BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SAS NAGAR, MOHALI

                                  Consumer Complaint No.265 of 2015

                                 Date of institution:          04.06.2015

                                                   Date of Decision:            30.12.2015

Inderjeet Singh, village Cholta Kala, Tehsil Kharar, District Mohali.

    ……..Complainant

                                        Versus

1.    Senior State Medical Commissioner, Employees’ State Insurance Corporation, Sector 19-A, Madhya Marg, Chandigarh.

2.    Director Health Services (ESI), Parivar Kalyan Bhawan, Sector 34-A, Chandigarh.

3.    Social Security Officer, ESIC Local Office, Phase-VII, Industrial Area, Mohali.

4.    Medical Officer, ESI Hospital, Kharar

5.    SMO, ESIC Hospital, Phase-VII, Industrial Area, Mohali.

………. Opposite Parties

Complaint under Section 12 of the

Consumer Protection Act, 1986.

CORAM

Mrs. Madhu. P. Singh, President.

Shri Amrinder Singh Sidhu, Member.

Present:    Shri Jasbir Singh, counsel for the complainant.

Shri Ravi Inder Singh, counsel for OP No.1 and 3.

Shri Balkar Singh, Sr. Assistant on behalf of OP No.2

Dr.P.P. Ghuman,  on behalf of OP No.4

Dr. Gurcharan Singh, SMO on behalf of OP No.5

(Mrs. Madhu P. Singh, President)

ORDER

                The complainant has filed the present complaint under Section 12 of the Consumer Protection Act for issuance of following direction to the OPs:

(a)    to reimburse the medical bills amounting to Rs.8,143/-.      

(b)    to pay him compensation of Rs.40,000/- for harassment and mental agony.

(c)    to pay him cost of litigation to the tune of Rs.20,000/-.

                The complainant has pleaded in the complaint that he is working with M/s. Gilard Electronics P. Ltd., Mohali since 16.10.1996 with insurance No.1207314243. He is regularly depositing ESI contribution @ 1.75% from his salary alongwith employer contribution @ 4.75%.  The wife of the complainant took treatment from PGI Chandigarh from 08.01.2011 to 10.06.2011, 23.06.2011 to 08.09.2011 and from 28.05.2013 to 11.07.2013.  The complainant submitted medical bills amounting to Rs.2,030/-, Rs.2,271/- and Rs.3,842/-, total being Rs.8,143/-  for reimbursement  with OP No.4 on 30.05.2012 and 09.12.2013. Till date, despite his repeated visits to the OPs, reimbursement of the medical bills has not been made to him. Thus, alleging deficiency in service on the part of the OPs, the complainant has filed the present complaint. 

2.             OP No.1 in the written statement has pleaded that the complainant has not approached this Forum with clean hands. The complainant has the remedy under Section 75 of the ESI Act to approach the employees’ insurance court and not this Forum. The complainant has not leveled any allegation in the complaint against OP No.1.  The bills are to be submitted in the concerned dispensary and then to the Medical Superintendent or SMO Incharge. These are verified and then sent to the Director Health Services for passing and sanctioning and then to State Medical Commissioner, ESIC who issues the cheque of the sanctioned amount. Then the cheque is sent to Director Health Services and then to concerned dispensary by DHS. The bills of the complainant for Rs.2030/- and Rs.2271/- were received by OP No.1 on 03.07.2012 from the DHS.  The bills pertain to ESI Dispensary Mandi Gobindgarh as per sanction issued by OP No.2 and the cheque of the sanctioned amount was sent back to DHS on 09.08.2012.  ESI Dispensary Mandi Gobindgarh sent back the cheque for revalidation which was revalidated on 14.01.2013. As regards bill for Rs.3842/- the same has not been received by OP No.1.   Thus, OP No.1 has sought dismissal of the complaint against it, as there is no deficiency in service on its part.

3.             OP No.2 in its separate written statement has pleaded that bills of Rs.2030/- and Rs.2271/- of the complainant  has already been sent to OP No.1 for sanction vide letter dated 25.06.2012.  The medical bill of Rs.3842/- has not been received from Medical Officer Incharge ESI Dispensary Kharar.

4.             OP No.3 has pleaded in the written statement that it has no role to play in the verification, passing, sanctioning of the bills as per Section 45 (2) of the ESI Act. The complainant has not submitted any proof regarding his visit to OP No.3. There is no deficiency in service on the part of OP No.3.

