit the bill to opposite party no.2.  It is also certified therein that the deceased patient is entitled for super specialty for the period from 01.07.2012 to 31.12.2012.  Ex.A2 is the certificate issued by Tata Memorial Centre dated 27.11.2012 besides certifying that Ms Manda Shanthi Ayani was its patient mentioned the approximate cost of the treatment as Rs.50.75 lakhs and requested to deposit an amount of Rs.10.75 lakhs before search for unrelated donor is started while the balance amount of Rs.40 lakhs has to be deposited once the potential unrelated donor is identified.  The final bill would be based on actual expenditure incurred and excess money if any would be refunded.  Exs.A3, A4, A6 and A7 and B2,  are the copies of approval letters stating that approval is granted for referral to Tata Memorial Centre Mumbai for the purpose of performing Allogeneic Stem Cell Transplant in respect of M.Shanti Ayani, daughter of the complainant.  Ex.A5 and B3 is the copy of letter dated 02.07.2013 of the opposite party no.2 to the opposite party no.3 requesting it to approve and sanction the advance amount to the mentioned persons in the said letter.  Ex.A8 is the copy of letter dated 28.08.2013 of Dr.Sinivas Chakravarthy .G, Consultant Medical Oncologist, Apollo Hospital  regarding allogeneic stem cell transplantation.  Exs.A9 and A10 are the copies of representations submitted to the then Hon’ble Prime Minister and to the Chairman National Human Rights Commission praying to issue necessary instructions to the concerned ESIC officials in New Delhi for approval of deposit of the required amount for commencement of treatment.  Ex.A11 is the copy of WPMP No.36729 of 2013 in WP No.29570 of 2013 wherein the Hon’ble High Court had directed the opposite parties to immediately approve and sanction the advance amounts as per the entitlement of the complainant for treatment of her daughter at Tata Memorial Centre Mumbai.  Ex.A12 is the copy of legal notice dated 12.10.2013 got issued by the complainant to the opposite parties calling upon them to implement the directions of the High Court.  Ex.A13 is the copy of counter of the opposite party no.1 in writ petitioner.  Ex.A14 is the copy counter in contempt case filed by the opposite parties before the High Court. 

16.               Ex.B4 is the copy of    letter dated 31.07.2013 issued by opposite party no.1 to  the Regional Director (PICI) ESI Corporation, Hyderabad  requesting for verification of employers records with reference to coverage of insured woman and submit the report on top priority for onward transmission to Hqrs. Office.  Ex.B5 is the copy of letter dated 07.08.2013 of the opposite party no.1 to the Director (Vigilance) South Zone requesting to investigate the matter on the observations made by Hqrs. Office and arrange to submit a comprehensive report to the Hqrs office on top priority basis.  Ex.B6 is the copy of vigilance report dated 16.08.2013.  Ex.B7 is the copy report of verification status of employment for availing super specialty treatment in respect of complainant dated 16.08.2013.  Ex.B8 is the copy of letter of the opposite party no.1 dated 22.08.2013 to the opposite party  no.3 forwarding the report for taking necessary action.  Ex.B9 is the letter from opposite party no.3 dated 21.10.2013 to the Regional Director Hyderabad stating that since the matter relates to life of dependent of insured woman requesting to give his clear opinion as to whether the insured woman should be allowed to get the benefit of doubt.  In case the reply is against giving benefit of doubt to insured woman then the same may also be communicated to the office along with report confirming action taken in the matter against employer and insured woman.  Ex.B10 is the copy of letter of opposite party no.3 dated 23.10.2013 to the Regional Director Hyderabad requesting to expedite the matter and send the information sought in the letter dated 21.10.2013 at the earliest.  Ex.B11 is the copy of letter dated 29.10.2013 of opposite party no.1 to the Director General (Bft.I) stating that the insured woman may be considered for allowing the benefit of doubt.  Ex.B12 is the copy of report of investigation of the case of the complainant.  Ex.B13 sit he copy of letter dated 04.11.2013 of the opposite party no.1 to the opposite party no.3 requesting to issue advance cheque for Rs.50.75 lakhs to enable them to comply with the order of the High Court.  Ex.B14 is the copy of letter of Headquarters’ Office to the opposite party no.1 informing it that the Director General has approved the required amount for the prescribed treatment of the patient at Tata Memorial Centre Mumbai subject to necessary compliance of observations mentioned in the letter.   Ex.B15 copy of cheque dated 06.12.2013 for Rs.50,75,000/- of opposite parties.  Ex.B16 copy of detailed expenditure incurred towards treatment of the daughter of the complainant.

