By Smt. C.S. Sulekha Beevi, President,<br /> <br /> 1. The case of the complainant is that he is a beneficiary of the Employees State Insurance Scheme. His wife was treated for kidney disease. On 21-3-2003 he submitted claim of treatment expenses for Rs.10941/-. He was assured several times <br /> <br /> <br /> by the doctor of E.S.I. Dispensary that the balance would be sanctioned very soon. Although he made enquiries as to why the balance of Rs.7125/- was not paid, he alleges that opposite parties have failed to given a satisfactory reply. The amount has not been paid so far. Hence the complaint.<br /> <br /> 2. Opposite parties have filed joint version. It is admitted that they received application for reimbursement of Rs.10941/-. The claim was sent to opposite party No.2 on 13-8-2003. The application was later returned to opposite party No.1 on 18-9-2004 with direction to take appropriate action after examing the admissibility of the claim. That Rs.3816/- was sanctioned after perusing the documents produced and as per government prescribed rates. The balance amount was not passed because complainant was unable to produce supporting documents. That opposite parties are bound to strictly adhere to the existing rules. Complaint is liable to be dismissed.<br /> <br /> 3. Ext.A1 series marked on the side of complainant. Exts.B1 to B4 marked on the side of opposite parties. No affidavit filed by either side.<br /> <br /> 4. The grievance of the complainant is that although he claimed reimbursement of Rs.10941/- the amount sanctioned was only Rs.3186/-. The claim of complainant for medical bills is Rs.3584/-. The claim towards lab test expenses and travelling expenses is Rs.4387/- and Rs.2970/- respectively. Ext.A1 series are the medical <br /> <br /> <br /> <br /> treatment records of the wife of the complainant. The amount sanctioned by opposite parties towards medical bills is Rs.3119.18. Against Rs.3584/- claimed by complainant. Ext.B1 series are the medical bills submitted to opposite party by complainant. Some bills have been rejected by opposite party with the reason that they are not endorsed by the doctor. Opposite party has clearly stated the reason for rejection against each medical bill. Ext.B1 series proves that the amount sanctioned by opposite parties towards medical bills is proper and legal.<br /> <br /> 5. The amount claimed by complainant towards lab test expenses is Rs.4387/- Ext.B2 series is the details of the claim received by opposite party. The amount sanctioned under this head is Rs.687/-. The difference is Rs.3700/-. In Ext.B2 opposite party explains the reason for disallowing each and every lab test bill rejected. Ext.B4 is the G.O.(P)27/94/H&FWD. Opposite party submits that the amount for lab test is sanctioned as per norms in the above Government Order. Ext.B2 and B4 proves that the amount sanctioned for lab test expenses is proper and legal.<br /> <br /> 6. Complainant has claimed Rs.2970/- towards travelling expenses. Ext.B3 is the details of the claim submitted by complainant. The amount sanctioned by opposite parties is only Rs.47/-. In Ext.B3 opposite parties have rejected the claim amount of Rs.2923/- on the ground that complainant has not produced any supporting documents to<br /> <br /> <br /> <br /> <br /> prove the traveling expenses. Complainant produced bus tickets for Rs.47/-. This amount has been sanctioned by opposite parties. Complainant is mainly aggrieved by the less amount sanctioned towards travelling expenses. He is a resident of Nilambur. Treatment was taken at Medical College, Kozhikkode. According to complainant Ext.A1 series treatment book is sufficient to prove the number of times he and his wife have travelled to Medical College. In Ext.B3 complainant has claimed bus charges, auto charges and jeep charges. These amounts were disallowed on the failure to produce supporting documents. Opposite parties contend that they are bound to maintain social security of insured persons and that department cannot do anything beyond the rules of E.S.I. Corporation. Complainant has not produced relevant documents to prove the expenses incurred for travelling. We do not find opposite parties have rejected the claim for travelling expenses deliberately or without valid reason. In the light of aforesaid facts, we hold that there is no deficiency in service on the side of opposite parties.<br /> <br /> 7. In the result, complaint is dismissed with no order as to costs. <br /> Dated this 16th day of November, 2007.<br /> <br /> <br /> C.S. SULEKHA BEEVI, PRESIDENT<br /> <br /> <br /> <br /> K.T.SIDHIQ, MEMBER<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> APPENDIX<br /> <br /> <br /> Witness examined on the side of the complainant : Nil <br /> Documents marked on the side of the complainant : Ext.A1 series<br /> Ext.A1 series: Medical treatment records of the wife of the <br /> complainant.<br /> Witness examined on the side of the opposite parties : Nil<br /> Documents marked on the side of the opposite parties : Ext.B1 to B4<br /> Ext.B1 series : Medical bills submitted to opposite party<br /> by complainant.<br /> Ext.B2 series : Details of the claim received by opposite parties.<br /> Ext.B3 : Form of Essentiality Certificate dated, 27-3-2003.<br /> Ext.B4 : G.O.(P)27/94/H&FWD. Dated, 8-2-1994. <br /> <br /> <br /> <br /> C.S. SULEKHA BEEVI, PRESIDENT<br /> <br /> <br /> <br /> K.T.SIDHIQ, MEMBER<br />