Haryana

StateCommission

A/751/2024

ECHS POLY CLINIC REWARI - Complainant(s)

Versus

HANS RAJ - Opp.Party(s)

RAJESH KAUL

01 Aug 2024

ORDER

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA, PANCHKULA

 

First Appeal No.751 of 2024

                   Date of Institution:04.06.2024

          Date of Decision:01.08.2024

 

1.      The Officer In-charge ECHS Poly Clinic Rewari, near Gopal Dev Chonk, Tehsil and District, Rewari, Haryana 123401.

2.      The Director, ECHS Regional Centre Jaipur, Pin-900337, C/o 56 APO.

3.      The Managing Director, ECHS Central Organization, ECHS Integrated Headquarter Ministry of Defense (Army) Thimayya Marg, near Gopinath Circle Delhi Cantt.-110010.

4.      The Govt. of India, Ministry of Defense, through its Chief Secretary to Ministry of defense, New Delhi 110011.

…Appellants

Versus

 

Hans  Raj S/o Sh.Amar Singh aged 60 year R/o village Chandawas Tehsil and District Rewari.

…Respondent

 

CORAM:   Hon’ble Mr. Justice T.P.S Mann, President.

                   Mr.S.P.Sood, Judicial Member

                   Mrs. Manjula, Member.

 

Present:-    Shri  Rajesh  Kaul, counsel for the appellants.

 

O R D E R

T.P.S. MANN J.

 

          Delay of 182 days in filing the appeal is condoned for the reasons stated in the application for condonation of delay.

2.      Opposite Parties-Appellants, have filed the instant appeal under Section 41 of the Consumer Protection Act, 2019 for challenging the order dated 20.10.2023 passed by learned District Consumer Disputes Redressal Commission, Rewari whereby complaint filed by complainant-Hans Raj was allowed with direction to the OPs to pay Rs.4,32,277/- jointly and severally, alongwith compensation of Rs.35,000/- on account of mental agony and harassment and Rs.11000/- as litigation expenses to the complainant, along with interest @ 9% per annum with yearly rests from the date of filing of the complaint till its expiry of period of one month, from today, failing which the said amount shall fetch interest @ 12% per annum with yearly rests from the date of filing of the complaint till realization.

3.      The brief facts of the case are that  complainant joined Indian Army on 10.12.1982 as SKT and retired on 1.03.2014 on completion of 31 years 3 months and 22 days distinguished service as Subedar Major. The complainant had paid a sum of Rs.39,000/- as contribution towards ECHS (Ex-serviceman Contributory Health Scheme) at the time of discharge from the Indian Army and same has been mentioned in PPO in ECHS contribution clause. On 08.05.2021, complainant’s wife Mrs. Dhanvatti was admitted in Capt. Nand Lal Yadav Hospital Rewari in Emergency having COVID-19 + (positive) infection.  Subsequently, an emergency certificate dated 08.05.2021 was issued by the treating doctor. On 09.05.2021, the matter was brought to the notice of the officer-in-charge ECHS Polyclinic Rewari at 12.20 hours on 10.05.2021.  ECHS Polyclinic Rewari also issued the emergency information report. On 08.05.2021, HR CT chest  of patient Smt.Dhanvatti was carried out at Dr.Deepak Ultra Sound & Diagnostic Centre Rewari. The complainant’s wife Smt.Dhanvatti was admitted on 08.05.2021 and discharged on 18.05.2021. The complainant spent Rs.5,37,277/- on her treatment. He submitted the bills to the officer-in-charge, ECHS Poly Clinic, Rewari, Haryana and duly countersigned the same were forwarded to OP No.2. However, only a sum of Rs.1,05,000/- has been reimbursed to the complainant.  The complainant was entitled to balance amount of Rs.4,32,277/-.  The complainant requested the OPs to pay the outstanding amount of Rs.4,32,277/- in accordance with Director General, Health Service, Haryana Memo No.3PM(COVID)/2020/20564-20614 dated 18.09.2020 and Managing Director ECHS, Central Organisation ECHS, Adjutant General’s Branch, Intergated Headquarters, Ministry of Defence (Army), Thimayya Marg, near Gopinath Circle, Delhi Cantt 110010 letter No. B/49761/AG/ECHS dated 06.05.2021, but all in vain. Faced with this situation, he got issued notice through his counsel to the OPs.However, OP No.2 had replied vide letter dated 02.11.2021. Thus there was deficiency in service on the part of the OPs. The complainant  prayedfor refunding the balance amount of Rs.4,32,277/- alongwith litigation charges of Rs.30,000/- and also to pay Rs.5000/- as cost of notice.

4.       The complaint was resisted by the opposite parties by filing theirwrittenstatement in which OPsraising preliminary objections aboutcomplainant not consumer, jurisdiction, locus standi, cause of action and maintainability of complaint, etc. were also raised and requested to dismiss the complaint.

