Punjab

Fatehgarh Sahib

CC/43/2014

Brij Bhushan Tyagi - Complainant(s)

Versus

employees state insurance corporation - Opp.Party(s)

Sh Sumit Gupta

28 Aug 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHGARH SAHIB.

                                                                                           Consumer Complaint No.43 of 2014

                                                                                         Date of institution: 01/04/2014                                                                                                                                                              Date of decision  :  28.08.2015

1.       Brij Bhushan Tyagi son of Sh. M.L.Tyagi,                                                                                                                                         2.         Sushma Tyagi W/o Brij Bhushan Tyagi r/o,

Both residents of 1841/17, B/S Star Colony, Near Markfed  Godown, Sirhind Mandi, Tehsil & District Fatehgarh Sahib.

……..Complainants

Versus

1. Employee State Insurance Corporation, Madhya Marg, Sector 19-A,  Chandigarh through Senior State Medical Commissioner.
2. Director Health Services(SI) Punjab, Pariwar Kalyan Bhawan,   Sector 34-A, Chandigarh-160022 through its Director.
3. Employees State Insurance Corporation Dispensary, Star Colony, Sirhind Mandi, Tehsil & District Fatehgarh Sahib through senior Medical Officer.

…..Opposite parties      

Complaint Under Sections 12 to 14 of the Consumer Protection Act

Quorum

           Sh. Ajit Pal Singh Rajput, President                                                                                                                                                   Smt. Veena Chahal, Member   

Sh. Amar Bhushan Aggarwal, Member                      

Present :       Sh. Sumit Gupta, Adv. Cl. for the complainant  

                              Sh. K.S.Khera, Adv.Cl. for OP No.1.   

                             OP No.2 exparte               

                            Dr. Avinash Kaur Rep. of OP No.3.                 

ORDER

By Sh. Amar Bhushan Aggarwal, Member

                          Complainants, Brij Bhushan Tyagi son of M.L.Tyagi and Sushma Tyagi W/o Brij Bhushan Tyagi r/o, both residents of 1841/17, B/S Star Colony, Near Markfed  Godown, Sirhind Mandi, Tehsil & District Fatehgarh Sahib, has filed this complaint against the Opposite parties (hereinafter referred to as “the OPs”) under Sections 12 to 14 of the Consumer Protection Act. The brief facts of the complaint are as under:

2.                 Complainant No.1 is an employee of M/s Vardhman Adarsh Ispat (P) Ltd. Village Ambey Majra, G.T.Road, Sirhind Side, Mandi Gobindgarh and both the complainants are insured under ESIC Scheme w.e.f. 30.01.2007 vide policy No.8377752. The said employer is deducting contribution towards insurance under ESI Act from the salary of complaiant No.1 and deposited along with his share regularly in the account of ESIC and monthly return is being sent to Local Office of ESIC at Mandi Gobindgarh.  As per the insurance policy, the complainant is entitled to get the medical treatment from ESIC Dispensary,  for himself and his family members against the contribution paid under ESI Scheme by the complainant and his employer. Complainant No.2 has been suffering from R/A factor since long and complainant No.1 is diabetic and has been operated heart bypass surgery and both are under treatment by the specialist doctor of ESIC Hospital, Mandi Gobindgarh referred by Medical Officer, ESIC Dispensary, Star Colony, Sirhind. It is stated that 23 Medical Bills duly verified by the specialist doctor of ESIC Hospital along with requisite documents has been submitted, against the purchase of medicines, to the Medical Officer ESIC dispensary for reimbursement. As per the provisions of ESI Act if prescribed medicines are not in the stock of the ESIC dispensary, such medicines may be purchased by the insured person/consumer at his own cost and such amount is to be reimbursed by the medical officer of the ESIC Dispensary under Regulation 96A. But the payment has not been made till date.  The complainants have also sent their grievances to Senior State Medical Commissioner, ESIC, Chandigarh vide email dated 11.01.2013 and they forwarded the said email to Director Health Services (SI) Punjab but there is no response despite repeated reminders.  The said Senior State Medical Commissioner, ESIC,  has also forwarded our grievance to SMO Incharge ESIC dispensary, to take action on the subject matter but in vain.  Thereafter the complainant was informed by Senior State Medical Commissioner, ESIC, vide their letter that bill No.219/13 for Rs.4057/- has been sent to accounts Section to issue cheque but no cheque has been delivered to complainant No.1 till date. The complainants also served registered notice to the OPs but no reply has been given till date. The act and conduct of the OPs amounts to negligence and deficiency in service. Hence, this complaint for giving directions to the opposite parties to pay the claim amount Rs.49,320/- i.e the amount of bills and further to pay Rs.20,000/-, as compensation on account of mental agony, physical harassment and Rs. 20,000/-, as cost/expenses of the complaint.

3.                 Notice of the complaint was sent to opposite parties No.2, who choose not to appear to contest this complaint, hence OP No.2 was proceeded against exparte. OP No.1, appeared through Representative, failed to file written version despite several opportunities. Therefore, the defence of OP No.1 was struck off.

