BEFORE THE ADDITIONAL BENCH OF A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD.
FA.No.1364/2007 AGAINST C.C.No.384/2006 DISTRICT FORUM-II, VISAKHAPATNAM.
Between:
C.Rama Rao,
S/o.late Narayana,
Flat No.101, Om Vigneswara Apartments,
Abid Nagar, Akkayyapalem,
Visakhapatnam. Appellant/
Complainant
A N D
1. The Divisional Railway Manager (P)
D.R.M.Office, S.E.Railway, Visakhapatnam.
2. The Chief Medical Superitendent,
Railway Hospital,
Opposite to Sangam Sarat Theatres,
Visakhapatnam. Respondent/
Opposite parties
For the Appellant: - Party in person
Counsel for the Respondents:-Mr.K.Yadagiri Reddy
QUORUM: SMT.M.SHREESHA, MEMBER
&
SRI K.SATYANAND, MEMBER
THURSDAY, THE TWENTY NINTH DAY OF OCTOBER,
TWO THOUSAND NINE
(Order typed to the dictation of Sri K.Satyanand, Hon’ble Member)
***
The unsuccessful complainant preferred the present appeal in order to get the relief what he was denied in the District Forum
The facts of the case that led to filing this appeal are briefly as follows:
The complainant is a retired employee of railways. He claimed that he was eligible OPD in railway hospitals as per the railway Board’s order of the year 1999. He complained that the railway hospital failed to give him OPD treatment for want of identification card. As such, he approached the Divisional Personal Officer for identity card but with no result. As he had no identity card, himself and his wife were compelled to take treatment in private hospital. On that basis, he claimed to have submitted bills worth 113.90 ps for reimbursement. The opposite parties obviously did not make payment in response to the said claim. He therefore filed CD.269/2000. The District Forum allowed the complaint and directed the opposite parties to pay the said amount besides giving some other reliefs. Aggrieved by the said order, the opposite parties preferred FA No.183/2001 which was later dismissed confirming the order of the District Forum. During the pendency of the said litigation, he incurred some more medical expenses to a tune of Rs.4,480-22 ps. For that subsequent amount instead of filing a CD, he filed EA in the earlier CD. Thereupon the District Forum dismissed the said EA and gave a direction to the complainant to file a separate complaint. As such the complainant professed to have filed the present CD alleging deficiency of service on the part of the opposite parties.
The opposite parties who are the authorities of the railways especially in connection with passing the medical bills and sanctioning the reimbursement filed a combined counter resisting the claim mainly contending that the complainant right from the date of retirement till 2000 remained himself under the benefit of OPD scheme. He opted for retired employees liberalization scheme in 2000 and accordingly a card was issued to him assigning it number 906/2000. According to them the rules of OPD scheme and the later scheme are quite different. The ruling given in CD.269/2000 cannot be followed in the present case as the medical bills submitted by the complainant related to the period from 5-7-2000 to 30-3-2002. As such the reimbursement in respect of these bills had to be processed subject to fulfillment of the conditions laid down in RELHS scheme. The opposite parties narrated the essential features of the RELHS and finally contended that the complainant could have approached the other private hospitals only on an authorization in that behalf from the railway hospital that they did not possess the facilities for the given medical treatment. In the instant case, the complainant bypassed the said requirement. He cannot pass a judgment against the quality of treatment in the railway hospitals and claim reimbursement for the treatment taken elsewhere on his own bypassing the requirements of the conditions set out in the scheme which he opted to join.
In support of his case, the complainant relied upon documents marked as Exs.A1 to A12. On the other hand, an affidavit was filed on behalf of the opposite parties and relied upon Exs.B1 and B2.
On a Consideration of the evidence adduced on either side, the District Forum came to the conclusion that the complainant claimed reimbursement on the strength of the bills for the treatment he had undergone after joining the scheme obviously without following the procedure contemplated therein. Thus the District Forum came to the opinion that the refusal to reimburse the medical bills cannot be faulted as deficiency in service and accordingly dismissed the complaint.
Aggrieved by the said order, the complainant filed the present appeal finding fault with the conclusion of the District Forum stating that the District Forum wrongly came to the conclusion that the bills pertained to the period after he joined RELHS though he joined the said scheme only on 31-3-2002, after the period of bills. He also urged other points which are not of much significance.
Now the point that arises for consideration is whether there is any infirmity in the order of the District Forum?
Heard. The fate of the appeal depends upon one single question, namely, whether the bills for which he claimed to have treatment related to the period after he joined the RELHS or prior thereto for which the very parameters of CD 269/2000 could have applied if really it was the period during which he continued to be covered by OPD treatment. Thus it is a question of fact. It is the categorical case of opposite parties that the bills were of the period subsequent to his joining the RELHS scheme which according to them was during the year 2000 but their own document, Ex.B2 gives a lie to the said assertion. Ex.B2 is the identity card issued to the complainant obviously in relation to his opting for Retired Railway Employees Liberalized health scheme and obviously the date of issue and number are 906 dated 3-4-2002. The bills claimed related to the period from 5-7-2000 to 30-3-2002. This clearly shows that the entire defense of the opposite parties was totally false. It is therefore very clear that the treatment for which the subject bills were taken was during the period he was still covered by the earlier OPD scheme. It is not in controversy that till this retired employee opted for the RELHS, he was governed by OPD and it could not be anything else. His claim under the OPD scheme had come to be upheld by the District Forum as also the State Commission in the earlier litigation. We do not see any material to differ from such kind of decision. That means till he joined RELHS the procedure he resorted to for making claims under the OPD was correct and it was the same as was resorted to while making the claim that ultimately came to be upheld in the earlier litigation mentioned in the narration herein before. The District Forum misguided itself by the wrong assertion made by the opposite parties that the bills pertained subsequent to the complainant joining RELHS which is negatived by Ex.B2, the document of the opposite parties themselves. Thus the finding of the District Forum is utterly untenable. The complaint was wrongly dismissed. In these circumstances we feel this is a fit case to allow the appeal and consequently allow the complaint of the complainant.
Accordingly the appeal is allowed setting aside the order of the District Forum and as a consequence the complaint before the District Forum is allowed directing the opposite parties to pay to the complainant an amount of Rs.4,480-22 ps. with interest at the rate of 9% p.a. from the date of complaint till the date of realization and also pay a further amount of Rs.5,000/- for harassing him by not applying their mind to the facts and on the top of it taking a false plea before a judicial authority. Further they shall pay an amount of Rs.3,000/- towards costs of this litigation. The opposite parties shall comply with this order within six weeks of the receipt of this order.
Sd/
MEMBER.
Sd/-
MEMBER
JM Dt.29-10-2009
