DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA :  AGARTALA

 

CASE   NO:   CC- 22 of 2019

 

1. Sri Pradyut Kumar Saha,

S/O.-Ranjit Saha,

Of Ranir Gaon, P.O.-Majlishpur,

P.S.-Ranirbazar, 

Pin-799035, Dist.- West Tripura …....…....................Complainant.

 

-VERSUS-

 

1. Administrative Medical Officer,

(Labour Commissioner)

ESI Dispensary, Shyamali Bazar,

P.O.-Kunjaban, Agartala, 

Kunjaban-6, Pin-799006,

Dist.-West Tripura.

 

2. Senior State Medical Officer,

Employees State Insurance Corporation, 

Regional Office, North East Region, 

Bamunimaidam, Guwahati-21,

Pin-781021….......................................................Opposite parties.

 

    __________PRESENT__________

 

 SRI RUHIDAS  PAL

PRESIDENT,

  DISTRICT CONSUMER  

DISPUTES REDRESSAL COMMISSION,

      WEST TRIPURA, AGARTALA. 

 

DR (SMT) BINDU PAL

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL COMMISSION, 

  WEST TRIPURA,  AGARTALA.

 

SRI SAMIR  GUPTA

MEMBER,

  DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA. 

 

C O U N S E L

 

For the Complainant : Sri Bhaskar Debroy,

  Advocate. 

 

For the O.P. No.1 : Sri Nepal Majumdar,

  Advocae.

For the O.P. No.2 : Sri Kishore Kr. Pal,

  Advocate. 

 

JUDGMENT  DELIVERED  ON: 24/11/2021.

 

J U D G M E N T

The complainant Sri Pradyut Kumar Saha,  set the law in motion by presenting the petition U/S 12 of the Consumer Protection Act, 1986 complaining deficiency of service committed by the O.Ps.  

  The complainants' case, in brief, is that the Complainant has availed one insurance policy under Employees State Insurance Corporation(ESI) vide Insurance No.4600014630, date of registration 01/11/2013. The Complainant and his family members i.e. his spouse, dependant father & mother, minor dependant son was covered by the said policy. The Complainant used to pay the monthly insurance policy charges i.e. 1.75% of his salary. During the validity of the said period since January, 2016 his dependant mother namely Smt. Shila Rani Saha became seriously ill and undergone treatment in ESI Dispensary Shamolibazar. Thereafter the mother of the Complainant has been referred from the ESI Dispensary to AGMC & GBP Hospital for better treatment but she was not cured hence she has been referred from AGMC & GBP Hospital to Tata Medical Centre, Kolkata. At last Tata Medical Centre detected that the mother of the Complainant was suffering from cancer. After discharging from Tata Medical Centre she had received Chemo for two times at Agartala. After long treatment she was not cured and ultimately she died on 18/02/2017. As per the terms and condition of ESI being a policy holder the Complainant is entitled to receive the Medical expenditure which he had incurred for the treatment of his dependant mother who was covered under the said insurance policy. Thereafter, the Complainant has submitted the original medical prescriptions, medical bills, death certificate etc. of his deceased mother for claiming insurance benefit. However despite elapse of considerable period the O.P. did not pay the Insurance claim to the Complainant of which he is legally entitled. The Complainant has submitted a request letter to the O.P. on 12/11/2018 with a request to pay the insurance claim within 15 days. But the O.Ps. illegally refused to pay the insurance claim to the Complainant. Lastly on 16/01/2019 the Complainant sent one notice to the O.Ps. through his lawyer demanding for insurance claim amount to be paid to him within 1 month from the receipt of the said notice.  

Hence this case. 

On the other hand both the O.P. contested the proceedings by way of filing separate written statement. 

O.P. No.1 in their written statement stated that the proceedings are bad for non-joinder and mis-joinder of necessary party. The Complainant did not made party to the Senior State Medical Commissioner, Employees' State Insurance Corporation who is Competent Authority for consideration of benefit of insurance policy, if any. O.P. No.1 vehemently disputes and denies the complaint made by the Complainant. It is also stated that Complainant is not a consumer as per definition of the Consumer Protection Act, 1986. Ultimately, O.P. No.1 prayed for dismissing the instant petition as it is not maintainable. 

O.P. No.2 in their written statement stated that the Complainant did not follow the regulation prescribed by the Employees' State Insurance Act, 1948 for claiming medical benefit. It is further stated that without depended certificate and declaration form it is not possible to settle the claim. O.P. No.2 further stated that Complainant has to prove that his mother was dependent upon him. 

