BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.295/2017

DATED ON THIS THE 16^th February 2018

      Present:  1) Sri. H.M.Shivakumara Swamy

B.A., LLB., - PRESIDENT   

                     2) Sri. Devakumar.M.C.                  

                                                B.E., LLB., PGDCLP   - MEMBER

Sri M.C.DEVAKUMAR,

Member

1.     The complainant filed the complaint under section 12 of the C.P.Act 1986, against the opposite party, alleging repudiation of claim made towards treatment obtained, as deficiency in service and seeking a direction to pay Rs.29,593/- incurred towards medical treatment obtained and compensation of Rs.60,000/- towards mental agony, hardship suffered and Rs.10,000- towards litigation expenditure with other reliefs.
2.     The complainant submits that, he is a senior citizen and retired from the services, having worked for about 36 years in the Southern Railways as a Technician.  He was entitled to avail the medical benefit and free treatment at Railways Hospital, Mysuru.
3.     He suffered a fracture to his knee, when the car, in which he was travelling met with an accident on 29.04.2016 and approached the opposite party hospital for treatment at Mysuru.  The treating doctors on examination, adviced him to take treatment at K.R.Hospital, as there was no medical facility available in their hospital.  Since, there was shortage of beds and other facilities at K.R.Hospital, he got admitted to JSS Hospital for treatment.
4.     Upon surgery and treatment got discharged on 09.05.2016, and incurred a sum of Rs.29,593/- towards treatment.
5.     Submitting all the relevant documents, necessary for reimbursement of medical expenses made the claims on 28.07.2016.
6.     The opposite party repudiated the claims, vide letter dated 20.05.2017, stating, though the fracture patella not an emergency they referred to K.R. Hospital, as there was no specialist doctor available with them, but the complainant availed the treatment at an unrecognized private hospital, without prior permission from them.  Aggrieved by the reply, filed the complaint and sought for the reliefs.
7.     Upon issuance of notice, the opposite party failed to appear and defend the allegations. Hence placed exparte.  However, the opposite party sent a reply (on 02.11.2017) stating that, the claim for reimbursement would be considered and the admissible amount as per rules, would be directly deposited to complainant’s bank account, subsequent to vetting of the claims by their finance department.
8.     To establish the facts, the complainant filed affidavit evidence and relied on several documents.  Heard the oral submissions of complainant counsel. Perused the material on record and posted the matter for orders.
9.    The points arose for our consideration are:-

1. Whether the complainant establishes the deficiency in service by the opposite party, for non-reimbursement of medical expenses towards the treatment availed by him and thereby he is entitled for the relief sought?
2.  What order?

10.    Our findings on the aforesaid points are as follows:

Point No.1 :- Partly in the affirmative.

Point No.2 :- As per final order for the following

:: R E A S O N S ::

11. Point No.1:- The complainant, upon suffering a fracture on his knee, in an accident, approached the opposite party hospital for treatment.  Since, there was non-availability of specialist and appropriate facilities to proceed with the treatment, the treating doctors at opposite party hospital directed the complainant to avail treatment at K.R.Hospital, Mysuru.
12. Since there was lack of bed and other facilities at K.R.Hospital at Mysuru, immediately, he approached JSS Hospital at Mysuru and availed the necessary treatment incurring a sum of Rs.29,593/-.
13. After discharge from the hospital, a sum of Rs.29,593/- has been claimed towards the medical treatment availed by him (on 28.07.2016).
14. Vide letter dated 20.05.2017, the opposite party regretted for reimbursement of the amount claimed, for the reasons, the fracture of patella, not an emergency and was referred to avail treatment at K.R.Hospital, Mysuru as there was no specialist available with them, but the complainant availed treatment at a private unrecognised hospital without obtaining prior permission from them.
15. However, after the lapse of more than a year, vide letter dated 02.11.2017, the opposite party assured to reimburse the admissible medical expenses, payable to the complainant directly to the bank account, duly vetted by their finance department.
16. Thereby, the opposite party by rejecting the claims, and later assured to reimburse the admissible medical expenses duly vetted by their finance department, certainly amounts to deficiency in service and has caused mental agony and hardship to the complainant.  As such, we opine the opposite party, is liable to reimburse the entire medical treatment expenses with interest and also liable to pay compensation for the deficiency in service and damages for the mental agony and hardship caused.  Accordingly, the    point No.1 is answered partly in the affirmative.
17. Point No.2:- In view of the above observation in point No.1,  we proceed to pass the following order:-

:: O R D E R ::

1. The complaint is allowed in part.
2. The opposite party is hereby directed to pay Rs.29,593/- with interest at 10% p.a. from the date of claims made by the complainant (i.e. 28.07.2016) to till this date, within 30 days of this order.  Failing to comply, the opposite party shall pay penalty of Rs.100/- per day until compliance.
3. The opposite party is hereby directed to pay compensation of Rs.5,000/- towards deficiency in service and damages of Rs.3,000/- towards the mental agony and hardship caused and Rs.2,000/- towards litigation expenses to complainant, within 30 days of this order.  Failing to pay, the opposite party shall pay interest at 10% p.a. on the said total sum of Rs.10,000/- until payment made. 
4. In case of default to comply this order, the opposite party to undergo imprisonment and also liable for fine under section 27 of the C.P.Act, 1986.
5. Give the copies of this order to the parties, as per Rules.

(Dictated to the Stenographer transcribed, typed by her, transcript corrected by us and then pronounced in open court on this the 16^th February 2018)