5.             OP No.4 in its reply has admitted receipt of three medical bills from the complainant for reimbursement. These bills were duly verified and sent to Director ESI Punjab vide letter dated 29.05.2012 and 09.12.2013 for processing and issuance of cheque which would have been handed over to the complainant after receiving in its office. But these cheques have not been received by OP No.4 till date.  Budget for Rs.8143/- has been demanded from the office of SMO ESI Hospital vide letter dated 21.07.2015 and online payment of Rs.8143/- has been made in the account of the complainant account No.32511355117.

6.             OP No.5 in its reply has stated that total amount of Rs.8143/-   has been paid to the complainant vide demand draft dated 31.07.2015 through OP No.4.

7.             Evidence of the complainant consists of his affidavit Ex.CW1/1 and copies of documents Ex C-1 to Ex C-8.

8.             Evidence of OP No.1 and 3 consists of affidavits of Dr. Hardeep Sahni, Ex.OP-1/1 and of Sanjeev Kumar, Social Security Officer Ex.OP-3/1 and copies of documents Ex.OP-1/2  to OP-1/6.

9.             Evidence of OP No.2 consists of affidavit of Dr. Usha Bansal Ex.OP-2/1.

10.           Evidence of OP No.4 consists of affidavit Dr. P.P. Ghuman Ex.OP-4/1 and copies of documents Ex.OP-4/2 to Ex.OP-4/5.  Evidence of OP No.5 consists of affidavit Dr. Gurcharan Singh Ex.OP-5/1.

11.           We have heard learned counsel for the complainant and OP Nos.1, and 3 and Shri Balkar Singh, Sr. Assistant, Dr.P.P. Ghuman and Dr. Gurcharan Singh for OP No.2,4 and 5  and gone through the written arguments filed by the complainant and OP Nos.1 and 3.

12.           The issue involved in the present complaint is regarding delay in reimbursement of  medical bills, total amount being 8143/-which the complainant has submitted with OP No.4.As per the complainant there is delay of more than two years in reimbursement of the bills and act of the OPs in this regard is alleged to be an act of deficiency in service on the part of the OPs.

13.           As per OP Nos.1,2 and 4 the issue of reimbursement of the bills in question rests with OP No.2 as the amount involved in the bills falls within their purview. OP No.1 has admitted that the bills were sanctioned and inadvertently the cheque for reimbursement of the billed amount was sent to ESI Dispensary, Mandi Gobindgarh  whereas the bills in question pertains to ESI Dispensary , Kharar i.e. OP No.4. When this inadvertent mistake was brought to its notice, the cheque in question was received back from ESI, Dispensary, Mandi Gobindgarh for its revalidated  on 14.01.2013. Due to procedural lapse on the part of the OPs some delay has definitely occurred and finally the payment has been made to the complainant on 21.07.2015 online in his account no. 32511355117

14.           The limited issue in the present complaint remains to be answered whether there is a delay in processing and realization of the billed amount of Rs. 8143/- has occurred, causing financial loss and mental agony and harassment to the complainant.

15.           It is admitted by the OPs that the complainant is a subscriber to the ESI Scheme and is entitled to reimbursement of the medical treatment taken by his wife from PGI, Chandigarh from 08.01.2011 to 10.06.2011, 23.06.2011 to 08.09.2011 and from 28.05.2013 to 11.07.2013. OP No.4 has admitted having received the bill amounting to Rs.2030/- and Rs.2271/- and forwarded the same to OP No.2  vide dispatch dated 29.05.2012 as is evident from Ex.OP-4/2 and bill for amount of Rs.3842/-  which was sent to OP No.2 vide  letter dated 09.12.2013 Ex.OP-4/3.  As per OP No.4 the bills have been sent to OP No.2 for processing and sanctioning and till the date of filing the response to the complaint it has never received sanction letter from the OP No.2. However, during pendency of present complaint, the amount has been released to the complainant on 30.07.2015 as is evident from pay order Ex.OP-4/5.  Thus, it is ample clear that there is a delay in reimbursement of medical bills i.e. bill amounting to Rs.2030/- and Rs.2271/- from 29.05.2012 to 30.07.2015 and for bill amounting to Rs.3842/- from 09.12.2013 to 30.07.2015. 

16.           The next question for determination is at what level the delay has occurred and which of the OP is answerable for causing such delay leading to deficiency in service.

