Punjab

Sangrur

CC/303/2016

Manpreet Singh - Complainant(s)

Versus

Manager - Opp.Party(s)

Shri Rohit Jain

08 Sep 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                               

                                                Complaint No.  303

                                                Instituted on:    23.02.2016

                                                Decided on:       08.09.2016

 

Manpreet Singh aged about 21 years son of Shri Mohinder Singh son of Shri Sohan Singh, resident of Village Azimabad Sanghrian, Malerkotla, District Sangrur.

                                                        ..Complainant

                                        Versus

1.     Employees’ State Insurance Corporation through its Manager, Karbala Road, Malerkotla District Sangrur.

2.     Employees’ State Insurance Corporation, Madhya Marg, Sector 19-A, Chandigarh through its Deputy/Regional Director.

3.     Medical Officer, Incharge ESI Dispensary, Maloud Road, Kup Kalan, Tehsil Malerkotla, District Sangrur.

4.     Medical Superintendent, Deputy Director Zonal, ESI Model Hospital, Bharat Nagar Chowk, Ludhiana.

5.     Director Health Services (SI) Punjab, Parivar Kalyan Bhawan, Sector 34-A, Chandigarh.

                                                        ..Opposite parties

 

For the complainant  :       Shri Rohit Jain, Adv.

For OPS no.1&2       :       Shri S.M.Goyal, Adv.

For OP No.3,4&5      :       Dr.Tejinder Singh.

 

Quorum:   Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

Order by : Sukhpal Singh Gill, President.

 

1.             Shri Manpreet Singh,  complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the complainant was an employee of Nahar Fabric Jitwal Kalan and is covered/insured under ESI IP no. 1213558022 and is paying the necessary contribution, as such is a consumer of the OPs. 

 

2.             The case of the complainant is that when the complainant was coming back on motorcycle from his workplace on 1.5.2015, then he met with an accident with a rehra and sustained multiple injuries on his person and as such was taken to ESI Dispensary from where he was referred to ESI Hospital, Ludhiana and thereafter to CMC Hospital Ludhiana, where he remained admitted from 1.5.2015 to 12.5.2015 and spent an amount of Rs.1,30,000/- on his treatment including medicine, attendant, his food and transportation etc. As such, the complainant submitted the claim form along with the documents with the Ops, but nothing was done despite submission of the documents and lastly the Ops refused to pay the claim amount. Thus, alleging deficiency in service on the part of the OPs, the complainant has prayed that the OPs be directed to pay his claim amount of Rs.1,30,000/- along with interest and further claimed compensation and litigation expenses.

 

3.             In reply filed by OPs number 1 and 2, legal objections are taken up on the grounds that the complaint is not maintainable, that the complainant has no locus standi to file the present complaint and that the complainant has not come to the Forum with clean hands and that the complainant has not submitted all the documents etc. On merits, it is admitted that the complainant is an employee of M/s. Nahar Fabrics as stated above and his ESI number is also admitted. It is admitted that the complainant spent near about Rs.1,30,000/- on the treatment, but it is denied that the complainant submitted claim form along with all the documents with the Ops and nothing was done.  The other allegations levelled in the complaint have been denied.

 

4.             In reply filed by OPs number 3 to 5, legal objections are taken up on the grounds that the complainant has no locus standi to file the present complaint, that the complaint is not maintainable and that the complainant has no cause of action to file the complaint. On merits, it is admitted that the complainant is covered under ESI Scheme. It has been denied that ESI Dispensary Jitwal Kalan referred the complainant to CMD Ludhiana.  It is admitted that the complainant brought on 10.10.2015 the claim form to the Ops, but it has been denied that the complainant submitted discharge slip, referral slip, eligibility certificate etc. It has been denied that the Ops refused to make the payment of the claim amount and all the requests made by the complainant have been thrown by the OPs. The other allegations levelled in the complaint are also denied.

 

5.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-48 copies of bills, Ex.C-49, copy of objection, Ex.C-50 copy of declaration, Ex.C-51 copy of discharge summary, Ex.C-52 copy of ESI card of Manpreet Singh, Ex.C-53 and Ex.C-54 copies of bills, Ex.C-55 copy of passbook, Ex.C-56 copy of self declaration, Ex.C-57  copy of referral slip, Ex.C-58 detail of employee, Ex.C-59 affidavit and closed evidence. The learned counsel for the OPs number 1 and 2 have produced Ex.OP1&2/1 affidavit and closed evidence. The learned counsel for Ops number 3 to 5 have produced Ex.OP3,4&5/1 affidavit, Ex.OP3,4&5/2 copy of letter, Ex.OP3,4&5/3 list of required documents, Ex.OP3,4&5/4 copy of referral slip dated 2.5.2015, Ex.OP3,4&5/5 copy of CGHS file, Ex.OP3,4&5/6 eligibility certificate given by the complainant generated on 19.1.2016 and closed evidence.

 

6.             We have very carefully perused the pleadings of the parties and heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits part acceptance, for these reasons.

7.             It is an admitted fact that the complainant being an employee of M/s.Nahar Fabrics, Jitwal Kalan  Malerkotla was having an ESI account with the Ops number 1 and 2. Further it is an admitted fact of all the parties that the complainant met with an accident on 1.5.2015 with a rehra and was brought to the ESI Dispensary, Jitwal Kalan from where he was referred to ESI Hospital Ludhiana and from where he was referred to the CMC Hospital Ludhiana where he took treatment for the period from 1.5.2015 to 12.5.2015 and spent an amount of Rs.1,30,000/-.  Further grievance of the complainant is that the Ops have not paid the due claim despite submission of all the documents to the Ops.  But, on the other hand, the stand of all the Ops is that the complainant has not submitted the required documents to the Ops for settlement of the claim.  Now, the fact remains that the complainant has produced all of treatment documents/bills on record as Ex.C-1 to Ex.C-48 and further C-51 as copy of discharge summary, a copy of which have also been provided to the Ops. As such, we feel that sufficient time should be granted to the Ops for settlement of the claim after receiving the documents.  Under the circumstances, we feel that the ends of justice would be met if a direction is given to all the parties to cooperate with each other and to provide the documents and settle the claim thereof of the complainant.

8.             Without going further into merits of the case, we allow the complaint partly and direct OP number 3 to send the requisite documents along with the recommendation to OP number 4 on or before 20.09.2016.  Further the OP number 4 will send the documents along with recommendation to settle the claim to OP number 5 uptil 5.10.2016  and thereafter the OP number 5 shall decide the claim of the complainant uptil 5.11.2016 and intimate its decision to the complainant immediately by registered post.  It is made clear that if the complainant still feels unsatisfied with the decision of the OP number 5, then it is open for the complainant to approach this Forum again, if he so desired.  With these observations, the complaint in hand is disposed of accordingly. A copy of this order be supplied to the parties free of cost.  File be consigned to records.

                Pronounced.

                September 8, 2016.

                                                        (Sukhpal Singh Gill)

                                                           President

 

 

                                                             (K.C.Sharma)

                                                                  Member

 

 

                                                         

                                                                (Sarita Garg)

                                                                   Member