By Jayasree Kallat, Member:

 

            The petition was filed on 2-12-2006. The complainant is an employee of B.S.N.L., who is eligible for all the benefits including medical reimbursement. On 11-4-2005 the wife of the complainant was admitted in Baby Memorial Hospital, Kozhikode for surgery.  The wife of the complainant was discharged from B.M.H. on 21-4-2005. The hospital expenses including medicine was a total of Rs.22,690/-. The complainant had submitted all the bills and vouchers before the Accounts Office of B.S.N.L. for reimbursement.  The Accounts Office rejected the bill stating that the opposite party hospital charges were more than the contract scheme of B.S.N.L. The opposite party hospital was informed this matter by the complainant. After repeated requests the Accounts Office agreed to refund the amount as per agreed scheme. As such Accounts Officer, B.S.N.L. had refunded Rs.11050/-.   The complainant had repeatedly requested the Baby Memorial Hospital to reimburse the balance amount. O.P. hospital has not taken any steps to reimburse the medical expenses incurred by the complainant. Complainant is alleging deficiency of service on the part of opposite parties and has filed the complaint for refund of the medical expenses incurred for the treatment of his wife.

 

            Opposite paprty-1 the hospital filed a version denying the averments in the complaint except those that are expressly admitted. Opposite party hospital has raised the issue for non jointer of necessary parties.   According to O.P.1 B.S.N.L. is a necessary party to this proceeding. Opposite party admits that B.S.N.L. had entered into a memorandum of understanding with the opposite party hospital, in connection with the treatment of their employees. Complainant’s wife was admitted for the surgery on 11-4-2005 in opposite party hospital and had been discharged on 24-4-2005. The total bill collected by the O.P. hospital was only Rs.16721/- and not Rs.22690/- as mentioned in the complaint. The records of the opposite party hospital shows that only Rs.16721/- was paid for the treatment. The balance amount might have been for the purchase of medicine etc. for which opposite party-1 has no records. The opposite party hospital is not liable to pay any amount to the complainant. At the time of admission of the patient, the complainant was advised to produce the letter of authorization from the B.S.N.L. authorities and the medical identity card. As per the guidelines issued by B.S.N.L. by their order No.EMB/2200/RLBS/12 dated 16-2-2004 it was mandatory that the records be verified to find out whether an employee of the B.S.N.L. could be treated under the approved package between B.S.N.L. and the opposite party hospital. The complainant could not establish himself as a serving employee or pensioner and his wife as a beneficiary coming under the memorandum of understanding dated 30-10-2004.   Hence normal charges were collected from the complainant, as the complainant neither produced any records at the time of admission nor did he bring any authorization from the B.S.N.L. authorities. The memorandum of understanding between B.S.N.L. and the opposite party hospital specifies the name of the procedure and charges to be collected. The complainant has not followed the proper procedure. Under these circumstances O.P.-1 was not in a position to comply with the demands made by the complainant. O.P. prays to dismiss the complaint as there was no deficiency on the part of O.P.

 

            The Accounts Officer, Maintenance was impleaded as O.P.2 subsequently as per I.A. No.22/2208. Notice sent to O.P.2  was served but did not appear before the Forum. After several postings as O.P.2 did not appear before the Forum, O.P.2 was called absent and set exparte.

 

            The only point for consideration is whether the complainant is entitled for the relief sought in the petition?

 

            Complainant was examined as PW1 and Exts.A1 to A6 were marked on complainant’s side. O.P.-1 had filed affidavit. The complainant was not present to cross examine O.P.1. Hence document No.B1 was marked on O.P-1’s side.

 

            The case of the complainant is that he was an employee of B.S.N.L. and was eligible for the benefits under the reimbursement scheme by the memorandum of understanding with opposite party-1 hospital and B.S.N.L. The complainant’s wife who was a beneficiary under this scheme was treated at O.P.-1 hospital for surgery from 11-4-2005 to 21-4-2005. Complainant has produced Ext.A4series (21 in Nos.) which are bills for hospital charges and medicines for the treatment of complainant’s wife.   According to the complainant he had to expend Rs.22690/- towards the treatment of his wife. According to the O.P. the total bill collected by the opposite party was Rs.16721/- only. The complainant had impleaded Accounts Officer, Maintenance as O.P.2 in the party array. O.P.2 did not appear before the Forum or file any version on their part. Ext.A6 is produced by the complainant which shows that the complainant had treated his wife at Baby Memorial Hospital which was an empanelled one as per B.S.N.L. MR and submitted his claim for settlement. Ext.A6 further states that during the scrutiny of this bill it was noticed that the amount claimed for the medical treatment was higher than the B.S.N.L. MRS package rates which was approved by the hospital. This matter was intimated to the complainant and as per the request of the complainant for settling the bill, the bill was settled with reference to the CGHS rates admissible at that time. Ext.A6 is dated as 28-8-2008. Ext.A6 clearly shows that the complainant had received the reimbursement benefit as per admissible rates and the bill was settled by the B.S.N.L. The complainant has taken the stand that he is eligible for total reimbursement of the money expended towards the treatment of his wife. But he has not produced any other documents other than Ext.A6 document to prove his case. As per ext.A6 and according to the evidence of the complainant he has already received Rs.11050/- from the B.S.N.L. Perusing all the documents and taking into consideration the different aspects of this case we are of the opinion that the complainant is not entitled for any further amount from opposite party.

 

            In the result the petition is liable to be dismissed.

 

Pronounced in the open court this the 26^th day of October 2010.

Date of filing :2-12-2006

 

SD/- PRESIDENT                               SD/- MEMBER                       SD/-MEMBER

 

APPENDIX

 

Documents exhibited for the complainant:

A1. Photocopy of Memorandrum of Understanding between the DGM, BSNL, STSR, 

        Ernakulam and Baby Memorial Hospital, Calicut for recognition under BSNL   

        Employees Medical Re-imbursement Scheme.

A2. Photocopy of Certificate of Hospitalisation

A3. Photocopy of Medical reimbursement claim form for indoor treatment

A4 series (21 in Nos.) Photocopy of bills.

A5. Photocopy of Bill register.

A6  Photocopy of letter dt. 28-8-08.

 

Documents exhibited for the opposite party.

B1. Photocopy of bill.

Witness examined for the complainant:

PW1. Ramachandran.A.M.(Complainant)

Witness examined for the opposite party.

            None

 

                                                            Sd/- PRESIDENT

// True copy //

(Forwarded/By order)

 

 

SENIOR SUPERINTENDENT.