Punjab

StateCommission

A/1630/2014

Senior State Medical commissioner - Complainant(s)

Versus

Savita - Opp.Party(s)

Ravi Inder Singh

07 Jan 2015

ORDER

2^nd Additional Bench

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB

DAKSHIN MARG, SECTOR 37-A, CHANDIGARH

First Appeal No.   1630 of 2014

                                                           

                                   Date of institution: 18.12.2014  

                             Date of Decision:      7.1.2015

 

1. Senior State Medical Commissioner, ESIC, Sector 19-A, Chandigarh.
2. Social Security Officer, ESIC Local Office, Phase VII, Industrial Area, Mohali.

…..Appellants/Op Nos. 2 & 3

                                      Versus

1. Savita, House No. 261, Ekta Colony, Balongi, Distt. Mohali

…Respondent No.1/Complainant

2. SMO, ESIC Hospital, Phase VII, Industrial Area, Mohali.

…..Performa Respondent

 

First Appeal against the order dated 29.8.2014 passed by the District Consumer Disputes Redressal Forum, SAS Nagar (Mohali).

 

Quorum:-

 

              Shri Gurcharan Singh Saran, Presiding Judicial Member

              Shri Jasbir Singh Gill, Member

 

Present:-

 

          For the appellants            :         Sh. Ravi Inder Singh, Advocate

         

Gurcharan Singh Saran, Presiding Judicial Member

ORDER

The appellants/opposite parties No. 2 & 3(hereinafter referred as “OP Nos. 2 & 3”) have filed the present appeal against the order dated 29.8.2014 passed by the District Consumer Disputes Redressal Forum, SAS Nagar (Mohali)(hereinafter referred as “the District Forum”) in consumer complaint No.95      dated 11.2.2014 vide which the complaint filed by respondent No.1/complainant(hereinafter referred as ‘the complainant’) was allowed with a direction to OP Nos. 2 & 3 to pay lumpsum compensation of Rs. 20,000/- for harassment and cost of litigation on account of delay in passing her reimbursement bill. Whereas no liability was fixed against Op No. 1.

2.                The complaint was filed by the complainant under the Consumer Protection Act, 1986 (in short ‘the Act’) against the opposite parties on the allegations that she is working in M/s Intellinet Global Service Ltd., Phase VIII, Indl. Area, Mohali with insurance No. 1213299619 and her Employer was deposited ESI contribution i.e. Employees’ contribution @ 1.75% and Employer’s contribution @ 4.75% of her salary. Her father met with an accident on 4.9.2012 and admitted with Cheema Hospital, Phase IV, Mohali and paid bill of Rs. 32,149/-. After completing all the formalities, the bill was submitted in ESI Dispensary in Phase VII, Mohali on 26.11.2012 and it was despatched to ESIC, Chandigarh vide despatch No. 1327 dated 13.12.2012. She has been regularly visiting ESI Hospital for the last more than one year but her bill has not cleared, which amounts to deficiency in services. Hence, the complaint with a direction to the Ops to clear a bill alongwith interest and also pay Rs. 15,000/- on account of harassment and Rs. 10,000/- as litigation expenses.

3.                The complaint was contested by the Ops. Op No. 1 in its written statement has been stated that the bill of Rs. 32,106/- were sent to Op No. 2 and a sum of Rs. 32,106/- has been paid to the complainant on 3.4.2014.

4.                Whereas OP Nos. 2 & 3 in their written statement took the preliminary objections that the complaint was not maintainable for non-joinder of necessary parties as DHS has not been impleaded as a party. The bill is to be submitted through the concerned hospital to the Director Health Services, who after processing is to pass the sanction order and then the cheque was to be issued by the State Medical Commissioner ESIC. In case there was delay in the office of DHS then these Ops were not responsible. Hence, the complaint was not maintainable. Same averments were reiterated on merits and ultimately, it was submitted that the complaint is without merit and it be dismissed.

5.                The parties were allowed by the learned District Forum to lead their evidence.

6.                In support of his allegations, the complainant had tendered into evidence her affidavit EX. CW-1/1 with documents Exs. C-1 to C-4. On the other hand, opposite party No. 1 had tendered into evidence letter dated 24.2.2014 Ex. OP-2, and OP Nos. 2 & 3 had tendered into evidence affidavit of Sanjeev Kumar, SSO ESIC Ex. OP-2/1 and document Ex. OP-1.

7.                After going through the allegations in the complaint, written statement filed by the OPs, evidence and documents brought on the record, the complaint was allowed by the learned District Forum as referred above.

8.                In the grounds of appeal, it has been stated that DHS has not been made a party because under Section 58(1)  of the ESI Act, it has been provided that the State Government shall provide for insured person and their families in the state reasonable, medical, surgical and obstetric treatment and SMO Incharge is under the State Government and similarly DHS has also been under the State Government, which has not been made a party. The sanction order was received by the appellants on 20.3.2014 and cheque was issued on 3.4.2014, hence, there was no delay on the part of these Ops.

