DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD
Dated this the 03rd day of November, 2023
Present : Sri. Vinay Menon V., President
: Smt. Vidya A., Member Date of Filing: 06/05/2022
CC/79/2022
P.K.Vijayakrishnan,
S/o. Late Karunakaran Pillai,
319, Sahyadri Colony,
Chandranagar, Palakkad - 678 007. - Complainant
(By Adv. P. Sreenath Sankar)
Vs
- The Accounts Officer,
CHSS, ISRO, APEP Building,
Erumathala Post, Ernakulam – 685 112.
- Murali,
Accounts Assistant,
CHSS, ISRO, APEP Building,
Erumathala Post, Ernakulam – 685 112. - Opposite parties
(OPs by Adv. M/s Kusalan P.P. and Manoj Ambat)
O R D E R
By Sri. Vinay Menon V., President
1. Complainant is beneficiary of the statutory health benefit scheme floated by the Central Government and O.P.1 is a statutory body administering the process under the said health benefit scheme. O.P.2 is an employee in the office of the 1st O.P.
2. Complainant’s grievance is that the 2nd O.P., who has an axe to grind against the complainant, had been inordinately delaying a claim for reimbursement by resorting to frivolous and vexatious grounds. Further the objections raised by the 2nd O.P. could be raised only by officials well above the pay grade of the 2nd O.P. Rejection/return of the claims raised by the complainant is not based on any logical reasons. Eventhough the complainant had filed complaints against the 2nd O.P., no actions were taken by the 1st O.P. against the 2nd O.P. Aggrieved by the alleged illegal conduct on the part of the O.P.s, this complaint is filed.
`3 O.P.s filed version. They denied complaint allegations. Their contents stated briefly are that they had to make the complainant repeat the process as the complainant kept handing over incomplete documents which had to be filled in by the AMO or the doctor who treated the complainant. Such entries being mandatory in nature, claims could be processed only if they are filled by the doctor concerned. Since the complainant had failed to get such details entered as directed, his claim was rejected with a direction to resubmit with necessary details. As the complainant has failed to re-file the claim with necessary details, his claim was not considered till date. The complaint is only to be dismissed.
4. Based on the pleadings and counter pleadings, the following issues were framed:
1. Whether the complainant had submitted the claim in proper format?
2. Whether the non reimbursement of the medical bills of the complainant was due to non-following of the guidelines / orders issued by the OP ?
3. Whether there any deficiency in service on the part of OPs ?
4. Whether the complainant is entitled to the reliefs claimed ?
5. Any other Reliefs?
5. (i) Complainant filed proof affidavit and marked Exts. A1 to Ext. A4.
(ii) OPs did not adduce any evidence.
Issue No. 1
6. Per opposite party the reason for rejecting the claim is that the complainant had failed to fill the claim form in accordance with the proper entries by doctors who treated the complainant. Ext.A3 is a communication dated 8/3/2022 informing the complainant the reason for rejection of the claim. Ext.A3 shows that the claim was only rejected and not repudiated. There is also a direction to the complainant to obtain diagnosis either from AMO or specialists and to resubmit for processing.
7. It is aggrieved by Ext.A3 communication that the complainant had filed this complaint. In page 2 unnumbered paragraph 2, the complainant has stated his objections as herein below:
“The above exercise was totally uncalled for and the 2nd respondent has neither the qualification nor official status to decide such things all by himself. The 2nd respondent is holding only a clerical post without any administrative power. Ipso facto the petitioner has questioned how a non gazette person can brow beat the petitioner to direct him to do things which are against the basic tenets of procedures and rules”.
8. From a reading of the complaint as against issuance of Ext.A3 we can see that the grievance is not of any law but of the status of the 2nd OP and his competency to ask for further information. The complainant has not stated as to why such a certificate by the AMO is not required.
Ext.A3 is signed by the Accounts Officer, CHSS, i.e. the 1st OP. Whatever be the qualifications or authority conferred upon the 2nd OP to decide a claim of the complainant, Ext.A3 would prove that such authority or qualifications stands ratified by the first opposite party.
Complainant has no case that the 1st O.P. is not competent to issue Ext.A3 letter or that the communications issued by the 1st O.P. under the findings/directions of 2nd O.P. is illegal. The grievance of the complainant therefore is only of a personal nature arising as against the 2nd OP.
9. From a joint reading of Ext.A3 and the 2nd paragraph in page 2 of the memorandum of complaint we feel that the case of the OPs are more probable as the objection of the complainant as against OP 2 is merely his status. Balance of convenience therefore is tilted in favour of the O.P.s
Issue No. 2
10. As already stated Ext.A3 is a document issued by the 2nd O.P. in the course of their daily routine business. The complainant also has no legally valid or sustainable objection to issuance of Ext.A3 except that OP2 was only a clerk and had no administrative authority to decide on the requirements needed for allowing the claim of the complainant. The complainant has failed to comply with the directions as stated in Ext. A3.
11. Therefore we find this issue in favour of the opposite party and against the complainant.
Issue Nos. 3 to 5
12. In view of the findings in issue Nos.1 & 2 we hold that there is no deficiency in service on the part of opposite parties.
13. The complainant is not entitled to any of the reliefs sought for.
14. The factual matrix as made out in the memorandum of complaint goes to show that the entire dispute arise out of the complainant’s vendetta against the 2nd OP, who, in complainant’s opinion is not ranked enough to direct the complainant to bring in details as sought for in the format for claiming medical reimbursement. There is no other claims whatsoever in the complaint. We easily find that this case is nothing but an abuse of the process of law and the complainant should be forced to compensate the opposite parties for filing vexatious and frivolous litigations against the opposite parties. But we find that the complainant is an age old man. Considering his advanced age we condone the conduct of the complainant.
15. In the said circumstance, parties are directed to bear their respective costs.
Pronounced in open court on this the 03rd day of November, 2023
Sd/-
Vinay Menon V
President Sd/-
Smt. Vidya A.
Member
APPENDIX
Exhibits marked on the side of the complainant :
Ext.A1 – Copy of notice dated 2/3/2022
Ext.A2 – Copy of communication dated 14/3/2022
Ext.A3 – Original of communication dated 8/3/2022
Ext.A4 – Original invoice dated 10/12/2021
Exhibits marked on the side of the opposite party: Nil
Court Exhibit: Nil
Third party documents: Nil
Witness examined on the side of the complainant: Nil
Witness examined on the side of the opposite party: Nil
Court Witness: Nil
NB : Parties are directed to take back all extra set of documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.
