Delhi

StateCommission

A/10/826

DIRECTOR OF EDUCATION & ORS. - Complainant(s)

Versus

RAM GOPAL GARG - Opp.Party(s)

11 Mar 2015

ORDER

IN THE STATE COMMISSION : DELHI

(Constituted under Section 9 of the Consumer Protection Act, 1986)

Date of Decision :  11.03.2015

First Appeal No.826/2010

(Arising out of the order dated 20.08.2010 passed by District Consumer Disputes Redressal Forum (East) Convenient Shopping Centre, Saini Enclave, Delhi-110092 in Complaint Case No. 547/2009)

       

                                                        

1. The Director of Education

Delhi Administration

Govt. of NCT of Delhi

Old Sect.,

•  
• The Regional Director of Education (Distt. East)

Rani Garden

Geeta Colony

•  
• The Deputy Director of Education (Distt. East)

Anand Vihar

•  
• The Principal

Govt. Sarvodaya Boys Sr. Sec. School

Karkari Road

Vishwas Nagar

•  
• The Director of Health Services

Govt. of Health Services

Govt. of NCT of Delhi

Institutional Area

•  
•  
• The Medical Superintendent

I.P.Apollo Hospital

Sarita Vihar

New Delhi-110044                             …..Appellants

•  

Sh. Ram Gopal  Garg

R/o A-249, Surajmal Vihar

Delhi-110092                                        ……Respondent

 

CORAM

Salma Noor, Member

N P Kaushik, Member (Judicial)

1.     Whether reporters of local newspaper be allowed to see the judgment?

2.      To be referred to the reporter or not?

 

 

N P Kaushik, Member (Judicial)

JUDGMENT

1.     The appellants have impugned the orders dt. 20.08.2010 passed by the District Forum East Saini Enclave, Delhi. Vide impugned orders Ld. District Forum had directed the OPs to reimburse to the complainant his balance medical claim of Rs. 66,719/- (Rs. Sixty Six Thousand Seven Hundred and Nineteen Only). Compensation to the tune of Rs. 5,000/- and litigation charges of Rs. 3,000/- were also awarded.
2.     Facts in brief of the case are that the complainant is a retired employee of Delhi Administration, Govt. Of NCT of Delhi. He is a subscriber to employee’s health scheme meant for pensioners. Complainants and his family members were issued a medical card. His wife was a heart patient and getting treatment from Apollo Hospital, Delhi. She was also suffering from gall bladder stones, asthma and HTN. On 11.11.2008 Medical Officer of Delhi Govt. Dispensary referred her to Apollo Hospital (OP-6). On 11.11.2008 she was not given the facility of cashless treatment. On discharge she had to pay to the hospital a bill of Rs. 2,10,000/-. Grievance of the complainant is that the Apollo Hospital charged him at their own prescribed rates instead of the rates prescribed by the Delhi Govt. Employees covered under health scheme. She was discharged on 22.11.2008. On 27.11.2008 she died in Metro Hospital, Noida. Govt. Sarvodaya Boys Sr. Sec. School, Karkari Road, Vishwas Nagar, Delhi-110031 i.e. (OP-4) restricted the reimbursement of medical expenditure incurred by the complainant at Apollo Hospital, Delhi to Rs. 1,51,096/-. Thus a balance of Rs. 66,719/- remained without unimbursed. Complainant filed the complaint in the District Forum. OP-1 to 4 filed their joint, written statement. They admitted that the case of the complainants wife was referred in emergency by their medical officer on 11.11.2008. Apollo Hospital, Delhi was on the panel for Delhi Govt. for the purpose of giving treatment to its employees on cashless basis. Contention of the OP-1 to 4 is that Apollo Hospital, New Delhi did not abide by the panel rates of the health scheme of the Govt. of Delhi. Contention of the OPs 1 to 4 is that they met with their part of obligation by making payment of Rs. 1,51,096/-. OPs i.e. Direction of Education Govt. of NCT of Delhi stated that Apollo Hospital Delhi is covered for treatment of all the Radiological Investigation and Nuclear Medicines, Laparoscopic Surgery, Dialysis, Urology, Organ Transplant (Renal, Liver), Lithotripsy, Joint Replacement, Radiation Therapy, Cardiology, Cardiac Surgery, Cardio Thoracic, Vascular Surgery, only. OP-6 Apollo Hospital Delhi raised a plea that Delhi Govt. Employees health scheme does not empanel hospitals for the management of the gastro and pulmonary ailments. Complainant’s wife was treated in Apollo Hospital Delhi for Gastro and Pulmonary disease. Delhi Govt. employees health scheme rates were thus not applicable.
3.     Ld. Trial Forum held that non reimbursement of Rs. 66,719/- from the bill by OP-4 i.e. the Principal Govt. Sarvodaya Boys Sr. Sec. School, was arbitrary. Since there was no agreed rates for Gastro and Pulmonary disease, non reimbursement of the balance amount was arbitrary. Relying upon the case of the State of Punjab and Ors. V/s Mohinder Singh Chawla (JT 1997 (1) SC. Ld. Trial Forum held that OP-1 to 4 were jointly and severally liable to reimburse the balance medical claim of Rs. 66,419/- along with costs of litigation and compensation referred to above.
4.     In their present appeal, the appellant took a plea that the complainant was entitled to compensation only for loss or injury suffered by him due to the negligence of the OP. Bills of the complainant was duly processed and reimbursed keeping in view the entitlement.
5.     Arguments addressed by the counsels for the parties were heard at length. Admittedly wife of the complainant had undergone treatment from one of the Doctors Sh. Sanjay Mittal of Apollo Hospital Delhi. She was referred to the said hospital for merely for cardiac care. She however, developed certain complications relating to gastro pulmonary problems. Ld. Trial Forum has rightly relied upon the case of the State of Punjab and Ors. V/s Mohinder Singh Chawla (Supra). The relevant portion of the judgment is reproduced below:-

“The government servant has suffered an ailment which requires treatment at a specialized approved hospital and on reference where at the government servant had undergone such treatment therein, it is but the duty of the State to bear the expenditure incurred by the government servant. Expenditure, thus, incurred requires to be reimbursed by the State to the employee.”

6.     Clearly the complainant was entitled to reimbursement of the expenditure incurred by him as Apollo Hospital Delhi was on the panel of the Govt. of NCT of Delhi. Though the agreement between the Govt. of NCT of Delhi and Apollo Hospital Delhi related to certain health problems, but gastro pulmonary problem arose while the patient was being treated for cardiac treatment. It was not advisable for the complainant to wait for her discharge and get her treated for gastro pulmonary problem elsewhere. Obviously the Apollo Hospital Delhi was required to manage the patient for gastro pulmonary treatment as well. We are, therefore, of the considered opinion that the appeal is devoid of merits. The same is hence dismissed.

(Salma Noor)

• Member

(N P Kaushik)

 Member (Judicial