Punjab

Ludhiana

CC/16/444

Bhagwant Singh - Complainant(s)

Versus

ESIC Corpn. - Opp.Party(s)

R.D.Chaudhary

14 Dec 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA.                                                                   Complaint No: 444 dated 10.06.2016                                                                           Date of decision: 14.12.2017                 Bhagwant Singh son of Shri Harkamal Singh, resident of House No.3530, MIG Phase-II, Dugri, Ludhiana.                                                                                                                                                                                                   ..…Complainant                                                            Versus

1.The Director General, ESI Corporation, ESI Headquarters, Near Indra Prastha Post Office, Kotla Road, New Delhi.

2.The Regional Director, ESI Corporation, Sector 19-A, Madhya Marg, Chandigarh-19.

3.The Director, Health Services, Social Insurance, Punjab, Sector 34-D, Chandigarh.

4.The Incharge, ESI Hospital Campus, Bharat Nagar Chowk, Ludhiana.

5.M/s Gulzar Motors (P) Limited, G.T.Road, Dholewal, Ludhiana.

                                                                                                …..Opposite parties

            Complaint under Section 12 of Consumer Protection Act, 1986.

QUORUM:

SH. G.K. DHIR, PRESIDENT                                                                               SH. PARAM JIT SINGH BEWLI, MEMBER

COUNSEL FOR THE PARTIES:

For complainant            :         Ms.Suman Choudhary, Advocate.                                        For OP1 and OP2                 :         Sh.Sudhir Gupta, Advocate

For OP3                         :         Ex-parte.

For OP4                         :         Ms.Jaswinder Kaur, Senior Assistant along with

                                                Sh.Shashikant Verma, Representative.

For OP5                         :         Complaint not pressed by suffering statement by counsel

                                                for complainant on 19.08.2017.

ORDER

PER G.K. Dhir, PRESIDENT                                                                                  1.                 ESI deductions of complainant are made from his salary in view of his employment with OP5. Complainant suddenly suffered from acute pain in his stomach and liver and as such, due to guidance provided by OP4, he got treatment in Oswal Cancer Hospital in December 2013 and thereafter, on 25.4.2014. Again complainant suffered from acute pain in his abdomen and as such, he was taken to Shri Krihna Hospital, Model Town, Ludhiana, from where he was referred to DMC & Hospital, Ludhiana on 26.5.2014. Complainant remained admitted there till 9.6.2014. Complainant spent about Rs.83,517/- for his treatment in DMC & Hospital, Ludhiana. Bill of payment was forwarded to OP4, who failed to reimburse the same. In March 2015, complainant again suffered from some problem and on reference by OP4, complainant got treatment from CMC Hospital, Ludhiana by remaining admitted there from 20.3.2015 to 7.4.2015, from 10.4.2015 to 13.4.2015 and again from 1.5.2015 to 11.5.2015. It was diagnosed as if complainant is having pain of epigastrium on and off for the last two years; he has general body weakness for the last one month and is having yellowish discoloration of skin and sclera for the last 20 days. Abdomen was suggestive of calculus cholecystitis, gallbladder with thickness 4 MM. After treatment, complainant was discharged in satisfactory condition. Complainant had to spent Rs.9364/- from his own pocket in CMC Hospital, Ludhiana. Even the complainant was treated by the officials of OP4 during period from 24.4.2015 to 28.4.2015, but to no effect. Due to sufferance of acute and unbearable pain, complainant was brought to Satguru Partap Singh Apollo Hospital on 12.5.2015, where he was admitted with symptomatic gall stone disease + recurrent pancrotitis + pancriatic for four days. Operation was performed for saving life and limb of complainant and thereafter, he was discharged in satisfactory condition on 15.5.2015. Rs.2,87,244/- was paid to hospital authorities, regarding which, bill submitted with OP4, but reimbursement has not  taken place on one pretext or       the other. By pleading deficiency in service on the part of OPs and after serving legal notice dated 11.5.2016, this complaint filed for seeking reimbursement of spent amount of Rs.2,87,244/- plus Rs.83,517/- plus Rs.9364/- with interest @18% per annum. Compensation for mental harassment and humiliation of Rs.1 lac, but legal expenses of Rs.20,000/- and counsel fee of Rs.11,000/- more claimed.

2.                In joint written reply filed by OP1 and OP2, it is pleaded that the deductions of ESI from salary of complainant are subject to the verification of deposit with answering OPs. Complainant has to put answer by OP4 because the bills were forwarded by complainant to OP4. Moreover, the bills are to be reimbursed by DHS(PB) through ESI Dispensary/Hospital. Factum of reference of complainant for treatment by OP4 can be explained by OP4. There is no deficiency in service on the part of OP1 and OP2. As per office record of OP1 and OP2, complainant is having two insurance numbers and payment of Rs.4086/- as SB for the period 6.10.2014 to 1.11.2014 was made to complainant.