9.                It is clear from the pleadings of the parties that the complainant was subscriber to the ESI Scheme under which the complainant and her family members were entitled to medical reimbursement. After getting the treatment of her father, the complainant submitted the bill to OP No. 1 on 26.11.2012, which were forwarded to OP No. 3, who is the main executor regarding reimbursement of the bills. As an internal arrangement in case the bills is more than Rs. 5,000/- then sanction from the DHS is required, who was to process the bill and then to pass the sanction order. The grouse of the appellant is that in case the delay has occurred it was on the part of the DHS and they are responsible for it. In case we go to the scheme under the Employees State Insurance Act, 1948, mainly the Corporation is responsible for clearance of the bills. On account of internal arrangement, the channel of DHS has been provided to process the bill but it does not shelve the responsibilities of OP Nos. 2 & 3 to get clear the bills. Alongwith the grounds of appeal, the counsel for the appellants has placed on the record the Circular dated 14.3.2012 under which the duties and responsibilities of the SSOs has been referred, which reads as under:-

“E.     Duties and responsibilities of SSOs

          The duties and responsibilities of the Social Security Officers shall be as under:-

1. He/she shall ensure that all coverable employers and employees within his jurisdiction are registered with ESI Corporation and all the employees are issued with TIC/Pehchan cards.
2. He/she shall provide necessary assistance to all the beneficiaries in getting the benefits for which they are eligible.
3. He/She shall assist the employees in getting them and their employees registered, preparation of monthly contribution records/challan and payment of contribution.
4. He/she will also publicize the various benefits available under the ESI Act 1948 among the stakeholders.
5. He/she will conduct inspections in order of priorities laid down in the Inspection Policy in force from time to time.
6. While conducting the inspection, he/she shall ensure that all the employees working in the premises have been issued with the Pehchan cards. If he/she finds any employee who is not having Pehchan cards, he/she shall ascertain the reasons thereof and take necessary steps for capturing their biometric data, preparation of Pehchan cards and delivery of cards to IP through Branch Manager.
7. He/she shall also discuss with the employees working in the premises, at the time of inspection, about availability of benefits and shall make a report about their grievances, if any, on any type of deficiencies in Benefit Delivery System.
8. In addition to the above the SSO shall also carry out duties and responsibilities as assigned to them by the RD/Director(I/C)/JD(I/C) of RO/SRO/DO.”

10.              Therefore, it was the duty of the SSO to provide necessary assistance to all the beneficiaries in getting the benefits for which they are eligible. They shall also discuss with the employees working in the premises and about the availability of the benefits and shall make a report about their grievances, if any, and all Benefit Delivery System. These guidelines have been passed by the Corporation so that prompt action is taken to provide the benefits under the scheme as early as possible. However, in the present case the Ops took more than one year and three months to clear the bill, therefore, the appellants cannot absolve themselves from their responsibility merely because DHS was not made a party because under the Act as they are principle executor of the scheme. They were under legal obligation to pursue the claim of the complainant in DHS office to ensure timely payment in which they failed. On the one side the State Government is boasting to give timely disposal of the causes of public concern, however, at the same time instead of looking for the reasons, who were responsible for the delay and fix their responsibility are preferring the appeal. The Ops have failed to discharge their duties towards the concern of their subscribers, which amounts to deficiency in their services for which the penalty has been rightly imposed by the learned District Forum and the amount of the penalty is also appropriate so that it may awake the Employees and the Officers working in the Corporation to take prompt action on the matters under which some benefits are to be provided to the subscribers covered under the scheme and should not sit on the papers for years together for detriment to their subscribers for whose benefits this scheme has been provided under the Act. Therefore, the order so passed by the learned District Forum is justified and we affirm the order.

11.              The counsel for the appellants was unable to make out any point for admission of the appeal. Therefore, we dismiss the appeal in limine.

12.              The appellants had deposited an amount of Rs. 10,000/- with this Commission at the time of filing the appeal. This amount of Rs. 10,000/- with interest accrued thereon, if any, be remitted by the registry to respondent No. 1 by way of a crossed cheque/demand draft after the expiry of 45 days, subject to stay, if any, by the higher Fora/Court.

13.              Remaining amount shall be paid by the appellants to respondent No. 1 within 30 days from the receipt of the copy of the order.

14.              The arguments in this appeal were heard on 5.1.2015 and the order was reserved. Now the order be communicated to the parties as per rules.

 

 (Gurcharan Singh Saran)

Presiding Judicial Member

 

January 7, 2015.                                                                                                                                                          (Jasbir Singh Gill)

as                                                                                                                                                                                              Member