Haryana

Bhiwani

CC/122/2020

Ramesh kr. - Complainant(s)

Versus

Central org. - Opp.Party(s)

Pardeep Bajar

05 Feb 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BHIWANI.

 

                                                             Consumer Complaint No. : 122 of 2020

                                                        Date of Institution           : 10.09.2020

                                                                  Date of order                  : 05.02.2024

 

POELP  Ramesh Kumar (Retired) son of Sh. Net Ram R/o village Dohki, P.O. Kitlana Tehsil and District Charkhi Dadri, Haryana.

           ……Complainant.

 

Versus

 

1. Central Organization, ECHS Integrated HQ of MoD (Army) Adjutant General Branch Maude Line, Delhi Cantt. Through its authorized signatory.

 

2. Regional Central ECHS Hisar PIN 900383 C/o 56 APO through its authorized signatory.

 

3. ECHS Polyclinic, Bhiwani, H.No.126 (Raja House) Vijay Nagar, Bhiwani District Bhiwani-Haryana PIN 127021 through its authorized signatory.

 

…… Opposite Parties.

 

COMPLAINT U/S 35 OF CONSUMER PROECTION ACT, 2019.

 

BEFORE:       Mrs. Saroj Bala Bohra, Presiding Member.

  Ms. Shashi Kiran Panwar, Member.

 

Present:-        Sh. Pradeep Kumar Bajar, Advocate for complainant.

           Sh. Anil Khurana, Advocate for OPs.

 

ORDER:

 

Saroj Bala Bohra, Presiding Member:

 

1.                 In brief, facts of this case are that complainant is a member of Ex-Servicemen Contributory Health Scheme (ECHS).  On 27.07.2016, the tongue of complainant hacked and left part of the body became paralytic. On 28.07.2016, complainant approached the OP No.3 for treatment, upon which, he was referred to J.B. Gupta (Paneled-1) Hospital, Bhiwani where he remained admitted for 2 days. He was prescribed medicine for 5 days and was discharged with an observation of complaint of survical. Thereafter, complainant reported the OP No.3, he was given 20 days medicines and was told that survical is a normal disease and it would be recovered shortly. But complainant did not get relief and problem was as such. However, complainant was given 10 days more medicines. In the intervening period, complainant again suffered paralytic attack on 03.09.2016. But OP No.3 referred the complainant to Sukhda Hospital, Hisar for better treatment where he remained admitted for five days and discharged on 09.09.2016 and purchased medicines for 25 days at his own cost. Again on 16.09.2016 complainant occurred same problem and immediately reported the OP No.3 with a request to refer him RR Hospital Delhi but he was referred to Base Hospital, Delhi where he was prescribed 20 days medicines. But he did not get relief thus he contacted Balaji Hospital, Bhiwani who advised to contact at Jindal Hospital, Hisar where on 21.09.2016 Dr. Vijay Kumar after examining MIR report  opined that there is clotting in his head which immediate requires operation otherwise it might be dangerous. As such, 28.09.2016, complainant was operated and was discharged on 05.10.2016. On this treatment, complainant spent Rs.47,173/-. Claim qua this was lodged with OP No.3 but it was rejected by OP No.1 vide letter dated 30.11.2017. Complainant has submitted that he is taking regular treatment and prescribed medicines and spends Rs.2500/- per month since August 2016. Hence, the present complaint has been preferred by complainant alleging deficiency in service resulting into monetary loss as well as mental and physical harassment. Thus complainant has sought directions against the OPs to pay Rs.47,173/- + Rs.1,20,000 (medicnes purchased after discharge i.e. August 2016 to July 2020) besides Rs.1.00 lac on account of compensation for harassment and further Rs.50,000/- towards litigation expenses. Any other relief to which this Commission deems fit, has also been sought.