4.                 The complaint was contested by OP No.3, who filed the written reply. In reply to the complaint OP No.3 stated that the complainant had already received the amount i.e Rs.24,150/- from them against some bills. Apart from it, the bills amounting to Rs.3618/-, Rs.3341/-, Rs.12,999/- and Rs.2,430/- have already been sent to the Director Health Services through ESI Hospital, Mandi Gobindgarh for payment to be made to the complainants and to this effect a letter No.16 dated 28.05.2014 has been written.  OP No.3 also demanded the M.S.Budget, through letter No.50 dated 06.05.2014, for  the amount claimed by the complainant through bills.  The remaining amount as per the bills would be given to the complainant after approval from the higher authorities. Hence, there is no deficiency on their part. After denying the other averments made in the complaint, they prayed for dismissal of the complaint.

5.                 In order to prove the case, the complainants tendered affidavit of complainant No.1  Ex. C-1, statement of pending bill Ex. C-2, self attested copy of letter dated 21.01.2013 Ex. C-3, attested copy of letter dated 01.03.2013 Ex. C-4, self attested copy of letter dated 16.07.2013 Ex. C-5, copies of bills Ex. C-6 to Ex. C-22, annexure A as mark A and closed the evidence.

6.                  In rebuttal the OP No.1 tendered in evidence copy of letter dated 09.06.2014 Ex. OP-1/1,  copy of letter dated 22.01.2014 Ex. OP-1/2, copy of list of insured persons Ex.  OP1/3  and closed the evidence.  OP No.3 tendered into evidence true copy of letter dated 02.06.2014 Ex. OP-3/1, true copy  of letter dated 09.06.2014 Ex. OP-3/2, true copy of receipt dated 09.06.2014 Ex. OP-3/3, copies of cheque Ex. OP-3/4, affidavit of Dr. Balwinder Singh Multani, Ex. OP-3/5 and closed the evidence.

7.                 Ld. counsel for the complainant argued that 23 medical bills duly verified by the specialist doctor were submitted between 03.10.2011 to 20.03.2014 as per annexure-A. After that various reminders were sent and even legal notice was served for the reimbursement of the medical bills but nothing was paid to the complainant. Payment of only 5 medical bills was made in June 2014, that too during the pendency of the complaint in the District Forum. Thus, there is great deficiency in service on the part of the OPs for which they should be penalized besides making the reimbursement of the remaining medical bills.

8.                 On the other hand OP No.3 in his written reply and affidavit Ex. OP3/5 has contended that there is no deficiency on his part as his competency for reimbursement is only upto Rs.1000/-. He made the payments as per his competency and grants available with him. He has submitted in his affidavit that complainant had already received the payments of Rs.24,153/-. The Ld. counsel for the OP has contended that there was no deficiency in service on his part and the complaint against him be dismissed.

9.                 After hearing the Ld. counsel for the parties and going through the pleadings, evidence produced by the parties, written and oral arguments, we find that there is force in the plea of the Ld. counsel for the complainant. It is evident from the affidavit of the complainant and Ex. C-1 to Ex. C-22, that medical bills duly verified by the specialist doctor of ESIC dispensary/hospital along with requisite documents submitted to the medical officer ESIC dispensary for reimbursement. Even the complainant had to serve a legal notice for the payment of medical bills, which has been accepted by OPs vide Ex. OP-1/1. Thus, OPs have certainly committed deficiency in service by not reimbursing the payment of medical bills for so long period.

10.               The complaint was filed on 01.04.2014. A sum of Rs.19,995/-, vide Ex. OP-3/4, was paid to the complainant on 09.06.2014 and the balance amount was paid as late as in July 2015 during the pendency of the complaint.

11.               Hence, we find that OPs No.1&2 have committed deficiency in service and has not been able to properly redress the grievance of the complainant.  Accordingly, we allow the complaint and direct the OPs No.1 and 2 to pay interest @ 9% p.a. on the amount of pending medical bills from the date of filing of this complaint i.e. 01.04.2014 till realization & also  to pay a lump sum compensation of Rs.10,000/-( Ten thousands only)  towards mental agony, harassment & cost of litigation. Complaint against OP No.3 is dismissed. The OPs No.1 and 2 are directed to comply with the order of this Forum within a period of 45 days from the date of receipt of this order. In case they fail to comply with the order, the OPs No.1 and 2 shall also be held liable to pay 9% p.a. interest till its realization.

12.               The complaint could not be decided within the statutory period as the OPs requested many times for adjournment since there was scope for compromise, as per their version. The case was also fixed for compromise in Lok Adalat, but compromise could not be effected. Thus, there was delay in the disposal of the present complaint.

13.               The arguments on the complaint were heard on 27.08.2015 and the order was reserved. Now the order be communicated to the parties. Copy of the order be sent to the parties free of cost and thereafter the file be consigned to the record room.

Pronounced

Dated:28.08.2015

(A.P.S.Rajput)               President

 

(Veena Chahal)              Member

                                                                             (A.B.Aggarwal)              Member