BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
Complaint No.337 of 2021
Date of Instt. 06.10.2021
Date of Decision: 31.10.2022
Kuldip Kumar son of Shri Lal Chand resident of # 107/C, Ravinder Nagar, P. O: Model Town, Jalandhar-144003.
..........Complainant
Versus
1. Food Corporation of India through the Divisional Manager, Divisional Office, S. C. O:48, Ladowali Road, Opposite Tehsil Complex, Jalandhar-144001.
2. Food Corporation of India through the General Manager, (Region), Regional Office (Punjab), BAY No.34-38, Sector:31A, Chandigarh-160017.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Smt. Jyotsna (Member) Sh. Jaswant Singh Dhillon (Member)
Present: Complainant in Person.
Sh. Iqbal Singh, Adv. Counsel for OPs No.1 & 2.
Order
Dr. Harveen Bhardwaj (President)
1. The instant complaint has been filed by the complainant, wherein it is alleged that the complainant is retired from the office of General Manager (Region), Regional Office, (Punjab), Food Corporation of India, Chandigarh-160017 (Respondent No.2), on 31-5-2008 as Assistant General Manager (General). The Headquarters of Respondents, FCI, New Delhi notified Medical Health Scheme for the retirees of the Corporation vide Circular No.48 of 1999 bearing File No.EP.43111//90-Vol.III dated December. 15, 1999. The same however, was circulated by OP No.1 vide endorsement No.Admn/A-17(3)/Medical/99/14225 dated 22.02.2000. Consequent upon retirement on superannuation the complainant was given permission for permanent settlement at Jalandhar and also to avail medical facility under medical health scheme after superannuation from District Office (Now Divisional Office) Jalandhar vide office order No. A/1(2273)/07/EI/5959 dated 9/10.7.08. A medical identity card bearing No.02 was also issued. This card was however, replaced by Respondent No.1 by issuing a fresh card bearing No.447/19.
The para No.3 of this scheme which is reproduced below suggests that:-
“The Scheme would be a reimbursement scheme of actual expenses incurred by the retired employees/spouse in any hospital in India for indoor treatment with the ceiling amount prescribed and subject to production of original vouchers/cash memos for the admissible item only".
This scheme was however, modified by the Headquarters of respondents vide Circular No.EP-12-2004-26 dated October 28, 2004 issued from File No EP 43(9)/2002-Vol-1. By this circular, it was allowed reimbursement up to Rs.5000.00 (Rupees Five Thousand only) per annum financial year for OPD treatment with the annual ceiling of Rs.50,000/- in the existing scheme on the treatment of the following prolonged disease subject to the condition that the retired employee has to obtain a medical certificate from the specialized Doctor of Govt. hospital/empanelled hospital/Medical Officer of the FCI:-
(i) Heart ailments &FUC Hypertension
(ii) Disbetes mellitus.
(iii) Paralysis/Cerebrovascular attael
(iv) FUC Thyroid disorder.
(v) Kidney disorders.
(vi) Bronchial Asthma.
(vii) Cancer
Again vide Circular No.EP-12-2006-25 dated October 20, 2006 issued from File No.EP.43(22)/2005 has modified the scheme vide para 3 which is read as under:-
With a view to ensure that the medical facilities could be availed of by the maximum number of retired employees/workers while maintaining self sustaining character of the Scheme, the existing Scheme has been modified as follows:-
Quantum of Reimbursement
The Members of the Scheme would now be eligible for reimbursement of expenditure incurred for indoor/outdoor treatment up to Rs.1,00,000/- against the existing Rs.50,000/- for every financial year, with expenditure on outdoor treatment for special diseases being limited to Rs.10,000/ within the annual ceiling of Rs.1,00,000/-.
