Present (1) Nisha Nath Ojha,
District & Sessions Judge (Retd.) President
(2) Smt. Karishma Mandal,
Member
Date of Order : 31.12.2016
Smt. Karishma Mandal
- In the instant case the Complainant has sought for following reliefs against the Opposite party:-
- To direct the opposite parties to pay the real expenses on treatment of Brain of Rs. 29,201/- ( Rs. Twenty Nine Thousand Two Hundred One only ).
- To direct the opposite parties to pay Rs. 20,000/- ( Rs. Twenty Thousand only ) as compensation.
- To direct the opposite parties to pay Rs. 6,000/- ( Rs. Six Thousand only ) as litigation costs.
- The facts of this case lies in a narrow compass which is as follows:-
The complainant has asserted that he is a class IV employee (Peon) in E.S.I.C. registered Pvt. School i.e. Baldwin Academy, Boring Road, Patna. His son Himanshu had fallen from the roof and he had head injury. Thereafter, the complainant took his son at E.S.I.C. Model Hospital, Phulwari Sharif, Patna for treatment but his son was not admitted and he was admitted to P.M.C.H. as will appear from annexure – 1. Thereafter the complainant took his child to P.M.C.H. where the Doctor advised C.T. Scan but his son was not admitted. Later on when the C.T. Scan of his son was not done by the staff of P.M.C.H. then his son was rushed to Hospito India Pvt. Ltd. Where C.T. Scan was done as will appear from annexure – 3. Thereafter as the Doctor of P.M.C.H. refused to admit his son and the condition of his son was detoriating hence as per advice of the family member his son was admitted in Sanjeevani center for Neurosurgery Pvt. Ltd. Where his son was operated and he incurred the cost of Rs. 29,201/- as will appear from annexure – 4 series. After operation, his son recovered very fastly and the complainant thereafter submitted an application for payment of treatment expenses before Director E.S.I.C. Bailey Road, Patna on 17.10.2006 but no action has been taken on his application.
On behalf of opposite parties a written statement has been filed denying the allegation of the complainant that his son was denied admission in P.M.C.H. It has been stated that under section 58 of E.S.I.C. Act 1948 the State Government is required to “provide IP and (where such benefit is extended to their family) their families in the state reasonable medical cost, surgical and obstetric treatment” hence the complainant should have filed his claim before authority designated for the purpose i.e. State Government.”
It has been further stated that the application of Mritunjay Kumar Sharma was received at Regional Office E.S.I.C., Patna on 18.10.2006 and his application was forwarded to director medical services E.S.I.C. Government of Bihar, Vikas Bhawan, Patna vide office letter no. 42-Bft./16/15/2/95/02 Med. Dated 17/21.11.2006 as the onus of providing medical treatment reimbursement of medical claim lies of director medical services referred above.
It has been further asserted by opposite party no. 2 in this written statement that as the petitioner does appear to have approached to the director of medical services E.S.I.C. Government of Bihar, Vikas Bhawan, Patna ( opposite party no. 3) to know the real position about the reimbursement of the claim. In Para – 9 of the written statement opposite party no. 2 has stated as follows, “ it is submitted that this petitioner are not competent authority for reimbursement of his claim under the E.S.I.C. Act. In fact the Director E.S.I. ( Scheme) Government of Bihar ( minister of labour) is empowered to reimburse the medical claims.”
No rejoinder has been filed by the complainant to the written statement filed by opposite parties.
We have narrated the facts of the parties in their complaint petition and written statement briefly in forgoing paragraphs and also perused the record of this case carefully.
From combined reading of complaint petition and written statement it is crystal clear that no final order have been passed by competent authority on the claim application of the complainant.
From perusal of Para – 7 of written statement it transpires that the application of Sri Mritunjay Kumar Sharma ( complainant) has been forwarded to opposite party no. 2 i.e. Director Medical Services E.S.I. Scheme Government of Bihar. Hence we are unable to know about the fate of claim application of the complainant which was forwarded by opposite party no. 1 to opposite party no. 2 in November 2006. Hence we are unable to pass any order in this case as the matter appears to have been pending before competent authority i.e. opposite party no. 2.
In view of the fact stated above we direct the complainant to approach opposite party no. 3 ( Director Medical Services) with certified copy of this order and filed a fresh representation for passing appropriate order on the claim petition which appears to have been forwarded to opposite party no. 3 vide office order no. 42-Bft./16/15/2/95/02 Med. Dated 17/21.11.2006 by opposite party no. 2 within the period of two months from the date of receipt of this order or certified copy of this order.
It will be open for opposite party no. 3 to ask fresh application with relevant documents if the earlier claim application is not traceable because the matter is very old.
Opposite party no. 3 is directed to pass appropriate order on the representation/claim application furnished by the complainant to opposite party no. 2 within the period of two months from the filing of aforesaid representation/claim application.
With the aforesaid direction this complaint petition stands disposed off.
Member President
