Complainant by filing this complaint has submitted that he is holder of ESI Card No. 8912169 and on 01.01.2011 he admitted his mother RenukaKhanra for treatment at Baltikuri ESI Hospital for ERCP operation and for ERCP operation at Baltikuri ESI Hospital on 10.06.2011 the Baltikuri ESI Hospital authority failed to operate considering the mother’s conditions and was referred to AMRI Hospital at Dhakuria for treatment vide Memo No. ESI/BLT dated 10.06.2011 and accordingly his mother was admitted to AMRI Hospital on 13.06.2011 and after operation his mother was released and AMRI Hospital authority forced the complainant to clear the bill otherwise the patient shall not be released and for the above situation complainant was compelled to take personal loan of Rs. 12,960/- from relatives and that was paid to the AMRI Hospital and his mother was released from AMRI Hospital.
But fact remains that there is a contract in between the AMRI Hospitals and Baltikuri ESI Hospital in respect of the treatment of the ESI card holders and their family and soBaltikuri ESI Hospital is bound to pay the same. But Baltikuri ESI Hospital did not pay the same and for which the mother was deferred along with prescription to Baltikuri ESI Hospital on 22.06.2011 for disbursement of the said amount and the matter was reported to Head Office of the Baltikuri ESI Hospital on 04.01.2012 and all original papers were received by the Head Office and in Xerox copy they noted it in support of the receipt of the same. But thereafter complainant knocked the door at the Baltikuri ESI Hospital, but no fruitful result was received and it was also reported by the Head Office of ESI Hospital why all those documents were submitted in their office. After that complainant lodged a complaint to CA&FBP at Kolkata against Baltikuri ESI Hospital op no.1 on 19.03.2014 and complainant and op’s office were present but the matter could not be mediated for which as per instruction of the CA&FBP, complainant prayed for redressal considering negligent manner of service and also for deceitful manner of act.
On the other hand Baltikuri ESI Hospital authority by filing written statement submitted that Baltikuri ESI Hospital is under the administrative control of Director (MB Scheme) ESI Government of West Bengal. But the said Director has not been made a party and ESI Corporation stated that they only provide fund for maintenance of the said Baltikuri ESI Hospital and they have no administrative control over the Hospital and as such it is the Director (MB Scheme) ESI Government of West Bengal is the administrative head who is necessary party of the instant case.
Further it is submitted that ESI Corporation cannot dispose of the matter and as ESI Corporation is not the authority to make any representation before the Director (MB Scheme) ESI Government of West Bengal and further it is submitted that there is no provision in ESI Act for making any bill to make payment of the complainant if same is not submitted through the Director (MB Scheme) ESI Government of West Bengal and any dispute against violation of any provision of the ESI Act and they have also submitted that ESI Corporation is not a necessary party and for which this complaint should be dismissed.
The AMRI Hospitals op no.2 by filing this written statement submitted that there is an agreement in between Baltikuri ESI Hospital and AMRI Hospitals and that was executed on 21.03.2011 and as per agreement they are giving treatment to the members, staff and beneficiaries of ESI for treatment of Cardiological cases and radiotherapy etc. and as per recommendation from the op no.1 the patient was admitted in the nursing home where the op no.2 intimated the situation that as the nature of treatment is beyond of beneficial scheme of ESI Hospital therefore the patient party is to bear cost of treatment and accordingly after being assured about making payment of cost of treatment by the patient parties the op no.2 admitted the patient on 13.06.2011 and no doubt the patient party pays the cost of the treatment and at the time of making payment the patient party did not raise any objection and in fact there was no question of threatening the complainant of creating pressure to him to pay the same and the entire complaint is vexatious and for which same should be dismissed.
Decision with reasons
On proper evaluation of the ops’ documents including the complainant’s documents as filed by the both parties and further hearing the argument of the Ld. Lawyers, it is found that no doubt the complainant UdayKahanra is an employee of Dasnagar Mill Equipments Pvt. Ltd., Dasnagar, Howrah and he is covered under Employees State Insurance Corporation having his Card No. 8912169. Fact remains the mother of the complainant Smt. RenukaKhanra was admitted to Baltikuri ESI Hospital for treatment and operation on 10.06.2011 and thereafter office of the Superintendent of Baltikuri ESI Hospital referred the complainant’s mother to AMRI Hospital for treatment and that was referred by the office of the Superintendent, Baltikuri ESI Hospital, and Howrah under Memo No. ESI/BLT/249 dated 10.06.2011 and the reason for referring the patient is also noted in the said letter and in the said letter the ESI Card No. is also noted as 8912169 and in the said letter it is also noted that as per bill of Hospital it shall be paid. So, it is clear that complainant himself did not admit his mother for treatment. But when the Baltikuri ESI Hospital authority failed to give proper treatment and failed to undergo such operation, the complainant’s mother was referred to AMRI Hospital and AMRI Hospital was asked to arrange the performance of the above investigation upon RenukaKhanra.