3.                In separate written reply filed by OP4, it is pleaded interalia as if complaint is not maintainable because the same does not discloses any cause of action; complainant is confused between two wings of ESI Scheme and this Forum has no jurisdiction in matter governed by the provisions of ESI Act because separate mechanism developed under the provisions of the said Act for redressal of the grievances. Director General, ESI Corporation and OP4 are merely controlling the dispensaries under ESI Scheme, where the workers are registered under the provisions of ESI Act. The second wing runs hospital known as ESI Hospital. In this complaint, complainant himself is mentioning that he has got treatment from Apollo Hospital, D.M.C. Hospital, CMC Hospital and Oswal Cancer Hospital, but his medical bills have not been disbursed to him. However, it is claimed that complainant has never submitted the bills for reimbursement with OP4 till date and as such, question of disbursement does not arise. OP4 cannot comment qua any amount spent by the complainant from his pocket on the treatment as alleged. Complainant may have been treated by ESI Model Hospital, Ludhiana, but he was never treated by Op4. No legal and valid notice was ever received by OP4 and as such, by denying other averments of the complaint, prayer made for dismissal of complaint.

4.                OP3 is ex-parte in this case, whereas complaint against OP5 was not pressed as per recorded statement of counsel for complainant dated 12.7.2016.

5.                Complainant to prove his case tendered in evidence his affidavit Ex.CA along with documents Ex.C1 to Ex.C88 and thereafter, his counsel closed the evidence.

6.                On the other hand, Counsel for the OP1 and Op2 tendered in evidence affidavit Ex.RA/1 of Sh.Sunil Dutt, SSO Employee of State Insurance Corporation, Ludhiana and thereafter, closed the evidence.

7.                Representative of OP4 tendered in evidence affidavit Ex.RA4 of Dr.Tarsinder Kumar and thereafter, closed the evidence.

8.                Written arguments not submitted by any of the parties. Oral arguments alone addressed by counsel for the parties and those were heard. Records gone through carefully.

9.                It is contended by representative of OP4 that original bills has not been submitted with OP4 and had those been submitted, then the processing of the same would have been done for making payment as per GHS rules. So, virtually Op4 has no objection in processing and allowing reimbursement of due amount, but as per GHS rules. Even contents of affidavit Ex.RA4 of Dr.Tarsinder Kumar establishes that bills in original have never been submitted by the complainant with OP4. When confronted with this position, then counsel for complainant was unable to respond for establishing that original bills actually were submitted with Op4. If that be the position, then fitness of thing warrants that complainant should be given chance to submit the original bills with OP4 within 15 days from the date of receipt of copy of order and on such submission, OP4 will take steps for getting the claim processed within 40 days from the date of receipt of the bills and thereafter, got the payment made within 30 days of processing, failing which, to pay interest on the present FDR rate of the banks namely 6% per annum with effect from today till payment. As fault lay with complainant himself in not submitting the original bills and as such, he is not entitled to any amount of compensation for mental harassment or to litigation expenses.

10.              Record produced by complainant consist of copy of temporary identification certificate Ex.C1 along with receipts of payments/bills/invoices as Ex.C2 to Ex.C82 and copy of legal notice Ex.C83 along with postal receipts Ex.C84 to Ex.C88. None of the documents produced to show that bills in original has ever been sent by the complainant to OP4 and as such, plea of OP4 is fully believable that original bills for reimbursement purposes has never been submitted by the complainant with OP4 till date. Reimbursement of the bills to be done by the OP4 is the submission of Sh.Sudhir Gupta, Advocate, representing OP1 and OP2 and there is no denial of that fact by representative of OP4. If complainant may be having two ESI numbers, despite  fact  that he can have one ESI number only, then his entitlement for reimbursement is governed by the provisions of ESI Act and rules framed there-under. No other point argued.

11.              As a sequel of above discussion, complaint disposed of in terms that complainant will submit the original bills with OP4 within 15 days from the date of receipt of copy of order and on submission of these original bills by complainant with OP4, it will take steps for getting the claim processed within 40 days from date of receipt of the bills and thereafter, payment will be got made by OP4 within 30 days of processing, failing which OP4 will have to pay the due adjudged amount with interest @6% per annum with effect from today till payment. No order as to compensation and costs. Copies of order be supplied to parties free of costs as per rules.

12.              File be indexed and consigned to record room.

 

                             (Param Jit Singh Bewli)                     (G.K. Dhir)

                              Member                                            President

Announced in Open Forum.

Dated: 14.12.2017.

Gurpreet Sharma