17.              Now the only point of contention is that whether there is any deficiency in service in not approving the estimate immediately after requesting of Tata Memorial Hospital  for deposit  of the amount.  Admittedly, the complainant after diagnosing the disease that her daughter was indeed suffering from Acute Myeloid Leukemia i.e., Blood Cancer it was suggested that her daughter has to undergo Bone Marrow Transplantation in Tata Memorial Centre, Mumbai.  Tata Memorial Centre Mumbai has given an estimation of RS.50.75 lakhs for the cost of the said treatment.  Therefore, the complainant  applied to the opposite party no.1 for required assistance for treatment of her daughter.  After the request of the complainant,  the opposite party no.1   issued a letter of credit dated 20.11.2012 marked Ex.A1 to the Tata Memorial Centre.  But the Tata Memorial Centre vide its letter dated 27.11.2012 marked as Ex.A2  had asked to deposit the amount prior to commencement of treatment and the complainant informed the  same to the opposite party no.2.    Interestingly, the opposite party no.2 also issued  letters of credit for treatment of BMS vide letter dated 18.04.2013 marked as Exs.A3 and A4 after taking  a gap of 5 months from the first letter of credit without considering the request of the Tata Memorial Centre for depositing of the amount. The Tata Memorial Centre again reiterated their demand for depositing the amount to enable them to commence the treatment.  The demand of Tata Memorial Centre was informed to the opposite party no.2 and the opposite party no.2 in turn addressed letter dated 03.07.2013 marked as Ex.A6 after gap of nearly three months from the second letter of credit to the opposite party no.3 for approval to deposit the estimated amount with Tata Memorial Centre, Mumbai.   The opposite party no.3 instead of considering the request of the complainant has ordered enquiry into the complainant’s contribution when the daughter of the complainant was seriously ill.  The case was got investigated by the local Social Security Officer who confirmed the eligibility of the insured woman and the report was sent to the Head Quarters on 7.8.2013 but what the Head Quters did is that it was not satisfied with the said reply and in turn directed the Senior State Medical Commissioner Hyderabad to get the case investigated again by Vigilance (South Zone).  It is pertinent to note that the opposite party no.3 acted inhumanly by directing the opposite party no.1 to get the case investigated again when the patient is on the death bed looking for her life for the approval of the opposite party no.3 to undergo Bone Marrow Transplantation.    Thereafter the Deputy Director, Vigilance (South Zone) submitted his report on 16.08.2013 in which the he expressed the doubt about the coverage of insured woman and forwarded the same to the Head Quarters on 22.08.2013.  The complainant even made representations to the then Hon’ble Prime Minister of   India and the National Human Rights Commission,  begging them to save life of her only daughter who was waiting for approval of the opposite party no.3, by instructing it to approve the sanction of the amount to Tata Memorial Centre.  When there is no response from anywhere and the health of the daughter of the complainant deteriorating day by day she filed Writ Petition No.29570 of 2013 before the Hon’ble High Court of A.P.   seeking direction to the opposite parties to release the advance amount to Tata Memorial Centre and the High Court in WPMP No.36729 of 2013 dated 10.10.2013 granted interim direction directing the opposite parties to approve and sanction the advance amounts immediately.  The complainant on 12.10.2013 got issued notice to the opposite parties informed them about the direction given by the High Court but inspite of the said orders the opposite party no.3 simply ignored the order and again directed the Regional Director, Hyderabad to get the case investigated and the Regional Director Hyderabad has got the case reinvestigated and submitted the report to the Head Quarter vide letter dated 29.10.2013 in which the Regional Director has opined that no fraud or malafide intention of the employer regarding the coverage of the insured woman.  The opposite party no.3 ordered enquiry in to the genuineness of the complainant twice and in  the first report the local Social Security Officer confirmed the eligibility of the insured woman but being not satisfied with the said report the opposite party no.3 again ordered for enquiry and   the second report   suggested that there was fraud and in the final report the report  it was decided after investigation  there was no fraud or malafide intention of the employer.  It shows the gross negligence and indifferent attitude of the investigation officers and not only that  the opposite party no.3 goes on directing the opposite parties no.1 and 2 to reinvestigate the matter again and again and we do not know why the opposite party no.3 is particular about the investigations  about the genuineness of eligibility of the complainant when her daughter condition was  very serious. 

18.              At this juncture it is pertinent to mention the letter of Tata Memorial Centre  dated 27.11.2012 marked as Ex.A2 which we reproduce as under:

The cost mentioned in Sr.No.1 and 2 i.e. Rs.10,75,000/- has to be deposited before search for unrelated donor is started, while the cost mentioned in Sr.No.3(A) & 3(B) i.e., Rs.40,00,000/- has to e deposited once the potential unrelated donor is identified.

