Punjab

Sangrur

CC/1662/2015

Nasreen - Complainant(s)

Versus

Employee State Insurance Corporation - Opp.Party(s)

Shri Rohit Jain

01 Jul 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                       

                                                Complaint No.  1662

                                                Instituted on:    14.12.2015

                                                Decided on:       01.07.2016

 

Nasreen wife of Mohammad Ramzan, resident of Sirhandi Gate, Malerkotla, District Sangrur.

                                                        …Complainant

                                Versus

1.     Employees State Insurance Corporation, through its Manager Karbala Road, near Dr Zakhir Hussain Stadium, Malerkotla, Distt. Sangrur.

2.     Employees State Insurance Corporation, Madhya Marg, Sector 19-A, Chandigarh, through its Deputy/Regional Director.

3.     Medical Officer, Incharge ESI Dispensary, Lal Bazar, Malerkotla, Distt. Sangrur.

4.     Medical Superintendent, Deputy Director Zonal, ESI Model Hospital, Bharat Nagar Chowk, Ludhiana.

5.     Director Health Services (SI) Punjab, Parivar Kalyan Bhawan, Sector 34-A, Chandigarh.

                                                        ..Opposite parties

 

 

For the complainant  :       Shri Rohit Jain, Adv.

For OP No.1&2         :       Shri S.M.Goyal, Adv.

For OP No.3 to 5      :       Dr.  Ritu Miglani.

 

Quorum:   Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

Order by : Sukhpal Singh Gill, President

 

1.             Smt. Nasreen complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the complainant is an employee of M/s. R.M. Industries, Sirhandi Gate Malerkotla and as such is insured/covered under the ESI scheme of the OPs and her ESI IP number is 1207254450.  The grievance of the complainant is that on 3.11.2014, son of the complainant namely, Talib suffered illness and was admitted in Deep Nursing Home and Children Hospital, Ludhiana, where he died on the same day. It is further averred that the complainant spent an amount of Rs.45,000/- on the treatment of his son including medicines, attendant, food and transportation etc and thereafter submitted the bill to the Ops along with all the documents amounting to Rs.37,116.83 in November, 2014, but nothing happened thereafter, despite sending the notice and approaching the Ops.  As such, alleging deficiency in service on the part of the OPs, the complainant has prayed that the Ops be directed to pay to the complainant an amount of Rs.37,116.83  along with interest @ 24% per annum from 3.11.2014 till realisation and further claimed compensation and litigation expenses.

 

2.             In reply filed by OPs number 1 and 2, legal objections are taken up on the grounds that the complainant has no locus standi to file the present complaint, that the complaint is not legally maintainable, that the complainant has not come to the Forum with clean hands  and that the complainant is not a consumer of the OPs. On merits, it is admitted that the complainant is an employee of M/s. R.M. Industries and is covered under the ESI scheme as such along with herself and her children. However, it has been denied that the complainant submitted the claim form along with all the documents in November, 2014. It has been further admitted that the complainant sent registered notices dated 26.11.2015 and 30.11.2015. The remaining allegations levelled in the complaint have been denied in toto and any deficiency in service on the part of the Ops has been denied.

 

3.             It is worth mentioning here that though Dr. Ritu Miglani appeared on behalf of OPs number 3 to 5 , but she did not file any detailed written reply on behalf of the OPs.

 

4.             The learned counsel for the complainant has produced Ex.C-1 affidavit, Ex.C-2 copy of identity certificate, Ex.C-3 copy of medical reimbursement form, Ex.C-4 copy of legal notice, Ex.C-5 copy of postal receipt, Ex.C-6 copy of legal notice, Ex.C-7 postal receipt and closed evidence. On the other hand, the learned counsel for OP number 1 and 2 has produced Ex.OP1&2/1 affidavit and closed evidence.

 

5.             We have carefully perused the complaint, version of the opposite parties, evidence produced on the file and written submissions and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

 

6.             It is an admitted fact that the complainant being an employee of M/s. R.M. Industries, Malerkotla is insured with the Ops under ESI number 1207254450 under which the Ops are liable to bear/reimburse the medical expenses of the complainant as well as her family members. It is further an admitted fact that her son namely, Talib, died  on 3.11.2014 and she spent an amount of Rs.45,000/- on his treatment and she submitted the medical bill for Rs.37116.83 to the Ops for reimbursement, but the Ops did not pay the amount of bill to the complainant despite her best efforts and issuance of legal notices to them.

 

7.             It is worth mentioning here that Dr. Ritu Miglani, appearing on behalf of Ops number 3 to 5 made a statement on 20.5.2016 that the medical bill of the complainant was sent to the higher authorities vide letter number 754 on 9.12.2014, but the same was received back in July, 2015 due to some objections and after removing the objections the bill was again sent to the higher authorities in September, 2015, which was passed in the month of December, 2015 and thereafter the bills were made online on 30.12.2015 and the same was received by Ludhiana treasury on 4.1.2016, but the payments were banned/closed by the Treasury, as such, finally the total payment of Rs.31217/- made to the complainant on 15.3.2016, as such, it is stated that there is no deficiency in service on the part of the Ops number 3 to 5.  But, we are unable to accept such a contention of the OPs. It is true that the complainant had submitted the bill for Rs.37116.83 to the Ops, but the Ops only passed the bill for Rs.31217/- and paid to the complainant after an inordinate delay. There is no explanation from the side of the Ops that why and on what account the amount of Rs.5900/- has been deducted from the bill of the complainant.  Under the circumstances, we are of the considered opinion that it is a fit case of deficiency in service and negligence on the part of the Ops by not paying the full amount of the bill and further are of the considered opinion that there is no explanation from the side of the Ops that how and why they deducted the amount of Rs.5900/- from the bill of the complainant.  As such, we are of the view that the complainant is entitled to get the remaining claim amount of Rs.5900/- from OPs.

 

8.             In view of our above discussion, we allow the complaint and direct the OPs to pay to the complainant an amount of Rs.5900/- along with interest @ 9% per annum from the date of filing of the present complaint i.e. 14.12.2015 till realisation in full. Ops are further directed to pay to the complainant an amount of Rs.5,000/- on account of compensation for mental tension, agony and harassment and litigation expenses.

9.             This order of ours be complied with within a period of thirty days of its communication. A  copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                July 1, 2016.

                                                        (Sukhpal Singh Gill)

                                                           President

 

 

                                                              (K.C.Sharma)

                                                                   Member

 

 

                                                                (Sarita Garg)

                                                                    Member