Delhi

South Delhi

CC/602/2009

J N CHAURASIA - Complainant(s)

Versus

DIRECTOR HEATH - Opp.Party(s)

24 Mar 2015

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-II

UDYOG SADAN, C-22 & 23, QUTUB INSTITUTIONAL AREA

(BEHIND QUTUB HOTEL) : NEW DELHI – 110016.

 

                                Case No. 602/09

J.N. Chaurasia,

S/o Late Sh. Shyam Babu Chaurasia,

R/o CB-9A, DDA Flats, Munirka,

New Delhi – 110067.                                       - Complainant

 

Vs

 

1. Director (Health)

    CGHS, Nirman Bhavan,

    New Delhi – 110001.

 

2. Addl. Director (Health)

        CGHS, Sector-VIII, R.K. Puram,

        New Delhi – 11006.                                - Opposite Parties

 

                                                                                                                                          Date of Institution: 30.07.2009

                                                  Date of decision: 24.03.2015

O R D E R

 

         

    The facts which are not in dispute are that the  complainant who is a retired Central Govt. officer is a member of CGHS scheme vide card No. P054833 and his wife Smt. Sushila Chaurasia  is also covered under the scheme.  On 11.12.2008, wife of the complainant felt severe pain in her stomach and she was immediately  taken to the RG Urology & Laparoscopy Hospital Stone, East of Kailash, New Delhi, where she was examined and investigation conducted on her and the Doctor advised for immediate operation for the removal of Stone and Gallbladder  and  the  operation was conducted.  The patient was

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discharged on the next day i.e. on 12.12.2008.  The complainant paid Rs. 22,638.40p towards medical treatment to the Hospital and he submitted the bills for reimbursement to CGHS along with the emergency certificate.  However, the CGHS returned his claim with the remarks, “treatment taken in private unrecognized hospital.  No emergency on the day of treatment as per expert opinion of Safadarjung Hospital, New Delhi”.  The complainant again submitted papers for reconsideration citing the similar case of Smt. Chandra Keswani, R/o A-37B, DDA Flats, Munirka, New Delhi, who was operated on 30.08.2008 in the same hospital and reimbursement of medical expenses of Rs. 22,000/- was made to her vide ECS CGHS on 27.10.2008 but the complainant received back the same cyclostyled reply  and his claim was rejected.

    The complainant has filed the present complaint for issuing directions to the OP to reimburse the medical claim of Rs. 22,638.40p along with interest; to pay a sum of Rs. 25,000/- on account of mental harassment and Rs. 5000/- towards litigation charges.

    The dispute between the parties is that according to the complainant it was a case of emergency.  In other words, according to the complainant his wife had been suffering with severe pain due to  stretches  in the stomach and she had to be immediately taken to the said hospital and had to be got treated.

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    On the other hand, the case of OP in the written statement is that in such cases, the patients can   be   treated   conservatively   by    medical    treatment   in emergency to get immediate relief but the surgical procedure cannot be done in emergency as disclosed by the complainant; that the surgical specialist of S.J. Hospital has given the same opinion and denied the justification of procedure in emergency and so the claim was regretted.

    So far as the case of Smt. Chandra Keswani is concerned, the stand of the OP is that the reference of any other case  is not a justification of reconsideration of the case since every case has its own merits or demerits and justification.  Hence it is prayed that the complaint be dismissed.

    The complainant has filed a rejoinder to the written statement of OP.

    The complainant has filed his own affidavit in evidence.

     On the other hand, no affidavit in evidence has been filed on behalf of OP despite number of opportunities given to the OP in this behalf.  Rather, the defence of OP was struck off by our Ld. Predecessor vide order dated 1.5.12. 

    Written arguments have been filed on behalf of complainant but no  written arguments have been filed on behalf of the OP.

    We have heard the complainant in person.  None has appeared to advance arguments on behalf of the OP.  We have

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also gone through the file. 

    The complainant has filed copy of emergency certificate dated 12.12.08 issued by the above stated hospital in which the case of the wife of the complainant has been shown to be a case of admission in emergency with complaints of severe pain  abdomen  on 11.12.08.  This is a certificate issued by a famous hospital of Delhi dealing in Urology and Laparoscopy cases.  The OPD-cum-discharge card also shows it to be a case of emergency.  Therefore, the onus to prove that according to the opinion of the surgical specialist of Safdarjung Hospital, it was not a case of emergency to get the immediate treatment from the hospital was on the OP.  However, as stated hereinabove the OP has not led any evidence despite number of opportunities given to it.  The OP has even not disclosed the name of Surgical Specialist of Safdarjung  Hospital who had given such an opinion to the OP nor has even filed his report on the file.  Therefore, how can it be justified on behalf of the OP that the claim of the complainant had been rejected/regretted on the basis of an opinion given by the Surgical Specialist of Safarjung Hospital.

    It is, no doubt, true every case has to be dealt on the basis of its own merits and demerits.  However, in the present case, specific claim of the complainant is that Smt. Chandra Keswani was  operated in   the  same  hospital  on  30.8.2008   and   the

Case No. 602/09

 medical expenses incurred by her in the said hospital towards her medical treatment were reimbursed by the OP on 27.10.2008.  Therefore, in the absence of any evidence led to the contrary on behalf of the OP, it has to be inferred that Smt. Chandra Keswani had also undergone a similar type of operation under the similar situation in the said hospital.  Therefore, reliance by the complainant on the case of Smt. Chandra Keswani is totally justified.

    In our considered opinion, the OP committed deficiency in service by refusing claim of the complainant.

    In view of the above discussion, we allow the complaint and direct the OP to reimburse the amount of Rs. 22,638.40p or as per CGHS rules, whichever is less, along with interest @ 6% p.a.; Rs. 10,000/- towards harassment and mental agony and Rs. 3000/- towards litigation charges from the date of filing of complaint till realization within one month from the date of receipt of copy of this order to the complainant.

    Let a copy of this order be sent to the parties as per regulation 21 of the Consumer Protection Regulations.  Thereafter file be consigned to record room.