Chandigarh

DF-II

CC/190/2019

Mr. Jagmohan Singh - Complainant(s)

Versus

The Chief Medical Superintendent, Northern Railway Hospital - Opp.Party(s)

Gurdeep Singh Adv.

02 May 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II,

U.T. CHANDIGARH

 

Consumer Complaint  No	:	190 of 2019
Date  of  Institution	:	02.04.2019
Date   of   Decision	:	02.05.2022

 

 

 

 

 

Mr.Jagmohan Singh son of Lt. Teja Singh, aged about 82 years, resident of House No.3328, Sector 21-D, Chandigarh.  

 

             …..Complainant

 

Versus

 

1]  The Chief Medical Superintendent, Northern Railway Hospital, Ambala, Cantt. Haryana.

2]  The Chief Medical Director, Northern Railway, Baroda House, New Delhi.

3]  The Divisional Railway Manager Finance (P), Northern Railway, Divisional Office, Ambala Cantt. Haryana.

4]  Assistant Medical Officer, Northern Railway Lock-Up Dispensary (Health) Unit Chandigarh, Railway Colony, Near Railway Station, Chandigarh.   

 

    ….. Opposite Parties
 

 

 

BEFORE:  SMT.PRITI MALHOTRA        PRESIDING MEMBER 

                    SH.B.M.SHARMA                 MEMBER

                               

Argued by  : Sh.Gurdeep Singh, Adv. for complainant.

   Sh.Suchit Khurana, Adv. for Opposite Parties

 

PER PRITI MALHOTRA, PRESIDING MEMBER

         Concisely put, the complainant, a senior citizen and retired government officer, duly covered under Retired Employees Liberalized Health Scheme of OPs, unfortunately fell down in bathroom and sustained injury. The complainant was immediately rushed to Govt. Multi Specialty Hospital, Sector 16, Chandigarh where fracture in his Right Femur was detected.  It is averred that several tests of complainant were conducted on account of his history of Chronic Diseases of Cancer & Angioplasty.  Thereafter, the complainant was referred to Govt. Medical College & Hospital, Sector 32, Chandigarh  on 5.7.2018 (Ann.C-7 colly).  Then the complainant was shifted & admitted to Govt. Medical College & Hospital, Sector 32, Chandigarh and surgery was performed on him on 10.7.2018 by way of Operation Closed Reduction and femoral nailing Zimmer. Ultimately, the complainant was discharged from the said hospital on 26.7.2018 (Ann.C-7 colly). It is submitted that the complainant collected all the relevant documents/bills after getting them verified from hospital, lodged the claim with OP NO.4 on 2.3.2019 which OP NO.4 refused to accept it on the ground of delay in filing the claim.  The complainant also moved application for condoning the delay on 6.3.2019 and filed it along with claim to OP No.4, but the clerk at Railway Lock-Up Health Unit, Chandigarh / OP No.4 flatly refused to accept the medical reimbursement file of the complainant for an amount of Rs.56,037/-.  Alleging the said act & conduct of the OPs as gross deficiency in service and unfair trade practice, hence this complaint has been filed.

 

2]       The OPs have filed joint reply and while admitting the factual matrix of the case, stated that the reimbursement of medical claim file of complainant was not complete, the complainant did not fulfill the necessary requirement to get his claim processed and the time schedule for processing of medical reimbursement is within six months, however, the claim is already barred by time and no application for condonation of delay was moved by the complainant.  It is stated that the application for condonation of delay dated 6.3.2019 (Ann.C-7) does not inspire confidence.  It is submitted that the complete file has not been submitted by the complainant to the concerned officials and therefore the claim of the complainant could not be processed. Denying rest of the allegation and pleading no deficiency in service, the OPs have prayed for dismissal of the complaint.

 

3]       Rejoinder has been filed by complainant controverting the assertions of OPs made as in the reply.

 

4]      Parties led evidence in support of their contentions.

 

5]       We have heard the ld.Counsel for the parties and have perused the entire record.  

 

6]       Admittedly, the complainant, duly covered under ‘Retired Employees Liberalized Health Scheme’ of OPs, was treated for fracture in his Right Femur at Govt. Medical College & Hospital, Sector 32, Chandigarh and discharged from the said hospital on 26.7.2018 and thereafter, lodged claim with OPs for reimbursement of medical expenses incurred on said treatment.

 

7]       Perusal of the record reveals that the claim filed by the complainant was processed only during the pendency of the present complaint and an amount of Rs.47319/- against the claim amount of Rs.56037/- has been paid to him by the OPs (Ann.C-11).  The complainant by way of additional evidence also placed on record the copy of the rules as Ann.C-12 bearing No.2005/H/6-4/Policy-II, dated 31.01.2007 issued by Government of India, Ministry of Railways, Railway Board, whereby he is entitled for the full claim amount.  The relevant extract of the said letter/rule is reproduced as under:-

II  Calculation of the amount of reimbursement to be sanctioned out of the claimed amount:-

         Xxxx

1. Treatment taken in Govt. Hospital –Full admissible amount should be recommended for sanction.

8]       It is well proved on record and not contradicted by the OPs that the complainant availed whole treatment from Government Hospital and the amount claimed is genuine one as per bills submitted by the complainant. Thus, the complainant is entitled for the balance claim also which the OPs have deducted.  The OPs while deducting an amount of Rs.8718/- from the total claim amount of Rs.56037/-, have not placed on record any cogent evidence or the copy of the rules applicable in case of the complainant which justify the deductions made by them.  In the absence of any documentary evidence and in view of the letter/circular, referred above, the complainant is fully entitled for the balance claim amount as well.  Hence the deficiency in service on the part of OPs is writ large.

 

9]       It has also been observed that despite having been fully covered under the scheme of the OPs and also having a genuine claim for reimbursement on account of treatment taken by the complainant from Government Hospital, the complainant, a senior citizen and elderly person of 82 years of age, has unreasonably & unfairly been harassed by the OPs on account of their gross deficiency in rendering proper service, for which he deserves to be suitably compensated.

10]      In view of the foregoing, we are of the opinion that the deficiency in service on the part of Opposite Parties is proved. Accordingly, the present complaint is allowed against the Opposite Parties with directions to reimburse the balance claim amount of Rs.8718/- to the complainant. The Opposite Parties are is also directed to pay an amount of Rs.15000/- to the complainant towards compensation for causing him immense mental agony & harassment, along with litigation expenses of Rs.10,000/-.  

         This order shall be complied with by the Opposite Parties within a period of 30 days from the date of receipt of certified copy of this order, failing which they shall also be liable to pay additional compensatory cost of Rs.20000/- to the complainant apart from the above relief.

         Certified copy of this order be sent to the parties, free of charge. After compliance, file be consigned to record room.

Announced

2^nd May, 2022                                                                         

Sd/-

 (PRITI MALHOTRA)

PRESIDING MEMBER

 

Sd/-

(B.M.SHARMA)

MEMBER