O R D E R<br /> Sri. Santhosh Kesavanath P., President.<br /> Case of the petitioner's is as follows:<br /> Petitioner is a 72 yrs. old Ex-service man. The petitioner is a member of Ex-serviceman contributory health scheme. The petitioner states that he was under regular treatment at E.C.H.S Poly Clinic, Kochi, for acute blood pressure and heart ailment, from 2003 on wards. Petitioner was also undergoing treatment for Gr. III prostrate Hypertrophy and Bilateral Injunial Hernia. Due to severe bleeding and pain while passing urin the petitioner reported at E.C.H.S Kochi and the doctor who examined the petitioner referred petitioner to Lisie Hospital, Kochi, an empan elled Hospital of E.C.H.S, for getting of an advice of a urologist. The petitioner consulted the urologist of Lisie Hospital on 26..4..2005 and he advised the petitioner for cystoscopy and prostate biopsy at E.C.H.S, Kochi. According to the petitioner when his condition became worse, He reported the doctor of E.C.H.S, Kochi on 3..5..2001. Since the condition of the<br /> <br /> -2-<br /> petitioner was in a malignant stage and due to the non availability of a specialist for doing Cystoscopy and prostate biopsy, the petitioner was again referred to Lisie, Hospital for doing Cystoscopy and prostate biopsy. When the petitioner approached Lisie Hospital, urologist was attending international conference at Colombo. The authorities of the hospital gave the petitioner an appointment of the urologist on 11..5..2005. Due to repeated journey to E.C.H.S, Kochi and Lisie Hospital the physical condition of the petitioner became worse and complications of injunial hernia became worse due to hectic journey. According to the petitioner since the condition of the petitioner was in a sinking stage and he was facing a life threatening emergency he was admitted to a nearest hospital on 7..5..2005 ie.,“The Caritas Hospital , Kottayam” the matter of admission to the Caritas Hospital was intimated to E.C.H.S authority due to the history of heart ailment, the doctors advised eco-cardio graphy and its report revealed mild left ventricular Hypertrophy. The petitioner was subjected to surgeory on 9..5..2005. TRUP was done as a measure of relieving obstruction and also a control to heamatoma. An amount of Rs. 35399/- have spent to meet the hospital expenses. Later a claim for reimbursement was submitted to the opposite party the said claim was repudiated on 8..6..2005 by the opposite party on the ground that emergency was not established for treatment in a non-empanelled hospital. The petitioner states that act of the opposite party is clear deficiency of service so he prays for allowing a claim amount of Rs. 35399/-.<br /> The opposite party entered appearance and filed version and contented that complaint is not maintainable because there is no fees charged by the opposite party, there is only one time contribution to become the member of this scheme, and the <br /> -3-<br /> petitioner is not levied any fee for treatments. They contented that petitioner joined the scheme voluntary so he is bound by terms and condition of the scheme. According to the opposite party as per the relevant rules the case of the petitioner is not coming under the specified emergencies mentioned in the conditions of emergency. The opposite party contended that in case of emergency admission to non empanneled hospital the patient or his bystander is required to inform the E.C.H.S authorities within 48 hours. and the authorities is required to verify the state of emergency and make necessary entriesin the emergency admission register kept in the Policlinic. If the petitioner has any complaint in repudiation of his claim he has to make complaints to the station headquartors, Regional headquartors and central organisation at Delhi. Here he has not complained to any of higher authorities. The opposite party contented that there is no deficiency in service on the part of the E.C.H.S so the petition is to be dismissed with their costs.<br /> Points for determination are:<br /> i) Whether there is deficiency in service on the part of the opposite party?<br /> ii) Reliefs and costs.<br /> Evidence in this case consists of affidavit filed by both parties and Ext. A1 to A8 documents on the side of the petitioner and Ext. B1 to Ext. B3 document on the side of the opposite party.<br /> Point No. 1<br /> Since the opposite party raised a contention with regard to maintainability that question is to be answered. The opposite party states that since there is no element of fees being charged by the opposite party, petition is not maintainable. We are of the opinion that the said contention is not sustainable because the opposite party admitted <br /> -4-<br /> that there is a one time contribution to become a member of the opposite party. Inorder to the file the petition before the consumer Forum the act states that if any service for a consideration is availed then the person become a consumer. So definitely the case of the petitioner is a consumer dispute as refered under section ii (e) and the Consumer Protection Act. Another contention raised by the opposite party with regard to maintainability is that as per the scheme of the opposite party the petitioner can redress his grievance by making a complaint to station head quartors and central organisation. We are of the opinion that as per section( 3) of the Consumer Protection Act. The provisions of the act are not in derogation of law but in addition to the provisions of any other law. So, the petitioner can choose to either file petition to the higher authority or file petition to the consumer Forum. So, we are of the opinion that the petition is maintainable before this Forum. The main question to be decided in this case is whether the repudiation of the claim is justifiable or not. The petitioner produced the repudation letter dated 8..6..2005 issued by the opposite party. The said letter is marked as Ext. A8. In Ext. A8 the reason for repudiation of the claim is stated as “emergency is not established”. According to the opposite party treatment in non empanelled facility should be justified only in a case of emergency situation. ie. delay in treatment in an empanelled hospital is likely to cause loss of life or in a serious deterioration of medical condition. The petitioner on 3..5..2005 reported the doctor of E.C.H.S, Kochi the referred form is produced by the petitioner and is marked as Ext. A1. In Ext. A1 as clinical note the medical officer stated that the petitioner is adviced cystoscopy and prostrate biopsy because the disease of the petitioner is adviced by the urologist as a case of malignancy. The term malignant is defined in medical dictionary as becoming worse and ending in <br /> -5-<br /> death. So, From Ext. A1 the doctor of the E.C.H himself has stated that the case of the petitioner is worse and may cause death. We are of the opinion that repudiation of the claims of the insured on the ground that the condition of the patient is not an emergency is not good people take policy of this kind to ensure themselves against the disease of which they wish to cover themselves against heavy hospitalisation. So, we are of the opinion that the repudiation of the claim as per Ext. A8 is a clear deficiency of service. The petitioner had produced series of bills for an amount of Rs. 35399/- the said document is marked as Ext. A8. Point No. 1 is found accordingly.<br /> Point No. 2<br /> In view of finding in point No. 1, petition is to be allowed and the petitioner is entitled to get the relief.<br /> So, the 1st opposite party is ordered to pay the petitioner an amount of Rs. 35399/- ie. the amount claimed by the petitioner with 6% interest from 8..6..2005 till realisation. 1st opposite party is also ordered to pay Rs. 2000/- as cost of the proceedings . Since cost is ordered . No compensation is ordered. The order shall be complied with within 30 days of receipt of this order.<br /> Dictated by me, transcribed by the Confidential Assistant corrected by me and pronounced in the Open Forum on this the 28th day of June, 2008.