19.               The above letter shows that the Tata Memorial Centre initially asked to deposit an amount of Rs.10,75,000/- before search for unrelated donor is started and the balance amount has to be deposited once the potential unrelated donor is identified.   The opposite party no.3 initially before their investigations  at least ought to have deposited the amount of Rs.10,75,000/- before the Tata Memorial Centre so that Tata Memorial Centre will proceed to search for unrelated donor.  But the opposite party no.3 without going into the severe health condition of the daughter of the complainant got directed for investigations and reinvestigations until the patient died on 21.11.2013.  In the final stage of the patient when her hemoglobin, white blood cells and the count of platelets reduced she was forced to admin in Apollo Hospital for chemotherapy on 21.10.2013 and while undergoing the treatment she died on 21.11.2013.  After the death of the patient, the opposite party no.3 leisurely issued cheque on 06.12.2013 and informed the father of the deceased patient to come and collect the cheque but by the time the daughter of the complainant was died.   

20.              From the conspectus of facts and circumstances of this case, it is obvious that though the opposite party no.3   had the knowledge of  blood cancer  of the patient had taken nearly one year one month time for approval for deposit of the required amount for commencement of treatment. Had the opposite party no.3 initially,  when the Tata Memorial Centre requested for deposit of amount, released the required amount in time, Tata memorial Centre would have commenced the treatment and the daughter of the complainant would have survived.   The negligent and indifferent attitude of the opposite party no.3 caused the death of the daughter of the complainant.     Obviously, it had failed to exercise its duty in not releasing the amount in time instead dragged on the matter till the death of the patient    There is, therefore, clear-cut deficiency on the part of the opposite party no.3  in the present case and for that the opposite parties are liable to compensate the complainant for loss of her daughter.  Considering the nature of the  case and the gravity of the imputation of negligence  on the part of opposite party no.3   we feel a compensation of Rs. 5,00,000/-  could be awarded  which we feel reasonable and modest. Though there is no negligence on the part of the opposite parties no.1 and 2 yet all the opposite parties are one and the same, therefore they are jointly and severally liable to compensate the complainant. 

In the result, the complaint is allowed holding and directing the opposite parties no.1 to 3 jointly and severally liable to pay compensation of Rs.5,00,000/- to the complainant together with costs of Rs.10,000/-.  Time for compliance four weeks. 

                                                                   PRESIDENT                   MEMBER

                                                                                  06.09.2017

APPENDIX OF EVIDENCE

WITNESSES EXAMINED

                                                          NIL

                                                EXHIBITS MARKED

For complainant

Ex.A1          Copy of letter dated 20.11.2012 of opposite party no.1

To Tata Memorial Centre

Ex.A2          Copy of letter dated 27.11.2012 of Tata Memorial Centre

Ex.A3          Copy of letter of opposite party no.2 to Tata Memorial Centre

Ex.A4          Copy of approval letter of opposite party no.2 to Tata Memorial
                   Centre

Ex.A5          Copy of letter dated 02.07.2013 of opposite partyno.2 to opposite
                   party no.3

Ex.A6          Copy of letter of opposite party no.2 to Tata Memorial Centre

Ex.A7          Copy of approval letter of opposite partyno.2 to
                   Tata Memorial Centre

Ex.A8          Copy of letter of Apollo Cancer Institute dated 28.08.2013

Ex.A9          Copyu of representation to Prime Minister of India dt.29.9.2013

Ex.A10        Coipy of representation dt.01.10.2013 to

National Human Rights Commission

Ex.A11        Copy of order in WP No.29570 of 2013 dated 10.10.2013

Ex.A12        Copy of notice dated 12.10.2013

Ex.A13        Copy of counter of Ops in WP  No.29570 of 2013

Ex.A14        Copy of counter of Ops in Contempt Case No.2152/2013

For opposite parties

Ex.B1                   Copy of letter dt 20.11.2012 of Op 1 to Tata Memorial Centre

Ex.B2                   Copy of letter dt 18.04.2013 of Op 2 to Tata Memorial Centre

Ex.B3                   Copy of letter dt 02.07.2013 of Op 2 to Op 3

Ex.B4                   Copy of letter dt 31.07.2013 of Op1 to Regional Director ESI Hyd

Ex.B5                   Copy of letter dt 07.08.2013 of Op1 to  Director
                   Vigilance ESI  Chennai

Ex.B6                   Copy Vigilance Report dated 16.08.2013

Ex.B7                   Copy of Report of Verification Status of employment

                   For availing super specialty treatment dt.16.08.2013

Ex.B8                   Copy of letter dt.22.08.2013 from SSMC.AP to Hqrs ESIC,
                   New Delhi

Ex.B9                   Copy of letter from Hqrs to Regional Director AP

Ex.B10        Copy of reminder from Hqrs to Regional Director AP

Ex.B11        Copy of report dt.29.10.2013 from Regional Director AP to Hqrs

Ex.B12        Copy of report of Investigation dt.28.10.2013

Ex.B13        Copy of letter dated 04.11.2013 of SSMC AP to OP 3

Ex.B14        Copy of letter dated 03.12.2013 from Hqrs to SSMC AP

Ex.B15        Copy of cheque dated 06.12.2013 for Rs.50.75 lakhs

Ex.B16        Copy of expenditure details incurred by ESIC

                                                                             PRESIDENT                   MEMBER