Punjab

Fatehgarh Sahib

CC/13/2017

Beant Singh - Complainant(s)

Versus

E S Insu Corp - Opp.Party(s)

Sh Gurpreet Singh Saini

28 Aug 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHGARH SAHIB.

Consumer Complaint  No. 13 of 2017

                                           Date of institution :  21.02.2017                               

                                      Date of decision    :  28.08.2018

Beant Singh son of Shingara Singh resident of H.No.117, Ward No.17, Peerkhana Road, Khanna, Tehsil Khanna, District Ludhiana.

……..Complainant

Versus

1. Employees State Insurance Corporation, Sector 19A, Madhya Marg, Chandigarh through its Regional Director.
2. Employees State Insurance Corporation, Mandi Gobindgarh, through its Branch Manager.
3. M/s Bansal Alloys and Metals Pvt. Ltd. G.T.Road, Mandi Gobindgarh, through its Director/Manager.

…..Opposite Parties

Complaint Under Sections 12 of the Consumer Protection Act.     

Quorum

 Sh. Ajit Pal Singh Rajput, President                                   

 Sh. Inder Jit, Member

 

 

Present :  Sh.G.S.Saini, Advocate for complainant.

               Sh.K.S.Khera, Advocate for OPs No.1 & 2.

               None for Opposite party No.3.

ORDER

 

By Inder Jit, Member

                 Complainant, Beant Singh son of Shingara Singh resident of H.No.117, Ward No.17, Peerkhana Road, Khanna, Tehsil Khanna, District Ludhiana, has filed this complaint against the Opposite Parties (hereinafter referred to as the OPs) under Sections 12 of the Consumer Protection Act. The brief facts of the complaint are as under:

2.               The complainant, who is working with OP No.3, met with an accident on 19.06.2014 during the course of employment. He suffered major injuries on his stomach and seeing his serious condition, he was admitted to CMC Hospital Ludhiana for emergency treatment as the local civil hospital as well as ESI Hospital have no proper arrangement of treatment. The complainant was covered under ESI with OPs No.1 & 2 vide ESIC No.1213762930.  OP No.3 also sent reply to the letters of OPs No.1 & 2 stating that the condition of complainant was serious  and therefore, the complainant was got admitted to CMC Hospital Ludhiana. OP No.3 submitted medical bills to the tune of Rs.1,70,941/- with OPs No.1 & 2 but Rs.22,995/- only were sanctioned.  The act and conduct of the OPs No.1 & 2 amounts to clear cut deficiency in service on their part. The complainant is entitled to get the payment of all medical bills submitted to OPs No.1 & 2 but they refused to make payment vide their letter dated 09.11.2015. Hence, this complaint for giving directions to the OPs No. 1 & 2 to make balance payment of medical bills amounting to Rs.1,47,946/- and further to pay Rs.1,00,000/- as compensation on account of causing mental tension, harassment and agony  and Rs.22,000/- as litigation charges.

3.              The complaint is contested by the OPs. In reply to complaint, OPs No.1 & 2 raised certain preliminary objections, inter alia, that this complaint is not maintainable in the present form against ESI and this Forum has no jurisdiction to try and decide the present complaint. As regards the facts of the complaint, OPs No.1 & 2 stated that the complainant was not admitted in ESI Hospital Mandi Gobindgarh despite the fact that there is proper treatment in ESI Hospital and there are specialist doctors in every field.  There is no provisions in the rules to get the patient admitted in private hospital, without the permission of the ESI Hospital. The complainant was not referred to CMC Ludhiana by the ESI Hospital as provided under rules. After denying the other averments made in the complaint, OPs No.1 & 2 prayed for dismissal of the complaint.

4.              In reply to complaint, OP No.3 also raised preliminary objection that complaint is not maintainable against it. As regards the facts of the complaint, OP No.3 admitted that the complainant was working with them and is covered under the provisions of ESI. Rest of the facts were also admitted by OP No.3 and prayed for dismissal of the complaint qua it.

