Haryana

Rewari

CC/114/2011

Dharambir Singh - Complainant(s)

Versus

Employees State Ins. Corp. - Opp.Party(s)

Lal Chand Yadav

13 Jan 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,   REWARI.

 

                                                Consumer Complaint No: 114 of 2011.

Date of Institution:     25.2.2011.

Date of Decision:      13.1.2015.

 

 

Dharmbir Singh  son of Shri Ram Saroop, resident of village Konsiwas, Tehsil Rewari  Distt. Rewari, at present  working with M/s Uniproduct India Ltd. Village Ladhuwas, Post Office Sangwari, Tehsil Rewari  Distt. Rewari. 

 

 

 

                                                                         …....Complainant.

                                      Versus

 

 

1)  Branch Manager, Employee State Insurance Corporation, 295A, Housing Board Colony, Dharuhera, Tehsil and   Distt. Rewari. 

2)  Joint Director ( Incharge) Sub Regional Office, Plot no. 47, Sector-34, Gurgaon, District Gurgaon,

3) Employee State Insurance Corporation Hospital, Sector-9A, Gurgaon, District Gurgaon.

 

                                                                  ….…Opposite Parties.

 

 

Complaint Under Section 12  of Consumer Protection Act

 

 

        Before: Shri  Raj  Kumar ………. …..………..PRESIDENT

                       Shri Kapil Dev Sharma…………………MEMBER

 

                      

Present :          Shri L.C. Yadav, Advocate for the complainant.

                        Shri  Gajesh Yadav, Advocate for the opposite parties

                         No.1 and 2.

                         Shri R.P.Yadav, Advocate  for opposite party no.3.

                                                ORDER

 

 

 Per  Raj Kumar President

 

 

                             Factual matrix comprising the case of the complainant, shorn of details, is that the complainant who is working with M/s  Uniproduct India Ltd. Village Ladhuwas, Distt. Rewari was insured under ESI Act, 1948  eligible for the treatment of his family as well as himself.  It is alleged that her wife Smt. Savita became seriously ill and was admitted in Saxena Nursing Home, Rewari which was on the panel of the insurance.  That the condition of her wife did not improve due to typhoid, viral fever and malaria with infected lever and heart and thus she was referred to ESI, Hospital, Gurgaon and since the condition did not improve there also, she was again referred to Paras Artemise Gurgaon but since there was no vacant bed, the patient was admitted to Life Health Care, Gurgaon and thus  the complainant incurred a sum of Rs. 55,000/- on the treatment of his wife.   He requested the opposite parties for claiming the said amount but no heed was paid towards his requests; hence, this complaint seeking amount of Rs. 63058/- (55000+1150+6900/-  conveyance charges) with interest.

2)                         In reply opposite parties no. 1 and 2 besides taking several preliminary objections averred that  the complainant is  making a pressure of the ESI department to get the undue amount on account of alleging  seriousness of his wife.  Neither she was serious nor she was treated in the hospital as alleged.   Denying all other contents, it is alleged that the complainant did not try to get the treatment from the hospital on panel of ESI and thus dismissal of the complaint has been prayed for. 

                                    The reply of opposite party no.3 is also on he same footing alleging that since the matter is related to dispensary of ESIC, the complainant should approach the same. 

3)                     We have heard both the counsel for the parties and gone through both oral as well as documentary evidence on the file thoroughly. 

4)                         A perusal of Ex. C-12 shows that the patient was first treated at some private hospital Saxena Nursing  Home, Rewari where she was suspected from having suffered from Malaria, typhoid  and viral fever and she was accordingly treated symptomatically. However, she was referred to ESI Hospital Gurgaon  as per her entitlement  for further action.  Ex. C-3  shows that she was treated at  ESI hospital  New Delhi again symptomatically  suspecting fever and swelling on he body as she did not get the required relief, she got admitted herself in the    Life Line Health Care, Gurgaon .  Ex. C-14 shows that she was being treated in Intensive Care Unit   and after conducting investigation, she was treated for liver abscess with UTI.  Ex. C-14 conclusively establishes that her condition was quite serious and it is not possible to treat serious liver ailments in small hospitals.  No doubt, there is nothing to show on record that she was referred to private hospital i.e. Life Line Health Care, at Gurgaon by ESI Hospital but on that basis alone she cannot be denied the relief  as the documents itself goes to show , as discussed above, that her condition was precarious and she required immediate hospitalization.  The contention of the counsel for the opposite parties that the complaint does not disclose the details of the treatment and admission, is also devoid of merit as during her evidence the treatment has not been disputed.  The Consumer Court cannot adopt the rigidity of civil court while dispensing justice.  Thus, the opposite parties have displayed deficiency while not allowing and reimbursing the bills.  A  perusal  of  bill  Ex. C-16 goes to show that she incurred a sum of Rs.  45,040/- on her treatment.  However, it is admitted by the parties that the actual amount so incurred is Rs. 42,090/- for which the complainant is admittedly and undisputedly  entitled to have the same. 

5)                         Resultantly, the complaint is allowed directing the opposite parties to pay a sum of Rs. 42,090/- to the complainant with interest @ 9% p.a. from the date of filing of this complaint till payment maximum within a period of 45 days from the date of receipt of the copy of this order failing which the amount shall fetch penal  interest @ 12% p.a. from the date of expiry of the said stipulated period .  The complainant is also allowed compensation  to the tune of Rs. 5,000/- and litigation expenses of Rs. 2200/-against the opposite parties.   

Announced

13.01.2015.                        

                                                                    President,

                                                          Distt. Consumer Disputes

                                                          Redressal Forum, Rewari.

 

                    Member, 

             DCDRF,Rewari.