As circulated by the Headquarters of Respondents vide Circular Na.EP-12 2015-07 dated 9th March, 2015 circulated from F.No.EP.43(3)/2014 that with a view to simplify the procedures for reimbursement of Bills related to Medical treatment of FCI beneficiaries, the issue of removal of condition of submission of essentiality certificate has been examined in consultation with the Standing Committee of FCI Headquarters. Accordingly the existing condition of submission of Certificate-A (for OPD) and Certificate-B (for IPD) duly filled/certified for reimbursement of medical bills was dispensed with in respect of treatment taken by FCI beneficiaries from Govt. Hospital/FCI empanelled Hospital/FCI Doctor. To fulfill the requirement of Circular No.EP-12-2004-26 dated October 28, 2004 issued from File No.EP.43(9)/2002-Vol-1 for the declared (vii) prolonged diseases after obtaining the required certificate dated 12-5-2020 issued by Dr. Sujit S. Sawadtkar MD (Medicines) DNB (Cardiology) Interventional Cardiologist, NHS NASA & HUB Superspeciality, Hospital, Jalandhar an empanelled Hospital in respect of myself and dated 12-5-2020 issued by Dr. Tarun Aggarwal M.D (Internal Medicine) Specialize in Diabetes, Thyroid & Non-Invasive Cardiology in respect of my wife Smt. Satish Kumari were submitted to the Divisional Manager, Food Corporation of India, Jalandhar on 4 June, 2020, vide my letter dated 4 June, 2020. The same however, was diarized vide No.326.dated 06/06/2020. Vide circular No.EP-12-2016-23 dated 30th Dec. 2016 issued from file No.EP 43(06)/2016 the Headquarters of respondents Food Corporation of India, New Delhi has circulated the approval of Ministry of Consumer Affairs, Food and Public Distribution, Department of Food and Public Distribution, New Delhi as conveyed to FCI vide their letter No.16-1/2011-FC-1 dated 11.11.2016 for Post Retirement Medical Scheme (PRMS) of the Corporation applicable to the Employees of the Corporation (Category I, II, III and IV) only in supersession of the Medical Scheme for Retired employees issued vide No.48/1999 dated 16.02.1999 as amended from time to time. Further, in the circular ibid dated 30th December, 2016 Headquarters FCI, New Delhi has clarified that in respect of Departmental workers, the existing Medical Scheme and instructions issued vide Circular No.48/1999 dated 16.02.1999 and as amended vide. Circular No.EP-12-2012-13 dated 28-06-2012 and clarificatory circular No.EP-12-2013-03 dated 08.02.2013 shall continue to be applicable as amended from time to time. Since the desired certificate of prolonged disease as per the requirement was furnished as stated in preceding para No. 6 (Supra), the complainant submitted two claims in respect of treatment taken for self and treatment taken by his wife on dated 7th June, 2021 under Speed post, which were cleared/passed and an amount of Rs.1898/- was credited on 28th June, 2021 in the saving account of complainant in SBI, Mithapur Road, Jalandhar for eligible items and after deducting Rs.50/- as token annual membership fee to fulfill the requirement as dated 30 Dec. 2016 prescribed at point No.3.3 of circular No.EP-12-2016-23 issued from file No.EP-43(06)/2016 Headquarters, Food Corporation of India, New Delhi. The facts can be got confirmed from the record maintained in the Office of respondent No.1 i.e. Divisional Manager, FCI, Jalandhar as this record is mandatory to be maintained as suggested at point No.7.5 of Circular No.EP-12-2016-23 dated 30th Dec, 2016 issued from file No.EP-43(06)/2016 of Headquarters, Food Corporation of India, New Delhi. It is however, added that as per point No.7.9 of Circular. The validity of medical certificate issued by FCI Medical Officer/Govt. Hospital/ Specialized Doctor of empanelled hospital certifying prolonged disease will be 3 years. It is further submitted that point No.7.10 of Circular suggests that “where claims are required to be forwarded to Medical Officers, as per instructions, it would be the responsibility of the Drawing and Disbursing Officer of the concerned office to forward the claims to the Medical Officer within 15 working days of the receipt of claim. Medical Officer would be required to verify the claims within 30 working days from the date of the receipt of the claim. The complete processing of the claim will be completed within 60 working days failing which concerned erring official officer shall be liable for administrative action". Not only this, the facts stated in par No.12 (Supra), the Reportable judgment in Writ Petition (Civil) No.694 of 2015 of Hon'ble Supreme Court of India, Civil