APPEARED AT THE TIME OF ARGUMENTS

PRONOUNCED ON:    29^th   JUNE  2016

O R D E R

PER DR. B.C. GUPTA, PRESIDING MEMBER

          The impugned order dated 27.08.2013, passed by the Rajasthan State Consumer Disputes Redressal Commission, Circuit Bench Kota (hereinafter referred to as “the State Commission”) in Appeal No.161/2011, Satish Chandra Gupta vs. Board of Trustees, State of Rajasthan Pensioners’ Medical Concession Scheme & Ors., has been challenged by the petitioner, Board of Trustees in the present Revision Petition.  The State Commission, vide said order, allowed the appeal and set aside the order dated 02.12.2011, passed by the District Consumer  Disputes Redressal Forum, Kota, dismissing Consumer Complaint No. 311/2010, filed by the present respondent/complainant.

2.      Briefly stated, the facts of the case are that the complainant/respondent Satish Chandra Gupta, who is a pensioner of the State Government, had to undergo by-pass surgery of heart at Wockhardt Hospital, Mumbai on 11.02.2008.  He presented bills of the amount spent by him for the said surgery and the opposite party (OP), which is Board of Trustees, State of Rajasthan Pensioners’ Medical Concession Scheme, issued an order on 09.02.2010, sanctioning an amount of Rs. 52,400/- to the complainant.  The complainant was asked, vide letter dated 10.03.2010, to present an undertaking that the amount so approved, was in full and final settlement of the claim, after which the proceedings for payment of the said amount shall be carried out.  The complainant did not give the said undertaking, but made the Consumer Complaint in question, seeking direction to the OPs to make him additional payment for expenses on medicines, diagnostic tests, investigations and for meeting charges on accommodation etc.  He demanded a total sum of Rs. 73,386/- alongwith interest @ 12% p.a. and compensation of Rs. 1 lakh for mental harassment etc.  The complaint was resisted by the OP, by filing a written statement before the District Forum in which they stated that the complainant presented a bill of Rs. 3,58,203.59/- for reimbursement on 06.07.2009, but a sum of Rs. 52,400/- had been approved for him vide letter dated 09.02.2010.  The OP denied that they had asked the complainant to give an undertaking, vide letter dated 10.03.2010, for treating the amount so sanctioned as full and final payment.  According to the OP, the complainant had got his treatment done outside the State and in such cases, he could be allowed 80% of the hospital expenditure, limited to Rs. 48,000/-.

3.      The District Forum, after taking into account the contention of the rival parties, dismissed the Consumer Complaint and directed that the OP shall make payment of Rs. 52,400/-, as sanctioned by them, without receiving any undertaking.  Being aggrieved against this order, the complainant challenged the same by way of an appeal before the State Commission, which having been allowed vide impugned order dated 27.08.2013, the OP Board of Trustees is before this Commission by way of the present Revision Petition.

4.      The State Commission reached the conclusion that under an order dated 16.12.2009 of the State Government, the complainant was entitled to receive reimbursement at amended rates.  In addition, he was also entitled to receive expenses on drugs, medicines and the amount spent on the tests etc.  The complainant was also allowed a compensation of Rs. 25,000/- plus Rs. 5,000/- as cost of litigation.  The State Commission also observed in their order that the order dated 16.12.2009 was enforced from 16.09.2008 and hence, the complainant was eligible to be compensated at the amended rates, as he got the treatment from 10.10.2008 to 18.10.2008.

5.      A notice of the Revision Petition was sent to the complainant/respondent for appearance, but he did not put in appearance despite service.

6.      During hearing before me, the learned counsel for the petitioner stated that they had already complied with the order passed by the District Forum and made payment to the complainant accordingly.  However, the State Commission had failed to take into account that the respondent was not covered under the Government order dated 16.12.2009, because the claim in question was prior to the time the said circular was issued.  Further the complainant had not availed the medical facilities of an approved medical hospital outside the State and hence, not acted in accordance with the mandatory requirement of the policy for reimbursement.  The present Revision Petition should, therefore, be allowed and the order passed by the State Commission set aside.

7.      I have examined the entire material on record and given a thoughtful consideration to the arguments advanced before me.

8.      From the material on record, it is clear that the complainant got himself treated from 10.10.2008 to 18.10.2008, which was prior to the date of issue of the new Government order dated 16.12.2009.  However, the State Commission held that the order dated 16.12.2009 was enforced w.e.f. 16.09.2008 and hence, the complainant was liable to get the benefit of the provisions under the new order.  It has been explicitly made clear that the order dated 16.12.2009 shall come into force from 16.09.2008, although it is also stated that the earlier decided cases shall not be reopened.  In the present case, it is an admitted fact that sanction for payment of Rs. 52,400/- was granted to the complainant vide order dated 09.02.2010, which makes it clear that his case had not been decided when the order dated 16.12.2009 was issued.  I have, therefore, no reason to disagree with the findings of the State Commission that the benefits under the order dated 16.12.2009, shall be available to the complainant and hence, he is entitled to be paid in accordance with this revised policy circular.  The contention made by the petitioner that the treatment was taken from a hospital outside the territorial limits of the State without approval of the Medical Board, is not tenable, because if the complainant was held to be eligible for payment of a claim under the old Government circulars, it shall be wrong to deprive him of the benefits of the new circular dated 16.12.2009, taking the plea that the treatment was taken from outside the limits of the State.

9.      It is held, therefore, that there is no irregularity, illegality or jurisdictional error in the order passed by the State Commission and the same is upheld.  This revision petition is ordered to be dismissed, with no order as to costs.