2.                 Upon notice, OPs appeared through counsel and filed written statement taking preliminary objections qua complaint being false and frivolous, maintainability, locus standi, cause of action and suppression of material facts.  On merits, Inter-alia, the OPs has submitted that complainant submitted his emergency medical treatment documents and bill for Rs.56,884/- for the treatment taken in Jindal Hospital, Hisar a non-empanelled hospital, from 28.09.2016 to 05.10.2016. It has submitted that complainant neither reported the nearest polyclinic within 48 hours of emergency admission in a non-empanelled hospital for emergency information report not taken any prior sanction of such planned treatment and documents were also submitted after interval of ten months from the treatment taken. The case was taken up with higher authorities i.e. OPs No.1 & 2 which was finally rejected by the OP No.1 on the ground that emergency is not justified. It is submitted that medicines are provided free of cost by ECHS polyclinics. In case of non-availability of medicines, the patient can purchase medicines himself at his own cost base on non-availability certificate and can claim the cost of medicines from Govt. Further, whenever a patient is referred to empanelled hospital for admission, all medicines and treatment are given free of cost. In the end, deficiency and negligence in service has been denied and prayed for dismissal of the complaint with costs.

3.                 In evidence of complainant, affidavit of complainant Ex. CW1/A alongwith documents Annexure C-1 to Annexure C-61 (wrongly mentioned upto Annexure C-54) were tendered and closed the evidence on 17.12.2021.

4.                 On the other side, affidavit Annexure RW1/A alongwith document Annexure R-1 were filed in evidence of OPs and closed the evidence on 03.10.2022.

5.                 We have heard learned counsel for the parties and gone through the record minutely.

6.                 As per pleadings of OPs, the claim of complainant was rejected by OP No.1 on the ground that the treatment taken by complainant in emergency was not justified. Complainant in order to prove that the treatment taken by him at O.P. Jindal Institute of Cancer & Cardiac Research, Hisar was in emergent condition has placed on record Emergency Certificate (Annexure C-5) issued by Dr. Vijay Kumar (Neuro Surgeon) of the hospital, which proves that complainant was got admitted in the hospital on 28.09.2016 in emergency. As per document Annexure R-1 placed on record by OPs, Treatment in Emergency have various criteria, but in point (xii) it has mentioned that ‘Any other condition in which delay could result in loss of life or limb.’ Thus also the case of complainant falls within the ambit of treatment taken in emergency.  As per case of complainant, he spent Rs.47,173/- on his treatment during his admission in the Jindal Hospital, Hisar  and to this effect he has also placed on record bills thereof this fact has also not been denied by OPs in their pleadings. Thus it is ascertained that complainant is entitled to a sum of Rs.47,173/- as prayed for in the complaint.  With regard to rest of the prayer of complainant in his complaint qua reimbursement of medical expenses, he may approach proper authorities of the department concerned.

7.                 After hearing learned counsel for the parties and going through the record, we are of considered opinion that the treatment taken by the complainant was in emergency which has been proved on record. As such, rejection of the claim of complainant for reimbursement of medical expenses by OPs was not justified rather it was arbitrary and violation condition (xii) Treatment in Emergency (Annexure R-1) placed on record by them.

8.                 In view of the above, the OPs are deficient and negligent in providing proper services to the complainant for which complainant has to suffer monetary loss besides mental agony and physical harassment. Hence, the complaint is partly allowed and the OPs, jointly and severally, are directed to comply with the following directions within 40 days from the date of order:-

(i)       To pay a sum of Rs.47,173 /- (Rs. Forty Seven thousand one hundred seventy three) to the complainant, alongwith simple interest @ 9% per annum from the date of filing of complaint till the actual realization.

(iii)     To pay Rs.20,000/- (Rs. Twenty thousand) as compensation  for mental agony and physical harassment. 

4. To pay Rs.5500/- (Rs. Five thousand five hundred) as litigation expenses.

                    In case of default, the OPs shall liable to pay simple interest @ 12% per annum on all the aforesaid amounts for the period of default. If this order is not complied with, then the complainant shall be entitled to the execution petition under section 71 of Consumer Protection Act, 2019 and in that eventuality, the opposite party may also be liable for prosecution under Section 72 of the said Act which envisages punishment of imprisonment, which may extend to three years or fine upto rupees one lac or with both.  Certified copies of the order be sent to parties free of costs, as per rules. File be consigned to the record room, after due compliance.

Announced.

Dated:05.02.2024