Original Jurisdiction has given verdict that "We, hereby, direct the concerned Ministry to device a Committee for grievance redressal of the retired pensioners consisting of Special Directorate General, Directorate General, 2 (two) Additional Directors and 1 (One) Specialist in the field which shall ensure timely and hassle free disposal of the claims within a period of 7 (seven) days. We further direct the concerned Ministry to take steps to form the Committee as expeditiously as possible. Further, the above exercise would be futile if the delay occasioned at the very initial stage, i.e. after submitting relevant claim papers to the CMO-1/C, therefore, we are of the opinion that there shall be a timeframe for finalization and disbursement of the claim amounts of pensioners. In this view, we are of the opinion that after submitting the relevant papers for claim by a pensioner, the same shall be reimbursed within a period of 1 (one) month". Sir, what to talk to honor the Directions of Supreme Court of India (Judgment in an identical matter of medical claim of pensioner on CGHS pattern) as stated in the preceding para No.13 (Supra) for making the payment to Pensioners on account of medical reimbursement the Respondent is even not adhering to the instructions of his own Higher Authorities. The instructions for making the payment of claims by the Food Corporation of India are discussed in preceding para No.12 (Supra) as is evident from letter dated 17th August, 2021 of the complainant delivered in the office of Respondent No. 1 diarized vide No.2597 dated 18/8/21 sending thereby claims for reimbursement of OPD treatment taken from Empanelled Hospital for Rs.7155/-. What to speak of making/releasing the payment of the above claims of the complainant, the fate of these claims are not known to the complainant as to whether these have been referred to the Medical Officers of Food Corporation of India because neither the payment has been received/made to the complainant nor the claims have been returned to the complainant for removing/asking any deficiency/clarification observed if any by the Respondent No.l for removing the same and as such, the present complaint filed with the prayer that the OPs be directed to release/disburse the payment of Rs.7155.00 only which have been withheld arbitrarily violating prevailing instructions and as per the Law of land if the payment is withheld without any genuine grounds and not made within reasonable period, necessary interest of such rate as notified by the Central Govt. from time to time, up to the date of making/releasing the payment is liable to be paid on delayed payment to the complainant which may kindly be considered to be allowed. Further, OPs be directed to pay a compensation and punitive damage for mental tension paid and agony to the tune of Rs.75,000.00/- and Rs.5000/- as litigation expenses.
2. Notice of the complaint was given to the OPs, who filed their joint written reply and contested the complaint by taking preliminary objections that the present complaint is not maintainable as the complainant does not fall within the definition of consumer as provided under the Consumer Protection Act being an ex-employee of the OPs. Hence the present complaint is liable to be dismissed on this sole ground only. It is further averred that without prejudice to the above objections the present complaint is not maintainable as the complainant has got no cause of action against the OPs to file the present complaint. It is further averred that without prejudice to the above objection, the present complaint is not maintainable being infructuous as the due amount, which infact was more than what is being claimed by the complainant, has already been credited into the account of the complainant and nothing remains payable to the complainant. It is further averred that the present complaint is not maintainable as the complainant had not approached this Commission with clean hands. On merits, it is admitted that the complainant has retired employee from FCI, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
3. Rejoinder to the written statement filed by the complainant, whereby reasserted the entire facts as narrated in the complaint and denied the allegations raised in the written statement.
4. In order to prove their respective versions, both the parties have produced on the file their respective evidence.
5. We have heard the learned counsel for the respective parties and have also gone through the case file as well as written arguments submitted by counsel for both the parties very minutely.
