1. The present Revision Petition is filed by the Petitioner under Section 21(b) of the Consumer Protection Act, 1986 against the Order passed by the State Consumer Disputes Redressal Commission, Gujarat (hereinafter referred to as the “State Commission”) in CMA No. 613/2011 dated 29.02.2012.

2. In the complaint Case, it was stated that Respondent No.2 (hereinafter referred to as the Respondent) was working in Alembis Chemicals, Gorwa Road, Vadodara for the last several years as micro-lab operator. The, Respondent is a member of the Employee State Insurance Scheme. Necessary deductions were made from his salary towards insurance. On 09.04.2007, the Respondent suffered from chest pain. He started vomiting and felling restless and was taken to his family doctor Dr. Wanjani, who advised him to consult a cardiologist as angiography and angioplasty were required in his case. Under the provisions of State Employees Insurance Scheme, the Respondent was to move to Civil Hospital, Ahmedabad. Instead he got admitted in Baroda Heart Institute, where he underwent angioplasty and remained as an indoor patient from 09.04.2007 to 14.04.2007. He incurred an expenditure of Rs. 1,39,900/-towards the cost of the operation and medicines etc. The Respondent filed his claim on 19.06.2007 towards Insurance. The Petitioners sanctioned an amount of Rs. 54,000/- on 24.12.2007. The Respondent accepted the amount sanctioned by the Petitioners under protest. Being aggrieved by the part payment of his claim, the Respondent filed a Complaint in the District Forum with a prayer to direct the Petitioners to pay the remaining amount of Rs. 85,900/- towards the claim filed, with interest @18% from the date of filing the claim upto date of recovery. The Respondents also sought compensation for mental torture and Rs. 5,000/- towards Litigation Costs.

3. The District Forum, vide order dated 26.08.2009, directed the Petitioners to pay Rs. 85,900/- with 9% interest from the date of payment i.e. from 28.01.2008 till realization. Further, Petitioners were directed to pay to the Complainant Rs. 3,500/- as compensation for mental agony and inconvenience and Rs, 1,500/- towards litigation cost.

4. Thereafter, Opposite Party No.1(in the Complaint Case)has filed an Appeal before State Commission against the Respondents. The State Commission, vide order dated 21.06.2011, allowed Appeal No. 326/2010 and dismissed the order of District Forum only against the Opposite Party No.1.

5. The Petitioners filed C.M.A. No. 613/2011 before the State Commission. Condoning the delay of 45 days in filing Appeal No. 326/2010, the State Commission, vide order dated 29.02.2012, dismissed C.M.A No. 613 of 2011 on the ground that the said application was filed with an intention of delaying the matter. . Being aggrieved by the orders passed by the State Commission, Petitioner has preferred the present Revision Petition.

6. Heard the Learned Counsel for the Petitioner. The Respondents were proceeded ex-parte.

7. Learned Counsel for the Petitioners drew our attention to the Hon’ble Supreme Court judgement in State of Rajasthan versus Mahesh Kumar reported in (2011) 4SCC 257, para-8.

“In this connection it will be profitable to refer to the judgement of a bench of three judges of this Court in State of Punjab versus Ram Lubhaya Bagga where the bench has laid down that the Government would be justified in limiting the medical facilities to the extent it is permitted by its financial resources. In the instant case, the Government has formulated the necessary Rules, permitting the reimbursement of medical expense in certain situations and up to a certain limit. The Government has been reimbursing the necessary expenditure as permitted by the Rules uniformly. It will, therefore, not be proper for a Government employee or for his relatives to claim reimbursement of medical expenses otherwise than what was provided in the Rules”.

 As per Section 56 of Employees State Insurance Act, 1948, an insured person or (where such medical benefit is extended to his family) a member of his family whose condition requires medical treatment and attendance shall be entitled to receive medical benefit. Further, Section 57 provides for the scale of medical benefit provided to the insured person or to his extended family.

Section96-A talks about the claims for reimbursement of expenses incurred in respect of medical treatment of insured person and (where such medical benefit is extended to his family) his family may be accepted in circumstances and subject to such conditions as the Corporation may by general or special order specify.   

Section Officer of Health & Welfare Department had intimated to Petitioner No.2 vide letter dated 17.04.2001, that as per the rules and regulations of ESI Medical Manual, Insured Person cannot claim more and special facility for the treatment available at Government Hospital. Thus, sanction can’t be given for expenses for the treatment at Hospital having higher rate than as sanctioned by the Government.

Also, in Circular dated 31.01.2002 of the Director Medical Services, Employees State Insurance Scheme, Ahmedabad, it is stated that sanction can’t be given for expenses for the treatment at Hospital having higher rate than sanctioned by the Government.

State Commission failed to appreciate that the Petitioners were under bonafide belief that Opposite Party No.1 (in the Complaint Case) was deemed to have filed Appeal No. 326 of 2009 in respect of all original Opposite Parties (in the Complaint Case), since all of them are holding offices in the Employees State Insurance Scheme and were joined as parties in their official capacities. Opposite Party No.1 (in the Complaint case), however, has not impleaded the Petitioners as parties to his appeal. Thus, when Petitioners came to know about the above appeal filed by Opposite Party No.1 (in the Complaint case), they immediately filed C.M.A. No. 613/2011 in the said appeal. The State Commission, however, has rejected the same application on the ground that the said application was filed with an intention to delay the matter in providing justice to the Respondents.

8. Having heard the Learned Counsel for the Petitioners and after carefully going through the record, we are convinced that the Petitioners should be heard on merits by the State Commission. In view of the same, the present Revision Petition stands allowed with a cost of Rs. 25,000/- imposed on Petitioners for the delay in filing Appeal before State Commission and matter is remanded to State Commission to be heard on merits.