Punjab

Sangrur

CC/435/2016

Sadra - Complainant(s)

Versus

Employee State Insurance Corporation, - Opp.Party(s)

Shri Rohit Jain

08 Nov 2016

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR

                             

                                                                  Complaint no. 435                                                                                         Instituted on:   01.07.2016                                                                                   Decided on:    08.11.2016

 

Sadra wife of Mohammad Akram resident of Mohalla Nusrat Khani, Malerkotla, District Sangrur.

                                                …. Complainant

                                Versus

 

1. Employee State Insurance Corporation, through its Manager, Karbala Road, Malerkotla, District Sangrur.
2. Employee State Insurance Corporation, Madhya Marg, Sector 19-A Chandigarh through its Deputy/ Regional Director.
3. Medical Officer, Incharge ESI Dispensary, Lal Bazar, Maerkotla, District Sangrur.
4. Medical Superintendent, Deputy Director  Zonal, ESI Model Hospital, Bharat Nagar Chowk, Ludhiana.
5. Director Health Service (SI) Punjab, Parivar Kalyan Bhawan, Sector 34-A, Chandigarh.

 

                                                  ….Opposite parties.

 

 

FOR THE COMPLAINANT       :         Shri Rohit Jain, Advocate.                      

 

FOR T TOPP OPP. PARTIES No.1&2    :         Shri S.M.Goyal, Advocate

 

FOR T TOPP OPP. PARTIES No.3 to 5  :         Dr. Nadeem Akhtar                      

 

 

 

 

Quorum

         

                    Sukhpal Singh Gill, President

Sarita Garg, Member

     

 

 

ORDER:  

 

Sukhpal Singh Gill, President

 

1.             Sadra, complainant has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that she is employed as lecturer in Islamia Girls Senior Secondary School, Malerkotla and is covered under/ insured with OPs under  ESI IP No. 1213491468. The complainant got some problem in her uterus and ivories (blockage in tubes) with severe pain and got treatment from PGI, Chandigarh.  On 05.02.2016  Model Hospital Bharat Nagar Chowk, Ludhiana referred  the complainant to  Deep Hospital Ludhiana and after that the complainant started taking treatment. On 02.05.2016 doctors of Unique Fertility Centre, Deep Hospital Ludhiana advised that IVF  to be started from 2nd week of May 2016.  The complainant was shocked when doctors of Model Hospital Ludhiana refused to give approval for IVF-1st   attempt without asserting any reason. Thus, alleging deficiency in service on the part of OPs, the complainant has sought following reliefs:-

i)      OPs be directed to give approval  for IVF at advised  by doctors of Deep Hospital, Ludhiana,

ii)     OPs be directed to pay amount of medical bills of Rs.15575/- along with interest @24% per annum,

iii)   OPs be directed to pay Rs.50000/- on account of mental agony and Rs.11,000/- as litigation expenses.

2.             In reply filed by the OPs no.1&2, legal objections on the grounds of the maintainability, suppression of material facts and locus standi have been taken up.  It is submitted that some part of the ESI contribution is paid by the complainant and remaining part is paid by the employer.  It is denied that the complainant made so many verbal  requests to the OPs to make the payment of medical bills incurred by the complainant.

3.             In reply filed by the OPs no.3 to 5, legal objections on the similar grounds as taken by the OPs no.1 and 2 have been taken up.  On merits, it is denied that the OPs have wrongly refused to give approval for IVF-1st attempt. Further, it is also denied that the whole treatment was done under the Supervision of doctors of Model Hospital, Bharat Nagar Chowk, Ludhiana.   It is denied that the complainant made  so many verbal  requests to the OPs to make the payment of medical bills incurred by the complainant. Thus, there is no deficiency in service on the part of the OPs.

4.             The complainant in his evidence has tendered documents Ex.C-1 to Ex.C-24 and closed evidence. On the other hand , the OPs have tendered  an affidavit  Ex.OPs 1&2/1, Ex.OPs.3to5/1 to Ex.OPs.3to5/3 and closed evidence.    

5.             It is the complainant's case that she  on 05.02.2016  approached the Model Hospital, Bharat Nagar Chowk, Ludhiana  and she was referred to Deep Hospital, Ludhiana and the complainant started taking treatment from Unique Fertility Centre, Deep Hospital, Ludhiana. It is alleged that on 02.05.2016  doctors of Unique Fertility Centre Deep Hospital Ludhiana advised that IVF to be started from 2nd week of May 2016 for  approval of which the  complainant approached model Hospital Ludhiana but doctors at  Model Hospital Ludhiana refused to give approval for IVF-1st attempt. On the other hand, OPs have denied the facts as stated by the complainant in her complaint.

6.             After perusal of the documents placed on record and hearing the arguments of the parties, we find that the main and crucial question in this case for determination before us is whether the complainant is entitled for approval of  IVF-1st attempt or not ?

7.             During the arguments learned counsel for the OPs no.1 and 2 has produced a copy of  office memorandum  dated 22.11.2011  issued by Government of India Ministry of Health and Family Welfare Department of Health & Family Welfare Nirman Bhawan, New Delhi 110 108 on the subject that guidelines/ criteria for  reimbursement of expenses for in-Vitro Fertilisation ( IVF) treatment  to CGHS beneficiaries under Central Services ( Medical Attendance) Rules, 1944 wherein it has been specifically mentioned in column ( vi)  that the age of women undergoing IVF treatment procedure should be between 21 and 39 years. In the present case the age of the complainant is about 41 years which is evident from ESI identity card issued in the name of the complainant Ex.C-24 which was produced by the complainant herself on record.  It has also been mentioned in the card that date of birth of the complainant is 05.11.1974. Hence, we feel that the complainant is not entitled for getting approval of  IVF-1st attempt.

8.             Accordingly, without touching the merits of the case, we find that the complaint of the complainant is dismissed only on the abovementioned ground. Copy of the order be supplied to the parties free of charge. File be consigned to records in due course.                 

                Announced

                November 08, 2016

 

 

 

      ( Sarita Garg)                                    (Sukhpal Singh Gill)                                                                                                                                                                                                  Member                                            President

 

 

 

BBS/-