6. The complainant has retired from the OP as Assistant General Manager. He was allowed to avail medical facility as per notification Ex.C-1 under medical health scheme for the retirees of the Corporation. He has proved on record the copy of circular vide which this notification was circulated as Ex.C-2. He has also proved on record the medical identity card Ex.C-3 and Ex.C-4. It has been alleged that the complainant submitted two claims in respect of treatment taken for self and taken by his wife on 7 June, 2021 and he has proved on record the copies of the claims submitted before the OPs on 07, June, 2021 Ex.C-12 which were passed/cleared and the amount of Rs.1898/- was credited in his account on 28 June, 2021. The grudge of the complainant is that as per circular Ex.C-9, the Drawing and Disbursing Officer would forward the claim to Medical Officer within 15 working days of the receipt of the claim which will be verified by the Medical Officer within 30 days from the date of receipt of the claim. So, as per this circular, the entire process is to be completed within 60 working days, but in his case, the complainant is not aware of the fact as to whether his claims have been referred to Medical Officers of FCI or not or the payment has been received or not nor the claims have been returned to the complainant due to any deficiency nor the amount of Rs.7155/- have been reimbursed to the complainant. In such circumstances, the complainant is entitled to get the compensation and damages for mental tension and agony suffered by the complainant. It has been alleged that the OPs have not considered and followed the circulars issued by the Pb. Govt. from time to time, even the judgment passed by the Hon’ble Supreme Court has not been considered and implemented by the OPs. Therefore, the request has been made to allow the complaint.
7. The Ld. Counsel for the OPs has submitted that the present complaint is not maintainable as the complainant does not fall within the definition of consumer. He has submitted that all the circulars and notifications relied upon by the complainant are matter of record as those are government documents, circulars and notifications. It has been submitted by the opposite counsel that the claim submitted by the complainant of Rs.7155/- have already been deposited in his account. The complainant has submitted claim for Rs.7155/- on 18.08.2021 and this claim was passed on 07.09.2021 for Rs.7613/- and the amount has been paid on 18.09.2021, which is well within the time period granted as per the notifications and circulars. Since, the complainant has already received the payment, therefore he is not entitled to any relief.
8. The circulars and notifications relied upon by the complainant are not denied nor disputed. It is also not disputed that the complainant has retired from the OP. As per medical identity card, he is entitled to get medical facility under medical health scheme after superannuation from District Office, Jalandhar. The complainant has referred the claim furnished by him on 07.06.2021, which admittedly was paid to him. Now the complainant has alleged the amount of Rs.7155/-, which allegedly was not deposited in his account nor was returned to him. He had furnished the copy of the medical certificate issued by the Dr. Surjit Singh Sawadatkar Ex.C-8. He has referred about two claims which were submitted by him on 17.08.2021 as per Ex.C-14. These claims are for Rs.7155/-. As per his own case, as per circular, the entire process from submission of medical bill till its reimbursement is to be completed within 60 days. He furnished his claim on 17.08.2021. He has referred the circular Ex.C-15 in which, it has been directed by the Finance Department that the bills of the third party will be examined and passed within 6 days from the receipt of the bills in finance and the bill of employees shall be passed and cleared within 4 days from the receipt of the bill in finance. The complainant has also produced on record the bills Ex.C-17, which have been paid to him as per his own document Ex.C-18. Now the dispute as per complaint is with regard to the bills Ex.C-14 which have allegedly been not returned or deposited in his account. Perusal of document Ex.OP-1 shows that in detail, he has furnished three bills. Ex.C-14 is the detail of all the three bills, which as per the complainant amounts to Rs.7155/-, whereas the complainant has given less amount in one bill. He has mentioned Rs.1321/-, whereas as per the bills Ex.OP-1, it is Rs.1779/-. So, in total it comes Rs.7613/-. As per Ex.OP-4, Ex.OP-5 and Ex.OP-6, the amount has been deposited in the account of the complainant on 18.09.2021 i.e. within one month of the furnishing of the bill Ex.C-14. The circular pointed out by the complainant Ex.C-15 provides that the bill should be passed within four days from the receipt of bill in finance, but the complainant has not produced on record any document to show when the bill was presented before the finance department and when the same was passed and cleared, however as per own version of the complainant, the same has been cleared within 30 days. So, there is no delay in depositing the amount or clearing the bill of the complainant. There is no deficiency in service and no unfair trade practice on the part of the OPs. Thus, thpe complainant is not entitled to any interest and as such, the complaint of the complainant is dismissed with no order of costs. Parties will bear their own costs. This complaint could not be decided within stipulated time frame due to rush of work.
9. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jaswant Singh Dhillon Jyotsna Dr. Harveen Bhardwaj
31.10.2022 Member Member President