So, it is proved that she was referred by the Baltikuri ESI Hospital authority and Baltikuri ESI Hospital failed to give proper treatment. So they referred and asked the AMRI Hospital to do the needful and bill shall be paid by ESI Authority as per contract. But truth is that in this case in the written statement op has not denied all the above fact. But op no.1 Baltikuri ESI Hospital’s only defence is Baltikuri ESI Hospital has no administrative control over Director (MB Scheme), Government of West Bengal. So, they have no authority to do that and further it is submitted that Baltikuri ESI Hospital has not made a party in this case and also submitted that ESI Director of MB ESI is also not made a party.
It is their case that complainant did not file any representation before the said MB Scheme, Director, Government of West Bengal sothe present complaint should be dismissed. Considering all the above facts and circumstances, we are convinced that no doubt the Director ESI PanchadeepBhavan received all material documents as submitted by the complainant in original. But when they found that it would be filed or submitted before Director (MB Scheme) ESI Government of West Bengal in that case op no.1 ought to have referred the same to the Director (MB Scheme) ESI Government of West Bengal for consideration and at the same time op did not return those documents to the complainant which was original in nature for disbursing the cost of his mother’s treatment to the complainant.
Most interesting factor is that op no.1 has tried to convince that as if the complainant did not file those documents in proper Fora for settlement of his claim. But truth is that original documents along with prayer for disbursement of the said amount was made by the complainant was accepted by the op no.1. Then it is the duty of the op no.1 to send back it either to the complainant informing the complainant that it may be submitted to the Director (MB Scheme) ESI Government of West Bengal. But that has not been made and no doubt such an act on the part of the op no.1 is no doubt harassing.
Fact remains in such a way the ESI Hospital Authority are trying to dislodge the claim of so many card holders and it has become their practice not to entertain the claim of the ESI Card Holders only on the ground that it was not submitted in proper Fora. But in this case it is proved that op no.1 did not return all those documents which was original in nature and did not inform the complainant that complainant has filed the same not in proper place and at the same time op no.1 did not send it to the Director (MB Scheme) ESI Government of West Bengal for settlement and all the above act on the part of the op no.1 is no doubt unwanted, uncalled for, illegal and no doubt an misdeed act and truth is that for negative attitude of the complainant, complainant is being harassed and ultimately was compelled to file this complaint via CA & FBP, Kolkata.
Anyhow the question is whether such a dispute can be decided by this Forum. But in this regard it is to be mentioned that ESI Authority is not aware of the law and written statement is filed by the ESI Authority is full of baseless defence and already all over India there are so many ruling that ESI Card Holders are consumer under the ESI Authority and their any sort of claim covering under MB Scheme of ESI can easily be decided by the Consumer Forum as such ESI Card Holder is a consumer under the ESI Authority and their repetition ofdefence in all the cases that it is barred u/s 75 of ESI Act is completely against the rule of law and in this regard there is so many judgement ifs the Hon’ble Supreme Court and it is known to ESI Authority but even then ESI Authority has taken such illegal plea with intention to dislodge the claim of the complainant what is proved in this case also against op no.1.
It is to be mentioned that Government highest authorities are holding chair in a cool room, but they are not in a mood to give proper redressal to the relief seekers that is ESI Card Holders and in the present case, it is proved that op no.1 only for the purpose of harassing the complainant did not respond against the letter for settlement of his claim along with original papers and such an act is no doubt deceitful act on the part of the Government officials like the present op no.1 and practically it is op no.1’s negative attitude only for not rendering proper service for which op no.1 should be penalized. But truth is that op no.1 had his legal duty to sendthe entire file of the complainant which is lying in the office of the op no.1 to the office of Director (MB Scheme) ESI Government of West Bengal at once for disposal of the claim of the complainant and op no.1 shall have to report to this Forum that he has complied the order of this Forum failing which penal interest shall be assessed against the op no.1.
But against op no.2 this complaint is not maintainable in view of the fact that op no.2 did their duties as per forwarding letter of the Superintendent of ESI Hospital, Baltikuri and fact remains ESI Card Holders paid it. But the paid amount in respect of treatment of his mother shall be disbursed by the Director (MB Scheme) ESI Government of West Bengal. So, the case against op no.2 fails because main allegation is against ESI Corporation.
In the result, the complaint succeeds in part.
Hence, it is
ORDERED
That the complaint be and the same is allowed in part on contest against op no.1 with cost of Rs. 10,000/- and same is dismissed against op no.2 without any cost.
Op no.1 is hereby directed to send the entire file of the complainant in respect of disbursement of Rs. 12,960/- to Director (MB Scheme) Government of West Bengal within 45 days from the date of this order failing which the Director (MB Scheme) ESI Government of West Bengal shall have to pay the same to the complainant and after expiry of that 45 days for compliance if op no.1 and his Director (MB Scheme) ESI Government of West Bengal fail to comply that order in that case penal interest at the rate Rs. 200/- per day shall be assessed till full satisfaction of the decree and op no.1 shall be liable to pay the same along with Director (MB Scheme) ESI Government of West Bengal.
Even if it is found that op no.1 and his Director (MB Scheme) ESI Government of West Bengal are found reluctant to comply the order in that case for disobeyance of Forum’s order penal action shall be started against that op no.1 u/s 27 of C.P. Act 1986.
