Punjab

Ludhiana

CC/19/216

Raj Khan - Complainant(s)

Versus

Employee State Insurance Corpn. - Opp.Party(s)

Ravinder Modgill Adv.

01 Aug 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No:216 dated 09.05.2019.                                                         Date of decision: 01.08.2023.

 

Raj Khan son of Habib Khan, Resident of VPO Nathowal, Tehsil Raikot, District Ludhiana.                                                                                                                                                                                ..…Complainant

                                                Versus

1. Employees State Insurance Corporation Ltd., Bharat Nagar, Ludhiana through its Medical Superintendent.   
2. Mediways Hospital, Ferozepur Road, Ludhiana through its Medical Superintendent/Manager.                                                                                                                                                …..Opposite parties 

Complaint Under Section 12 of the Consumer Protection Act, 1986.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

SH. JASWINDER SINGH, MEMBER

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Ravinder Modgill, Advocate.

For OP1                         :         Sh. Vijay Kumar Sabherwal, Advocate.

For OP2                         :         Exparte.

 

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                Shorn of unnecessary details, the  facts of the complaint are that the complainant being an employee of Punjab Roadways/PUNBUS  is covered with ESI having insurance No.2612334443. Sh. Habib Khan, father of the complainant admitted in ESI Hospital, Ludhiana due to illness from where he was referred to Ludhiana Mediways Hospital, Ferozepur Road, Ludhiana on 24.02.2016. The complainant stated that the officials of Ludhiana Mediways Hospital told him to buy some medicines, platelets, blood etc. upon which he approached ESI authorities who told the complainant to spend the expenses from his pocket and the bills will be reimbursed to the complainant. On the assurance of ESI officials, the complainant spent a sum of Rs.19,700/- on treatment of his father in Ludhiana Mediways Hospital. Father of the complainant died on 11.03.2016. The complainant approached the ESI authorities many times for reimbursement of the bills but they delayed the matter and till date the amount of Rs.19,700/- has not been refunded to the complainant despite his visits to the opposite parties. Then the complainant moved an application dated 22.01.2019 to opposite party No.1 for reimbursement of medical bills and in response to said letter, the complainant received a letter dated 25.03.2019 from opposite party No.1 wherein opposite party No.2 was directed to reimburse the bills of the complainant and to sent intimation in this regard to opposite party No.1. The complainant further stated that he visited opposite party No.2 but no amount was disbursed to him till date which amounts to deficiency in service on the part of the opposite parties due to which the complainant has suffered mental pain and agony. In the end, the complainant has made a prayer with direction to opposite parties to reimburse the medical bills of Rs.19,700/- along with compensation of Rs.1,00,000/-.

2.                Notice was sent to opposite party No.2 through registered post on 29.05.2019 but none turned up for opposite party No2. Despite this service and as such, opposite party No.2 was proceeded against exparte vide order dated 19.09.2019.

3.                Upon notice, opposite party No.1 appeared and filed written statement by taking preliminary objections that the complaint is not maintainable; the complaint is time barred and the complainant has no cause of action. Opposite party No.1 stated that the father of the complainant was never referred to the Ludhiana Mediways Hospital on the payment basis treatment which was to be reimbursed later on by the ESIC authorities in fact father of the complainant was referred to the Ludhiana Mediways Hospital for cashless treatment as per terms of the agreement dated 17.01.2013 between the ESIC Hospital and Ludhiana Mediways Hospital.

                   On merits, opposite party No.1 reiterated the crux of averments made in the preliminary objections. However, opposite party No.1 stated that the father of the complainant was referred to Ludhiana Mediways Hospital for cashless treatment and when the matter came into their knowledge, a letter dated 25.03.2019 was sent to Ludhiana Mediways Hospital to reimburse the amount to the complainant and vide said letter, the complainant was asked to visit Ludhiana Mediways Hospital but he never informed opposite party No.1 whether his claim was settled or not by Ludhiana Mediways Hospital.  Opposite party has denied that there is any deficiency of service and has also prayed for dismissal of the complaint.

4.                In support of his claim, the complainant tendered his affidavit Ex. CA in which he reiterated the allegations and the claim of compensation as stated in the complaint. The complainant also tendered documents Ex. C1 is the copy of  discharge summary dated 07.03.2016, Ex. C2 is the copy of referral form (permission letter), Ex. C3 are  the copies of bills of medicine, Ex. C4 is the copy of letter dated 04.02.2019 of ESI hospital sent to the complainant, Ex. C5 is the copy of letter dated 25.03.2019 of ESI hospital sent to Mediways Hospital, Ludhiana and closed the evidence.

