Heard learned counsel for petitioner and respondent on admission. There has been delay of eight days in filing revision petition beyond prescribed period of limitation, for which an application for condonation of delay has been filed by petitioner. For the reasons assigned in the application filed by petitioner delay in filing revision petition is hereby condoned. Factual matrix are that surgical operation of knee of wife of respondent, who was beneficiary of CGHS available to Central Government Employees, was carried out in a private Hospital not recognized by CGHS. After treatment was over, claim of Rs.3,32,577/- was made by respondent with petitioner for reimbursement, which was rejected holding this to be not a case of Orthopedic, emergency necessitating treatment in private hospital. Aggrieved respondent took recourse for redressal of his grievance before Consumer Grievance Redressal Agency filing a consumer complaint with District Forum. Complaint was resisted by petitioner stating that since it was not a case of emergency necessitating immediate surgery, treatment could have been availed only in hospital recognized by CGHS. However, District Forum having overruled contention raised on behalf of petitioner directed reimbursement of expenses incurred over treatment by respondent alongwith compensation of Rs.1,00,000/-. State Commission too in appeal putting reliance on certificate issued by treating doctor, who was a Orthopedic surgeon, which showed emergency, dismissed appeal. Having regard to repudiation of claim only on premises of there being no evidence about emergency necessitating immediate surgical operation, certificate issued by Orthopedic Surgeon, who carried out operation, clinches the issue. Having considered submissions of parties and regard being had to the nature of repudiation, no fault can be found with order of the State Commission, which is accordingly affirmed and resultantly revision petition being without substance is dismissed, with no order as to costs.
......................JB.N.P. SINGHPRESIDING MEMBER | |