Chandigarh

StateCommission

A/180/2023

KAUR SAIN SINGLA - Complainant(s)

Versus

THE DIRECTOR, DEPARTMENT OF INDUSTRIES, PUNJAB - Opp.Party(s)

DEVINDER KUMAR

15 Dec 2023

ORDER

 STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

Appeal No.	:	180 of 2023
Date of Institution	:	24.07.2023
Date of Decision	:	15.12.2023

 

Kaur Sain Singla S/o Sh. Nand Ram, through his legal heirs:-

1. Satya Rani wife of late Sh. Kaur Sain Singla, aged about 80 years, r/o House No. 829, Sector 4, Panchkula.
2. Sanjeev Kumar son of late Sh. Kaur Sain Singla, aged about 53 years, r/o House No. 829, Sector 4, Panchkula.
3. Suman Gupta daughter of late Sh. Kaur Sain Singla wife of Sh. Vijay Gupta, aged about 57 years, r/o House No. 221, Virat Nagar near Bal Vikas School, Panipat, Haryana.
4. Renu Goyal daughter of late Sh. Kaur Sain Singla wife of Sh. Vinay Goyal, aged about 55 years, r/o House No. 45-E, Sector 11-C, Faridabad, Haryana

……Appellants/complainants

V e r s u s

1. The Director, Department of Industries Punjab, Sector 17, Chandigarh.
2.  The Director, Health Services/Department, Punjab, Sector 34, Chandigarh.
3. The General Manager, District Industries Centre, Bathinda, District Bathinda, Punjab.
4. Civil Surgeon, District Bathinda, Punjab.

 .... Respondents/opposite parties

BEFORE:    JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT.

                   MR.RAJESH K. ARYA, MEMBER.

 

Present:-    Sh.Devinder Kumar, Advocate for the appellant.

Sh.Jagwinder Singh, Functional Manager of respondents no.1 and 3 (On VC)

None for respondent no.2.

Dr.Mayank Jot Singh for respondent no.4.

 

JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT

                   This appeal has been filed by the appellants/complainants (legal heir of Kaur Saini Singla/deceased/original complainant), against the order dated 05.06.2023 passed by the District Commission-I, U.T., Chandigarh (in short the District Commission), whereby, consumer complaint bearing no.1066 of 2019 was dismissed while holding as under:-

“….We have perused the Annexure R-1 to R-12 annexed with the reply of OPs NO. 1 to 3 wherein expost facto sanction for treatment and verification of rates was sanctioned to the tune of Rs.8600/- and Rs.1,08,651/- respectively as per the rules in force at the time of treatment. The complainant has not adduced any documentary evidence by way of any rules/directions of the Govt. of Punjab, wherein he was entitled to get full reimbursement of the bill  as submitted by him. However, the OPs have adduced a copy of rules dated 13^th February 1995 issued by the Govt. of  Punjab, which reveal  the procedure to be adopted by the govt. for sanction of reimbursement of medical bills, when the treatment is taken from private hospitals in the country. According to the said rules the employee/pensioner shall be entitled for reimbursement as per rates fixed by the Director, Health and Family Welfare, Punjab. Thus we find no merit in the instant complaint…...”