 3. EVIDENCE ADDUCED BY THE PARTIES:

The Complainant examined himself and was cross examined as PW-I and submitted his examination in chief by way of affidavit. He has produced 47 documents comprising 70 sheets under a Firisti dated 03/01/2020. The documents on identification have been marked as Exhibit – 1 Series.  

On behalf of the O.Ps. one witness namely Sri H. Tangkhan John @ H. T. John, S/O. Late H. Thangliankhanm, Branch Manager of Employees' State Insurance Corporation, Agartala Branch, Agartala has been examined. He has produced 02 documents comprising 05 sheets under a Firisti dated 01/06/2020. The documents on identification have been marked as Exhibit – A Series. The said witness was also cross examined by the Complainant side.  

 POINTS TO BE DETERMINED:- 

4.  Based on the contentions raised by both the parties the following issues were framed for determination:  

   (i). Whether the complaint /petition is maintainable for non-joinder / mis-joinder of necessary party?

  (ii). Whether  there was/is  any deficiency of service committed by the O.Ps. towards the Complainant?

    (ii). Whether the Complainant is entitled to get any  compensation/relief ?

 

5. ARGUMENTS OF BOTH SIDES:

      We heard argument of Sri Pradyut Kumar Saha who is Complainant of this case. We also heard Learned Advocate Mr. K. K. Pal on behalf of the O.P. No.2. Complainant submitted that he has availed one Insurance Policy under Employees' State Insurance Corporation and used to pay monthly Insurance Premium from his salary. He stated that his family was consisting of spouse, dependent father, minor dependent son and dependent mother. His mother became ill in the month of January, 2016 and his mother was given treatment in ESI Dispensary, Shamolibazar. Thereafter his mother was referred to AGMC & GBP Hospital for better treatment. As his mother was not cured she was referred to Tata Medical Centre, Kolkata. Despite of giving long treatment his mother was not cured and ultimately she died on 18/02/2017. Being a policy holder of ESI he made a claim for the medical expenditure incurred for his mother but his claim was not settled. On the other hand Learned Advocate Mr. K. K. Pal submitted that complaint petition is not maintainable as per provision of Section 75 of the Employees' State Insurance Act, 1948. He further submitted that deceased mother of the Complainant was not dependent upon him as his father was a pensioner. So, the instant complaint is not maintainable as per provision of Employees' State Insurance Act and the complaint petition is liable to be dismissed.  

6. DECISION AND REASONS FOR DECISION:

Point No.1 : 

As it relates to jurisdiction of this Commission. In this regard the provision of Sub-Section of 3 of Section 75 of the Employees' State Insurance Act, 1948 is most relevant. We are quoting the provision. 

“(3) No Civil Court shall have jurisdiction to decide or deal with any question or dispute as aforesaid  or to adjudicate on any liability which by or under this Act is to be decided by a Medical Board, or by a Medical Appeal Tribunal or by the Employees' Insurance Court”  

The above provision is very much clear that only the Employees' Insurance Court or a Medical Board or by a Medical Appeal Tribunal have jurisdiction to decide or deal with any question or dispute mentioned in this Act. The dispute has arisen out of the Employees' State Insurance Act, 1948 and it is a special Act. So, this Commission has no jurisdiction to entertain the instant complaint. Therefore, the complaint is not maintainable in law. The issue is decided in the negative. 

 

Point Nos. 2 & 3 are taken-up together for convenience for decisions: 

We have gone through the pleadings as well as the evidences adduced from both sides. In cross examination Complainant admitted that his father was pensioner and he did  not submit any income certificate in respect of his mother's income. He also admitted that he did not make ESIC as a party in this case.  

7. In view of the above evidences and admitted fact we are in the opinion that the instant complaint is also not maintainable for non-joinder of necessary party as well as in view of the provisions of the Employees' State Insurance Act, 1948. 

In the result, the complaint is dismissed as not maintainable in law and no costs. 

    Supply a certified copy of the judgment to both the parties free of cost.    

 Announced.

 

 

SRI  RUHIDAS  PAL

PRESIDENT,

DISTRICT CONSUMER  DISPUTES 

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA

 

 

 

DR (SMT)  BINDU  PAL

MEMBER, 

DISTRICT CONSUMER DISPUTES 

REDRESSAL COMMISSION, 

WEST TRIPURA,  AGARTALA

 

SRI SAMIR  GUPTA

MEMBER,

 DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA.