Haryana

Karnal

CC/3/2020

Raj Singh - Complainant(s)

Versus

Esic Dispensary - Opp.Party(s)

Romil Chaudhary

03 Aug 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL  COMMISSION, KARNAL.

 

                                                          Complaint No. 03 of 2020

                                                          Date of instt.07.01.2020

                                                          Date of Decision 03.08.2022

 

Raj Singh son of Shri Satbir Singh, resident of VPO Phoosgarh District Karnal.

                                                …….Complainant.

                                              Versus

 

ESIC Dispensary, Sector-13, Karnal through its Medical Officer.

 

                                                                      …..Opposite Party.

 

Complaint Under section 12 of the Consumer Protection Act, 1986 as amended Under Section 35 of Consumer Protection Act, 2019.

 

Before:  Sh. Jaswant Singh……President.       

      Sh.Vineet Kaushik ………..Member

      Dr. Rekha Chaudhary…..Member

       

 Argued by: Shri Abhishek Lathar, counsel for the complainant.

                    Opposite party exparte.

 

                    (Jaswant Singh President)

ORDER:   

                

                        The complainant has filed the present complaint Under Section 12 of the Consumer Protection Act, 1986 as after amendment Under Section 35 of Consumer Protection Act, 2019 against the opposite party (hereinafter referred as to ‘OP’) on the averments that complainant is working as HR Executive in Sunbeam Auto Private Ltd. Bhiwadi District Alwar, Rajasthan. Complainant is having ESIC policy no.2416826710 in which the name of complainant and his family members are mentioned. Suddenly the daughter of the complainant namely Saavi Lather was admitted in N.C. Jindal Institute of Medical Care and Research, Hisar for “Hip open reductions (CDH)” as OP referred to Saavi Lather in the said institute for treatment. The daughter of complainant was admitted on 29.03.2019 and was discharged on 02.04.2019. On that treatment complainant was incurred Rs.27347/-.  Thereafter, complainant lodged claim against the abovesaid policy and also submitted all relevant documents as per the demand of the OP but OP always postponed the matter and till today did not release the claim amount. Then complainant sent an legal notice dated 25.11.2019 to the OP and requested to release the claim but it also did not yield any result. In this way there is deficiency in service on the part of the OP. Hence this complaint.

2.             On notice, OP appeared and filed its written version stating therein that Smt. Renu Verma working as Drug Agent and Shri Vishnu is clerk who works for funding of medical bills in ESIC. It is further submitted that on inspection of records, it has been found that they have not received any claimed bills relating to insured Shri Raj Singh i.e. complainant. It is further submitted that if complainant has submitted his mediclaim bills, in that situation, he should inform all the details of bills to the OP i.e. on which date and to whom (medical employee) the medical bill was submitted so that proper action can be taken with regard to non-payment of bill of complainant and strict legal disciplinary action can be taken against those guilty employees.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copies of medical bills Ex.C1 to Ex.C5 and closed the evidence on 18.08.2021 by suffering separate statement.

5.             It is pertinent to mention here that OP failed to conclude its evidence after availing several opportunities including three last opportunities. On 31.05.2022 none has put into appearance on behalf of OP and proceeded against exparte by the order of this Commission.

6.             We have heard the learned counsel for the complainant and have gone through the record available on the file carefully.

7.             Learned counsel for the complainant, while reiterating the contents of complainant, has vehemently argued that complainant is having ESIC policy of the OP in which the name of complainant and his family members are mentioned. The daughter of the complainant namely Saavi Lather was admitted on 29.03.2019 and was discharged on 02.04.2019 in N.C. Jindal Institute of Medical Care and Research, Hisar for “Hip open reductions (CDH)”. On the treatment of his daughter, complainant has incurred Rs.27347/-. After that complainant lodged the claim with the OP for reimbursement of the said amount but OP did not pay the claim amount and prayed for allowing the complaint.

8.             OP has taken a plea in its written version that complainant has failed to submit the claim. The onus to prove its version lies upon the OP but OP has miserably failed to prove the same by leading any cogent and convincing evidence. Rather, complainant to prove his case placed on record his affidavit Ex.CW1/A  and medical bills Ex.C1 to Ex.C5. It is evident from the medical bills Ex.C1 to Ex.C5, complainant has spent Rs.27346/-on the treatment of his daughter in N.C. Jindal Institute of Medical Care and Research, Hisar. Moreover, when the person whose personal interest is involved in form of the claim amount, then, as to why, he would not lodge the claim. Hence, plea taken by the OP is having no force.

9.             Further, to rebut the evidence produced by the complainant, OP did not appear and opted to be proceeded against exparte, thus the evidence produced by the complainant is unchallenged and unrebutted and there is no reason to disbelieve the same. Hence, in view of the above discussion, the act of the OP amounts to deficiency in service and unfair trade practice. Hence, OP is liable to reimburse the amount of Rs.27,346/- to the complainant alongwith interest, compensation for harassment, mental agony and litigation expenses to the complainant.

10.           In view of the above discussion, we allow the present complaint and direct the OP to pay the amount of Rs.27,346/- to the complainant with interest @ 9% per annum from the date of filing of the complaint till its realization. We further direct the OP to pay an amount of Rs.5,000/- as compensation for harassment and mental agony and Rs.3300/-towards litigation expenses to the complainant.  This order shall be complied with within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:03.08.2022

 

 

                                                                       

                                                                President,

                                                    District Consumer Disputes

                                                   Redressal Commission, Karnal.

 

       

                (Vineet Kaushik)        (Dr. Rekha Chaudhary)      

                     Member                        Member