5.                On the other hand, the counsel for opposite party No.1 tendered affidavit Ex. RA of Ms. Bhairavi Deshmukh, Medical Superintendent, ESIC, Model Hospital, Ludhiana along with documents Ex. R1 is the copy agreement between ESIC Model Hospital and Ludhiana Mediways Hospital, Ludhiana, Ex. R2 is the letter dated 25.03.2019 sent to Ludhiana Mediways Hospital  and closed the evidence.

6.                We have heard the arguments of the counsel for the parties and also gone through the complaint, affidavit and annexed documents and written reply along with affidavit and documents produced on record by both the parties.      

7.                Habib Khan, father of the complainant remained admitted from 24.02.2016 to 07.03.2016 in opposite party No.2 hospital and an amount of Rs.19,700/- were spent as medical expenses vide bills Ex. C3. Unfortunately on 11.03.2016 he expired. Opposite party No.1 in its written statement admitted that the patient was referred to opposite party No.2 hospital vide referral form Ex. C2 for cashless treatment as per terms of the agreement dated 17.01.2013 Ex. R1. It has also been admitted in the written statement that the payment of medical bill was to be reimbursed later by ESIC authorities. It can be deduced from the record that the contesting opposite party is not denying about the genuineness of the claim and further admitted vide letter Ex. C2 addressed to opposite party No.2 that the complainant had submitted the bills for reimbursement with them and the same are liable to be reimbursed by opposite party No.2 hospital.

8.                From the perusal of the documents, it is evident that both these opposite parties are shirking from their responsibility without any rhyme or reason and the complainant has been running from pillar to post to get the medical expenses reimbursed. So there is deficiency in service on the part of the opposite parties. Therefore, it would be just and appropriate if the opposite parties are directed to settle and reimburse the medical expenses incurred by the complainant for hospitalization of his father from 24.02.2016 to 07.03.2016 within 30 days from the date of receipt of copy of order. The complainant will be entitled to interest @8% per annum on the settled amount from the date of filing of complaint till actual payment. The interest paid on the amount shall be considered as compensation. However, the complainant is awarded litigation expenses of Rs.3,000/-.

9.                As a sequel of above discussion, the complaint is partly allowed with direction to the opposite parties to settle and reimburse the medical expenses incurred by the complainant for hospitalization of his father from 24.02.2016 to 07.03.2016 within 30 days from the date of receipt of copy of order. The complainant will be entitled to interest @8% per annum on the settled amount from the date of filing of complaint till actual payment. The interest paid on the amount shall be considered as compensation. However, the complainant is awarded litigation expenses of Rs.3,000/-. Compliance of the order be made within 30 days from the date of receipt of copy of order. Liability of the opposite parties shall be joint and several. Copies of the order be supplied to the parties free of costs as per rules. File be indexed and consigned to record room.

10.              Due to huge pendency of cases, the complaint could not be decided within statutory period.

 

(Monika Bhagat)          (Jaswinder Singh)                      (Sanjeev Batra)                          Member                            Member                                       President         

Announced in Open Commission.

Dated:01.08.2023.

Gobind Ram.

Raj Khan Vs Employees State Insurance Corporation               CC/19/216

Present:       Sh. Ravinder Modgill, Advocate for complainant.

                   Sh. Vijay Kumar Sabherwal, Advocate for OP1.

                   OP2 exparte.

 

                   Arguments heard. Vide separate detailed order of today, the complaint is partly allowed with direction to the opposite parties to settle and reimburse the medical expenses incurred by the complainant for hospitalization of his father from 24.02.2016 to 07.03.2016 within 30 days from the date of receipt of copy of order. The complainant will be entitled to interest @8% per annum on the settled amount from the date of filing of complaint till actual payment. The interest paid on the amount shall be considered as compensation. However, the complainant is awarded litigation expenses of Rs.3,000/-. Compliance of the order be made within 30 days from the date of receipt of copy of order. Liability of the opposite parties shall be joint and several. Copies of the order be supplied to the parties free of costs as per rules. File be indexed and consigned to record room.

 

(Monika Bhagat)          (Jaswinder Singh)                      (Sanjeev Batra)                       Member                     Member                                       President         

 

Announced in Open Commission.

Dated:01.08.2023.

Gobind Ram.