17.           It is evident that OP No.4 has forwarded the bills to the concerned quarter i.e. OP No.2 on 29.05.2012 and 09.12.2013. As per OP No.2  it has issued the necessary sanction in respect of two bills for Rs.2030/- and Rs.2271/-  and conveyed the same to OP No.1 vide letter dated 29.06.2012.  The said letter has been acknowledged by OP No.1. However, OP No.1 has admitted that the cheque for Rs.4031/- i.e. for two bills amounting to Rs.2031/- and Rs.2271/- has been inadvertently sent to ESI Mandi Gobindgarh as is evident from Ex.OP-1/2 and when referred back by Mandi Gobindgarh ESI Dispensary the same being stale cheque, was revalidated on 14.01.2013 and was sent back  after due  sanction to OP No.2 on 09.08.2012 vide dispatch register Ex.OP-1/3.  OP No.2 has not adduced any evidence to show the non receipt of re-validated cheque of Rs.4031/- sent by OP No.1. Therefore, the presumption is that the re-validated cheque sanction has been received by OP No.2 has failed to show its further transmission to OP No.4 for release of payment to the complainant.

                So far the bills amounting to Rs.3842/- is concerned, the OP No.2 has failed to show any contrary evidence of its non receipt from OP No.4 as the OP No.4 has proved the dispatch register Ex.OP-4/3. Further OP .2 has denied the receipt of bills for Rs. 3842/- . Denial simplicitor without any evidence to this effect is of no help to OP No.2.  OP No.4 has clearly proved having sent the bills to OP No.2 vide Ex.OP-4/3. Therefore, it can be squarely established that the delay has occurred at the level of OP No.2 while giving sanction of the billed amount of all the three bills in question. OP No.4 has released the amount after taking the budgetary sanction from the competent authority and, therefore, has discharged its duty as per procedure.  We do not find anything amiss on the part of OP No.4. Therefore, the presumption can easily be drawn that OP No.4 has discharged its obligation by sending the bill in question to the concerned quarters for sanctioning and approval.  OP No.2 thus, in our considered opinion, has caused the delay in sanction/release of the billed amount of Rs.8143/-  

18.           So far OP No.1 is concerned, the negligence of the officials of OP No.1 is writ large as they have wrongly issued the cheque to ESI Mandi Gobindgarh and then took some more time to revalidate the stale cheque and issue its sanction in favour of OP No.2. Thus, the delay caused by OP No.1 cannot be ignored and the same has been proved from the documents of OP No.1 itself. 

19.           So far OP No.3 and 5 are concerned, the complainant has failed to prove any delay caused on their part in processing, sanctioning and release of the amount in question.

19.           Therefore, the complaint against OP No. 1 and 2 for causing delay in reimbursement of billed amount of Rs.8143/- has been proved by the complainant and thus the said delay is, therefore, in our considered opinion is an act of deficiency in service on the part of OP No.1 and 2 causing mental harassment, agony and financial loss to the complainant.

20.           Therefore, the complaint deserves to be allowed and the complainant deserves to be compensated.  Since the complainant has received the amount during the pendency of the complaint, it will be appropriate to award interest for the delayed period on the amount of medical bills of Rs.2030/-, Rs.2271/- and Rs.3842/- which have been submitted by the complainant to OP No.4 and forwarded by OP No.4 to OP No.2 vide letters dated 29.05.12 Ex.OP-4/1 and 09.12.2013 Ex.OP-4/3.

21.           The complaint is, therefore, allowed against OP No.1 and 2. OP No.1 and 2 are jointly and severally liable to:

(a)    to pay interest @ 9% per annum on Rs.2030/-, Rs.2271/-  w.e.f. 29.05.2012 till 30.07.2015 and on Rs.3842/- from 09.12.2013 to 30.07.2015.

(b)    to pay interest on the amount so calculated as per (a) above  @ 9% per annum from 30.07.2015 till realisation.

(c)    pay a lump sum compensation of Rs.10,000/-(Rs. Ten thousand only) for mental harassment, agony and costs of litigation.

                Compliance of above directions be made within a period of one month from the date of receipt of a certified copy of this order. Certified copies of the orders be sent to the parties free of costs and thereafter the file be consigned to the record room.

Pronounced.                           

December 30, 2015.     

                             (Mrs. Madhu P. Singh)

                                                                        President

(Amrinder Singh Sidhu)

Member