5.              In order to prove his complaint, the complainant tendered in evidence his affidavit Ex. C-1 and true copies of documents Ex. C-2 to Ex. C-11 and closed the evidence.  In rebuttal OPs No.1 & 2 tendered in evidence affidavit of Sh. Harish Chander, Social Security Officer ESI Ex. OP1/1, interrogatories Ex. OP1/2 and closed the evidence.  OP No.3 did not tender any evidence despite several opportunities. Hence, evidence of OP No.3 was closed by order.

6.              The Ld. counsel for the complainant argued that the complainant had been working with OP No.3 and he fell from a height on dated 19.06.2014 while working in the factory of OP No.3. He received very serious injuries on his stomach. Seeing his very serious condition, he was taken to Christian Medical College and Hospital(CMC Ludhiana) for his emergency treatment by OP No.3, who spent Rs.1,70,941/- on the treatment of complainant. Ld. counsel further argued that the complainant, no doubt, was covered under the ESI Scheme and hence he could have first been taken to ESI Hospital Mandi Gobindgarh, but the condition of the complainant was so serious that he had to be taken to CMC Ludhiana for emergency treatment. This provision exists with the Employees State Insurance Corporation, Panchdeep Bhawan, CIG Road, New Delhi as per its letter No.U-16/24/7/10- Med.1 dated 21.05.2010( Letter placed on record), "Subject" of which reads as under:-

"Reimbursement of expenditure incurred by employer on treatment of its employees covered under ESI scheme for providing medical care in emergencies".

Ld. counsel further argued that if the complainant was to be taken to CMC Ludhiana or any other hospital only after a reference from the ESI Hospital Gobindgarh( as so provided in the ESI Rules), then the ESI Corporation could not have even sanctioned the meagre amount of Rs.22,995/- out of a total expenditure bill of Rs.1,70,941/-. Ld. counsel prayed for acceptance of complaint while ordering balance payment of medical bills along with interest as also compensation to the tune of Rs.1,00,000/- and litigation charges to the tune of 22,000/-.

7.              Ld. counsel for OP No.1 & 2 argued that the complainant met with an accident on 19.06.2014 but nowhere the time of accident has been mentioned.  He further argued that the complainant, who is covered under the ESI Scheme, should have first been taken to ESI Hospital Mandi Gobindgarh for treatment. ESI Hospital Mandi Gobindgarh could have referred the complainant to any other hospital including CMC Ludhiana for emergency treatment, in the event of non availability of adequate treatment in the ESI Hospital Mandi Gobindgarh. He further argued that had the aforesaid case been referred by ESI Hospital Mandi Gobindgarh to CMC Ludhiana, the ESI could have made the reimbursement of medical expenditure in full. He further argued that presently only Rs.22,995/- have been sanctioned/paid as per the guidelines of the health department. He prayed for dismissal of the complaint.

8.              Ld. counsel for OP No.3 could not turn up since so many hearings to argue this complaint. However, in reply to complaint, OP No.3 stated that the complaint be dismissed against him because he only had spent the whole amount of expenditure on the treatment of the complainant.

9.              We have gone through the written arguments, evidence placed on record and heard oral submissions of the Ld. counsel. We find force in the submission of the Ld. counsel for the complainant and hence, we accept this complaint. The payment of Rs.22,995/- released earlier to OP No.3 by OPs No.1 & 2 has been found to be prepared on a half paper wherein only four entities/entries have been shown and nothing else. It does not seem to be credible. Hence, we direct the OP No.1 & 2 to process the medical claim of the complainant afresh in view of ESI Corporation New Delhi letter No.U-16/24/7/10- Med.1 dated 21.05.2010 as per norms/rules and make the balance payment of medical bills to the complainant along with interest at the rate of 8% per annum from the date of filing of claim till its payment.  The complainant is also held entitled to lumpsum compensation of Rs.10,000/- on account of mental harassment etc together with litigation charges. The order be complied within a period of 30 days from the date of receipt of certified copy of this order.

10.           The arguments on the complaint were heard on 23.08.2018 and the order was reserved. Now the order be communicated to the parties. Copy of the order be sent to the parties free of cost and thereafter the file be consigned to the record room.

Pronounced

Dated: 28.08.2018