Factual scenario:-

2.           Before the District Commission, it was the case of the complainant-Kaur Sain Singla (now deceased) that due to his health problem he approached Alchemist Hospital, Panchkula on 4.11.2017 where angiography was done and thereafter he was advised by-pass surgery. Accordingly the complainant got himself admitted in Max Hospital Mohali on 4.11.2017 to 9.11.2017 and got operated for Coronary Artery Bypass Graft  (CABG) for which he spent Rs.2,82,951/- and Rs.12,770/-. After discharge from the hospital, the complainant submitted his claim for reimbursement alongwith all the original documents/bills with the OPs. However, despite, repeated requests, the OPs  failed to release the claim amount, as a result of which, he served legal notice dated 17.2.2019 upon the OPs. After receipt of legal notice, the OPs only released part claim amount of Rs.1,08,651/- and did not release the balance claim amount of Rs.1,74,300/- despite issuance of another  legal notice. Hence consumer complaint was filed before the District Commission.
3.           The  complaint was contested by the opposite parties.
4.           Opposite Parties no.1 and 3 in their joint written reply  while admitting the factual matrix of the case stated that the employee/retiree is entitled to medical reimbursement as per the rules and regulations of the department and as such, after receiving the bills in question, an amount of Rs.1,08,651/- was sanctioned. Delay in payment was not intentional, as the case had to pass many official channels.
5.           Opposite parties no.2 and 4 in their joint reply took similar defence as taken by opposite parties no.1 and 3 and stated that the complainant himself failed to supply proper documents and breakup of the amounts time and again.
6.           Rejoinder was filed by the complainant and averments made in the consumer complaint were reiterated
7.           Alongwith this appeal, an application for condonation of delay of 5 days in filing the same has also been filed by Kaur Sain Singla (now deceased) which was also contested by the respondents.
8.           We have heard the contesting parties, on the application for condonation of delay; in the main appeal on merits and have gone through the entire record of the case, including the written arguments, very carefully.
9.           First coming to the application for condonation of delay of 5 days in filing this appeal, it may be stated here that sufficient  cause has been explained by counsel for the appellants to condone the  said delay. Consequently, for the reasons explained in the said application, the delay of 5 days in filing this appeal stands condoned and the application stands disposed of, accordingly.
10.           Now coming to the merits of the case, the moot question that falls for consideration is, as to whether, the respondents were right in sanctioning the part amount of Rs.1,08,651/-  out of the total amount of  Rs.2,82,951/- spent by Kaur Sain Singla (now deceased) on his treatment of CABG in Max Hospital Mohali for the period from 4.11.2017 to 9.11.2017 or not.  It may be stated here that we have very minutely gone through the Punjab Service (Medical Attendance) Rules dated 13.02.1995 regarding Reimbursement facilities to Punjab Government employees and Pensioners, which says that if the treatment is taken by an employee/pensioner from private hospitals in the country, he/she shall be entitled for reimbursement as per rates fixed and approved by the Director, Health and Family Welfare, Punjab. In the present case also, it coming out that the Director Health and  Family Welfare Department, Punjab vide letter  dated 19.06.2019  has verified and accorded sanction to the medical bills of the appellant- Kaur Sain Singla to the tune of Rs.1,08,651/- (Rs.1,06,900/- for CABG and Rs.1751/- for medicines). It is significant to mention here that this amount has been sanctioned in line with the Notification dated 15.09.2014 (at page 107 of paper book of District Commission) having been issued by the AIIMS, New Delhi qua Revision of package charges for Cardiac-procedures/surgeries for Private Ward at C.T. Centre, AIIMS, New Delhi. Under these circumstances, the District Commission did not err in holding that the respondents have rightly allowed the reimbursement of claim amount to the tune of Rs.1,08,651/-, as per rates fixed and approved by the Director, Health and Family Welfare, Punjab. To this extent, the findings of the District Commission are upheld.
11.           As far as reliance placed by the appellants on Shiva Kant Jha Versus Union of India, 2018 (2) S.C.T. 529 is concerned, it may be stated here that in this case, the main dispute was qua the treatment taken by the patient/employee in the non-empanelled hospital and it was under those circumstances held by the Hon’ble Supreme Court that keeping in view the emergency nature of case,  treatment taken by him in the said hospital is genuine. At the same time, though in this case, the insurance company was directed to pay the balance amount incurred on the treatment, yet, at the same time, it was also made clear by the Hon’ble Supreme Court that the said decision is confined to this case only. Under these circumstances, reliance placed on Shiv Kant Jha’s case (supra) is misplaced.
12.           However, at the same time, this Commission also cannot lose sight of the fact that Kaur Sain Singla (now deceased) had taken treatment in November 2017 and sent the documents for reimbursement of amount incurred on his treatment on 18.12.2017. It is coming out from the record that in the first instance, Kaur Sain Singla (now deceased) did not attach the medical reimbursement certificate verified by the concerned doctor, which was ultimately supplied by him to the respondents  on 18.01.2018. Thereafter, the respondents kept on asking one or the other document from the appellant, which they could have asked from him, in one-go,  which resulted into inordinate delay and ultimately,  the claim amount of Rs.1,08,651/- was released on 03.09.2019. Under these circumstances, the appellants needs to be compensated on this count. In our considered opinion, if we award some interest on the said amount for the period the same was retained by the respondents i.e. from 18.01.2018 till 02.09.2019 alongwith compensation for mental agony and harassment that will meet the ends of justice. 
13.           For the reasons recorded above, this appeal is partly allowed. The order impugned passed by the District Commission dismissing the consumer complaint is set aside and the consumer complaint is partly accepted. The respondents/opposite parties no.1 to 4, jointly and severally are directed as under:-
    1. To pay to the appellants, interest @9% p.a. on the amount of Rs.1,08,651/-, from 18.01.2018 till 02.09.2019, within a period of 30 days from the date of receipt of a certified copy of this order, failing which, they shall pay penalty @Rs.100/- per day from the date of default till realization.
    2. To pay to the appellants, compensation to the tune of Rs.10,000/- for deficiency in service and adoption of unfair trade practice and also Rs.10,000/- as cost of litigation, within a period of 30 days from the date of receipt of a certified copy of this order, failing which, thereafter they shall make the said payments alongwith interest @ 9% per annum from the date of default till realization.
14.           Certified copies of this order be sent to the parties, free of charge, forthwith.
15.           The appeal file be consigned to Record Room, after completion and District Commission record be sent back immediately.

 

Pronounced.

15.12.2023

 

 

Sd/-

[JUSTICE RAJ SHEKHAR ATTRI]

PRESIDENT

 

 

 

Sd/-

 (RAJESH K. ARYA)

 MEMBER

 Rg.