5.      On merits, OPs alleged that it was very strange on the part of hospital/ complainant that HR CT of patient, Smt.Dhanvatti W/oSubedar Major Shri Hansraj (Retd.) carried out on 08 May 2021 shows CTSS of 13/25 and a subsequent HRCT done on 17.05.2021 shows CTSS of 14/25 indicating the deterioration in the clinical status of the patient.  Despite the deterioration of clinical status of patient, she was discharged by the hospital on 18.05.2021.  The bills were claimed against claim ID 18043446 on UTI site  on 22^nd July 2021 and bills were scrutinized by bill processing agency (BPA) in accordance with Haryana Govt. Letter No.2PM/Covid)/2020/9047-9097 dated 25.06.2020 promulgated as a policy to the hospitals for Covid-19 treatment.  It was further submitted that during the online submission of the claim, the hospital did not upload and submit covid-19 positive report and outside report. So the BPA validator on 2^nd August 2021 asked the hospital authorities to submit the same and also requested the hospital authorities to reconcile the bills as per State Govt. notified rates (Covid 19 positive patients stay in isolation ward/ICU without ventilator and ICU with ventilator) for the same and to upload and submit complete ICP (moderate, severe and very severe sickness details), nurses note and ICU chart, but instead of submitting the requisite documents asked by the BPA validator the hospital on 2^nd August submitted that All reports and breakups already uploaded.  No more provided by INDL for your info and further action. The BPA validator again on 11^th August 2021 requested to upload and submit covid mandatory for further processing of the claim.  On 12.08.2021 hospital submitted that Covid-19 report not provided by the INDL. Only for CT scan report already uploaded and finally when the hospital did not submit/upload the requisite documents asked by BPA validator then on 19^th August the BPA validator recommended the final amount of Rs.1,05,062/- and it was approved on 21^st August 2021 and claim settled through ECS on 3^rd Sep. 2021. The claim amount passed by the officials of OPs was correct and according to the Haryana Govt. Instructions. It was admitted that complainant is an ex-serviceman and he had paid Rs.39,000/- as contribution towards ECHS at the time of discharge from Indian Army.  Thus there was no deficiency in service on the part of the OPs and prayed for dismissal of the complaint.

6.      We have heard Sh.Rajesh Kaul, learned counsel for the appellants, perused the material available on record and have given our thoughtful consideration to the various pleas raised by the learned counsel for the appellants.

7.      Learned counsel for the appellantshas vehemently argued that  the treating hospitals did not upload and submit Covid-10 reports of the patient.  Further argued that according to the Haryana Govt. letter No.3PM(Covid)/2020/9047-9097 dated 25.06.2020, the appellants-OPs have already paid the total amount of Rs.1,05,062/-  to the complainant. The complainant was not entitled for any amount.  Therefore, the learned District Consumer Commission has wrongly and illegally allowed the complaint of the complainant.  Learned counsel for the appellants prays that appeal be allowed, impugned order be set aside and complaint of the complainant may be dismissed with costs.

8.        It is not in dispute that complainant has paid Rs.39,000/- as his contribution towards ECHS (Ex-servicemen Contributory Health Scheme) at the time of discharge from the Indian Army. It is also not in dispute that his wife remained admitted in Captain Nand Lal Yadav Hospital, Rewari from 08.05.2021 to 18.05.2021.  The plea of the appellants was that  the hospital did not submit  and upload the Covid-19 reports of patient, therefore, the BPA validator has recommended the claim of Rs.1,05,062/-. The amount approved by BPA validator is less than the actual amount spent by the complainant i.e. Rs.5,37,277/-.   Another plea was that as per Annexure A-4 and A-5, the reports of HRCT thorax and  HRCT Chest, carried out on 17 May 2021 shows CTSS 14/25 and subsequent on 08.05.2021 shows CTSS of 13/25 indicating the deterioration in the clinical status of the patient.    The patient got conducted several tests from different laboratories and it might be different results from different laboratories. Hence, the clinical status of the patient is correct.Perusal of the impugned order  20.10.2023 reveals that condition of complainant’s wife was critical, who battled for her life in the above said hospital during the wave of Corona Virus. The OPs have passed an order for settling the claim for meagre amount, which was wrong and illegal. The OPs illegally denied the total medical bills of the complainant.In para No.11 of the complaint it reveals that covid profile has been done by the hospital.   The OPs should have refunded the full medical reimbursement amount of Rs.5,37,277/- to the complainant because at the time of Covid-19, the Govt. of India has issued some important guidelines for the patient, who suffered with corona virus. The OPs paid an amount of Rs. 1,05,062/- to the complainant, which is lower than the amount spent by the complainant. The complainant is also entitled to Rs.4,32,277/-. Since, the complainant has suffered mentally, physically and monetarily due to the unprofessional, unqualified act on the part of the OPs.  The learned District Consumer Commission has rightly allowed the complaint of the complainant. The State Commission finds no reason or ground to interfere with the order of learned District Consumer Commission. Hence the appeal being devoid of merit stand dismissed in limine.

9. Statutory amount of Rs.2,82,182/- was deposited by appellants at the time of filing of this appeal. This amount is now ordered to be refunded to complainant-respondent-Hans Raj against proper receipt, identification and verification as per rules and registry of this Commission as accordingly directed.

10.  

11.    A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 2019. The judgment be uploaded forthwith on the website of the Commission for  perusal of the parties.

12.    File be consigned to record room.

 

01^st August, 2024       Manjula               S.P.Sood            T.P. S. Mann

                                      Member    Judicial Member        President

 

S.K

(Pvt. Secy.)