Punjab

Sangrur

CC/425/2016

Rahde Shyam Verma - Complainant(s)

Versus

Employee State Insurance Corporation - Opp.Party(s)

Shri Rohit Jain

12 Oct 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                               

 

                                                Complaint No.  425

                                                Instituted on:    15.06.2016

                                                Decided on:       12.10.2016

 

Radhey Shyam Verma aged about 61 years son of Late Shri Shrichand Verma, resident of F286, Near Balaji Mandir, Sector -2, Tirkha Colony, Ballabgarh (Haryana) now resident of M/s. G.I.S. Ltd. Colony, Akbarpur Channa, Tehsil Malerkotla, District Sangrur.

                                                        ..Complainant

                                        Versus

1.     Employees State Insurance Corporation through its Manager, Karbala Road, Malerkotla District Sangrur.

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

3.     Medical Officer, Incharge ESI Dispensary, Ahmedgarh, Tehsil Malerkotla, District 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 OPS no.1&2       :       Shri S.M.Goyal, Adv.

For OP No.3,4&5      :       Exparte.

 

 

 

Quorum:   Sukhpal Singh Gill, President

                Sarita Garg, Member

 

 

Order by : Sukhpal Singh Gill, President.

 

1.             Shri Radhey Shyam Verma,  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. G.I.S. Ltd. Akbarpur Channa and is covered/insured under ESI IP no. 2609634095 and is paying the necessary contribution, as such is a consumer of the OPs. 

 

2.             The case of the complainant is that he got some problem in his heart and got treatment from Metro Heart Institute with multispeciality, Faridabad and spent the amounts of Rs.4458.76, Rs.3189/- and Rs.2173/- on his treatment from 25.2.2013 to 30.3.2013, 17.7.2013 to 21.8.2013 and October to November, 2013 respectively. The complainant submitted all the bills to the Incharge ESI Dispensary, Akbarpur. It is further stated that the complainant took treatment on 23.11.2014 from Shri Shri 1008 Swani Rameshwar Giri Charitable Hospital, Ahemdgarh and spent Rs.700/- and submitted the bill to the OPs, but the amount of the bills were not paid.  Further case of the complainant is that he again took treatment from Hind Hospital, Ahemdgarh and spent Rs.19,915/- for the period from 3.3.2015 to 5.3.2015 and submitted the bills to the OP number 3, but the OP number 3 refused to accept the same and asked the complainant to submit the same with ESI Dipensary at Akbarpur, which has been closed by the Ops.  Thus, the grievance of the complainant is that the Ops are not paying the dues to the complainant and as such alleging deficiency in service on the part of the OPs, the complainant has prayed that the OPs be directed to pay his claim amount of Rs.30,436/- along with interest and further claimed compensation and litigation expenses.

 

3.             In reply filed by OPs number 1 and 2, legal objections are taken up on the grounds that the complaint is not maintainable, that the complainant has no locus standi to file the present complaint and that the complainant has not come to the Forum with clean hands and that the complainant has not submitted all the documents etc. On merits, it is admitted that the complainant is an employee of M/s. G.I.S. Ltd. Colony, and is covered under the ESI scheme as mentioned above.  It is admitted that the complainant spent near about Rs.30,436/- on the treatment including medicine, attendant, his food and transportation etc. It is stated that no claim is payable by the Ops number 1 and 2, rather the bills have been submitted to the Op number 3 and the claim is also payable by the Ops number 3 to 5.

 

4.             Record shows that the Ops number 3 to 5 are exparte.

 

5.             The learned counsel for the complainant has produced Ex.C-1 affidavit, Ex.C-2 to Ex.C-5 copies of reimbursement bills, Ex.C-6 copy of letter, Ex.C-7 copy of letter, Ex.C-8 copy of affidavit, Ex.C-9 copy of contribution, Ex.C-10 self declaration, Ex.C-11 copy of letter, Ex.C-12 copy of affidavit, Ex.C-13  to  Ex.C-31 copy of contribution slip, declaration and ESI card etc. and closed evidence. The learned counsel for the OPs number 1 and 2 have produced Ex.OP1&2/1 affidavit and closed evidence.

 

6.             We have very carefully perused the pleadings of the parties and heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

 

7.             It is an admitted fact that the complainant being an employee of M/s.G.I.S. Ltd, Akbarpur Channa was having an ESI account with the Ops number 1 and 2. Further it is an admitted fact of all contesting parties that the complainant took treatment on various dates i.e. for the period from 25.2.2013 to 30.3.2013, 17.7.2013 to 21.8.2013 and October to November, 2013 respectively and he further took treatment from the Hind Hospital Ahemdgarh and spent an amount of Rs.19,915/- for the period from 3.3.2015 to 5.3.2015, but the Ops did not pay the claim amount.  It is worth mentioning here that the claims are settled by the Ops number 3 to 5, but in the present case, the Ops number 3 to 5 chose to remain exparte.

 

8.             We have perused the copy of the bill Ex.C-2, which is bill submitted by the complainant and passed by the OP number 3 for Rs.3822/-, Ex.C-3 is the copy of bill for Rs.3189/-,  Ex.C-4 is the copy of bill for Rs.700/-, Ex.C-5 is the copy of the bill for Rs.19,915/- which is duly counter signed by Hind Hospital, Ahemdgarh and bill Ex.C-27 for Rs.2173/-, the total of which comes to Rs.29,799/-.  These bills are duly counter signed by the Doctor.  As mentioned above, the Ops number 3 to 5 are exparte, who had to make the payment to the complainant.  In the present case, it is clearly established that the OPs number 3 to 5 did not settle the claim, despite submission of the same by the complainant.  In the circumstances, we feel that the ends of justice would be met if the Ops number 3 to 5 are directed to pay the above said amount as claimed by the complainant.

 

9.     In view of our above discussion, we allow the complaint and direct the OPs number 3 to 5 to pay to the complainant the amount of Rs.29,799/- to the complainant along with interest @ 9% per annum from the date of filing of the present complaint i.e. 15.6.2016 till realisation.  We further direct the Ops number 3 to 5 to pay to the complainant the amount of Rs.5000/- in lieu of compensation and litigation expenses.

 

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

                Pronounced.

                October 12, 2016.

                                                        (Sukhpal Singh Gill)

                                                           President

 

 

                                                                                                                 

                                                                (Sarita Garg)

                                                                   Member