Chandigarh

DF-II

CC/134/2023

Bisheshwar Yadav - Complainant(s)

Versus

Employees' State Insurance Corporation - Opp.Party(s)

In Person

13 Feb 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II

U.T. CHANDIGARH

 

Consumer Complaint No.	:	134/2023
Date of Institution	:	28.02.2023
Date of Decision	:	13.02.2024

 

                     

            

 

Bisheshwar Yadav S/o Sh.Priti Yadav R/o House No.12, Sector 4, Chandigarh

….Complainant.

Versus

Employees' State Insurance Corporation, Panchdeep Bhawan, Sector-19-A, Chandigarh through its Regional Director.

…. Opposite Party.

 

BEFORE:
	SHRI AMRINDER SINGH SIDHU,	PRESIDENT
	SHRI B.M.SHARMA	MEMBER
Present:-
	Sh.Jasbir Singh, Counsel for complainant Sh.Vivek Mohan Sharma, Counsel for OP.

   

ORDER BY AMRINDER SINGH SIDHU, M.A.(Eng.),LLM,PRESIDENT

1.     The complainant has filed the present complaint stating therein that he is working with M/s Sahib Tradelinks Pvt. Ltd, Sector 34-A Chandigarh and is member of ESI Scheme, paying ESI contribution with effect from 17.02.2015 regularly with IP No.1213917218. His daughter, Shivani Kumari aged 5 years stated to be suffering from hearing loss from both ears by birth. Being referred from OP, the PGI Chandigarh conducted surgery of Shivani Kumari and implanted hearing aid in her right ear. For the treatment of left ear of his daughter, the ESIC again referred to PGI Chandigarh which after examination recommended for surgery of left ear for implantation of hearing aid and provided estimate certificate dated 12.01.2023 for Rs.6,18,050/- (Annexure C-2).  He submitted the application with the ESI Model Hospital, Ramdarbar Chandigarh  along with the estimate but the OP orally refused to accept the application for sanction of advance payment on the ground that there is no provision for second advance for implantation of hearing aid in left ear. Subsequently, he served a legal notice dated 13.01.2023 upon the OP and the OP vide reply dated 17.01.2023 informed that  the case has been forwarded to the Medical Superintendent ESIC Model Hospital Chandigarh for process but till date he did not receive any response.  Alleging that the aforesaid acts of omission and commission on the part of the OP amount to deficiency in service and unfair trade practice, the complainant has filed the instant complaint seeking directions to the OP to sanction the estimate amount as prepared by the PGI, along with compensation for mental agony and physical harassment as well as litigation expenses.
2.     After service of the notice upon the OP, they filed their written version taking preliminary objections the complaint qua it is not maintainable. It has further been stated that the  complainant be directed to produce the relevant record vide which ESIC Hospital Chandigarh has referred his daughter to PGI for the treatment of her left ear. The office of Medical Superintendent ESIC Model Hospital Chandigarh vide e-mail dated 31.1.2023 had duly informed that as per the Circular No.F.No.6-469/2003-CGHS/R&H dated 12^th  June 2009/Adopted by ESIC by Circular No.F.No.U-16/12/1/2020/Agenda/reporting item/Med-III dated 11.7.2022, the advance of Cochlear implant for the second ear is not admissible but the complainant intentionally deliberately withheld the vital facts with regard to receipt of reply and filed the present compliant without impleading ESIC Model Hospital Chandigarh as necessary party. The remaining allegations have been denied, being false. Pleading that there is no deficiency in service or unfair trade practice on their part, the OPs prayed for dismissal of the complaint.
3.     The parties filed their respective affidavits and documents in support of their case.
4.     We have heard the Counsel for the contesting parties and have gone through the documents on record, including written submissions.
5.     The case of the complainant is that his daughter Shivani Kumari aged 5 years is suffering from hearing loss from both ears by birth. The PGIMER, Chandigarh conducted surgery of the daughter of the complainant Shivani Kumari being referred by the OP and implanted hearing aid in her right ear. For the treatment of left ear of his daughter, the ESIC again referred to the PGIMER, Chandigarh which after examination recommended for surgery of left ear for implantation of hearing aid and provided estimate certificate dated 12.01.2023 to the tune of Rs.6,18,050/- (Annexure C-2).  However, the ESI Model Hospital, Ramdarbar Chandigarh had refused to accept the application for sanction of advance payment on the ground that as per the Circular No.F.No.6-469/2003-CGHS/R&H dated 12^th  June 2009/Adopted by ESIC by Circular No.F.No.U-16/12/1/2020/Agenda/reporting item/Med-III dated 11.7.2022, the Cochlear implant for the second ear is not admissible.  As per the aforesaid instructions, it appears that only unilateral implantation will be allowed and the daughter of the complainant cannot take benefit for implantation of the left ear because the complainant had already taken the benefit of implantation of right ear of his daughter. In our considered view, in the spirit of law, it is wrong to deny the medical treatment to the medically needy person simply on the ground that unilateral implantation is allowed by taking the shelter of the aforesaid instructions especially when the same was recommended by the PGIMER, Chandigarh and the same is required for the normal functioning of the ears of the daughter of the complainant. The main principle/objective to set up the Corporation is to provide certain benefits to its employees in case of sickness, maternity and employment injury etc. and not to deny the same. Thus, the OP has committed deficiency in service by not allowing the advance payment for the hearing aid of the left ear of the complainant’s daughter.
6.     In view of the above discussion, the present complaint deserves to be partly allowed  with a direction to the OP to sanction the advance of Rs.6,18,050/- as recommended by the PGIMER, Chandigarh for implantation of the hearing aid in left ear of his daughter namely Shivani Kumari.
7.      This order be complied with by the OP within 45 days from the date of receipt of its certified copy.
8.     The pending application(s) if any, stands disposed of accordingly.
9.     Certified copy of this order be sent to the parties, as per rules. After compliance file be consigned to record room.

Announced in open Commission 13.02.2024
	Sd/- (AMRINDER SINGH SIDHU) PRESIDENT
	Sd/- (B.M.SHARMA) MEMBER