Order No.  5  dt.  21/01/2019

          The case of the complainants in brief is that the complainant met with an accident and he went to o.p.s hospital for treatment. He got admission on 01/11/2016 to 4/11/2016 for conservative management and he had to take further admission from 9/11/2016 to 12/11/22016 for definitive management i.e. internal platting through operative procedure. The o.p.s hospital was informed from the very beginning that he is a State Government Employee and enrolled under West Bengal Health Scheme Cash Less Benefit. The complainant handed over the health scheme certificate i.e. cash less heath scheme benefit certificate. After recovery the complainant for realization of the amount from the health scheme and asked the o.p.s Hospital Superintendent for signing the mediclaim paper under West Bengal Govt. Health Scheme for reimbursement but the hospital management refused to do the same. The complainant has further stated that the o.p.s inflated bill amount for which they avoided to put their signature on the documents for submission of that paper to health scheme for realization of the amount from Government of West Bengal. The complainant thereafter approached before Government of West Bengal Clinical Establishment Regulatory Commission on 25/04/2017 but since the complainant admitted in the hospital prior to the establishment of the said Commission, therefore, Commission did not entertain the Application of the complainant.

                On the basis of the said fact the complainant filed this case praying for direction upon the o.ps. for reimbursement of the amount of Rs.1,10,497/- and also prayed for compensation of Rs.2,50,000/- as well as  litigation cost also.

                The o.ps. did not contest the case, as such, the case has proceeded ex-parte. The complainant in order to substantiate his claim submitted the documents that he is beneficiary of the West Bengal Government Cash Less Health Scheme and he filed certificate to that effect. The complainant also filed document to show that he had to bear expenses for his medical treatment to the o.p.s. The o.p.s hospital issued the receipt to that effect after receiving the bill amount from the complainant. It is also an admitted fact that the complainant after recovery wanted to have the signature from the o.p.s to establish his claim as per the requirement as envisaged to the beneficiary of West Bengal Government Cashless Health Scheme but the o.ps. did not cooperate with the complainant, for which the complainant has suffered.

                In view of the said fact, we hold that the complainant will be entitled to realize the said amount from the o.ps.

            Hence, ordered,

            That the CC No. 291/2018 is allowed ex parte with cost against the o.ps. The o.ps. are jointly and/or severally directed to reimburse the complainant’s medical expenses which was incurred by him to the tune of Rs.1,10,497/- (Rupees One Lakh Ten Thousand Four Hundred and Ninety Seven) only within one month from the date of issue of this order and to pay compensation of Rs.10,000/- (Rupees Ten Thousand) only for harassment and mental agony and litigation cost of Rs.2,000/- (Rupees Two Thousand) only within 30 days from the date of communication of this order, i.d. an interest @ 8% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.