Tamil Nadu

South Chennai

CC/354/2013

T.K.Lakshmanan Rao - Complainant(s)

Versus

The Director of Pension - Opp.Party(s)

Party in Person

06 Oct 2015

ORDER

                                                                        Date of Filing :   26.09. 2013

                                                                        Date of Order :   06.10.2015.

 

DISTRICT CONSUMER DISPUTE REDRESSAL FORUM, CHENNAI(SOUTH)

     2^nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3

 

PRESENT: THIRU. B. RAMALINGAM M.A.M.L.,                     : PRESIDENT

                 TMT. K.AMALA, M.A. L.L.B.,                                 : MEMBER I

                 DR. T.PAUL RAJASEKARAN, M.A PGDHRDI, AIII,BCS : MEMBER II

 

C.C.NO.354/2013

              TUESDAY THIS  6^TH  DAY OF OCTOBER  2015     

 

T.K. Lakshmana Rao,

H/o. Late Smt. P.Vjayalakshmi,

12, Kaveri Flats,

18, Sunderajan Street,

Abiramapuram,

Chennai – 18.                                               ..Complainant

                                      ..Vs..

 

1. The Director of Pension,

259, 2^nd Floor,

3^rd Block, DMS,

Tenampet,

Chennai 600 006.

 

2. The Principal Secretary,

Finance Department,

Govt. Of Tamil Nadu,

Rep. by Secretary-Finance Pension,

Govt. of Tamil Nadu, Govt. Secretariat

St. George Fort,

Chennai 600 009.                                            ..Opposite parties.

 

 

For the Complainant                 :  Party in person.  

 

For the Opposite parties 1 & 2   :  M/s. Ponram Rajaa

 

        This complaint is being filed by the complainant u/s 12 of the C.P. Act 1986 for a direction to the opposite parties to pay a sum of Rs.64,784/- and also to pay a sum of Rs.50,000/- as compensation to the complainant.

ORDER

 

THIRU. B. RAMALINGAM PRESIDENT

         

1.The case of the complainant is briefly as follows:-

        The complainant’s wife late Smt. P.Vijayalakshmi was retired teacher had been getting pension till her death i.e. March 2011.  While she was alive she was taken treatment in Apollo Multi Specialty Hospital, Chennai and underwent total knee replacement surgery  by incurring a sum of Rs.2,67,532/-.   Out of the said amount a sum of Rs.2,13,738/- was paid by the E-Meditek Insurance Company with whom the pensioner’s son had insured in favour of his parents.   For the remaining balance a sum of Rs.64,784/- inclusion of the other medical expenses incurred by the complainant for his deceased wife, the complainant has claimed from the 1^st opposite party under Tamil Nadu Health Scheme, for which the said pensioner Smt. P.Vijayalakshmi was contributing premium while she was in service and after retirement until March 2011.  The said claim was made by the complainant to the 1^st opposite party on 14.6.2011.  Whereas the said claim was not settled by the opposite parties despite of several reminders and exchange of communications by the complainant with the opposite parties, as such the complainant has filed this complaint for the said recovery of the amount with compensation.     As such the act of the opposite parties is amounts to deficiency of service and which caused mental agony and hardship to the complainant.   Hence the above complaint.    

Written version of  1^st  opposite party and adopted by the 2^nd opposite party  are  as follows:-

 

2.     It denies all the averments and allegation contained in the complaint except those that are specifically admitted herein.   The opposite parties submit that the complainant cannot be considered as a consumer and complaint is not maintainable and further stated that since as per the Tamil Nadu Health Scheme for which the deceased Smt.P.Vijayalakshmi has made contribution while she was in service and after retirement as pensioner having already been reimbursed by insurance company (Third Party Administrator) the same claim cannot be reimbursed under the said scheme twice.  As such the opposite party department have suitably replied to the complainant with regard to the said claim made by him, as such the complainant is not entitled for any relief sought for in the complaint.   Hence the compliant is liable to be dismissed.

 

3.   Complainant has filed his Proof affidavit and  Ex.A1 to Ex.A18 were marked on the side of the complainant.   Opposite parties have filed his proof affidavit and no document was marked on the side of the opposite parties. 

 

4.         The points that arise for consideration are as follows:-

1. Whether there is any deficiency in service on the part of the opposite parties ?

 

2. To what relief the complainant is entitled to?  

5.      POINTS 1 & 2 :

         Perused the complaint filed by the complainant, written version filed by the opposite parties,   proof  affidavit filed by complainant and opposite parties  and Ex.A1 to Ex.A18 filed on the side of the complainant and considered both side arguments.

6.     There is no dispute that the complainant’s wife late Smt. P.Vijayalakshmi was retired teacher had been getting pension till her death i.e. March 2011.  While she was alive she was taken treatment in Apollo Multi Specialty Hospital, Chennai and underwent total knee replacement surgery  by incurring a sum of Rs.2,67,532/-.   Out of the said amount a sum of Rs.2,13,738/- was paid by the E-Meditek Insurance Company with whom the pensioner’s son had insured in favour of his parents.   For the remaining balance a sum of Rs.64,784/- inclusion of the other medical expenses incurred by the complainant for his deceased wife, the complainant has claimed from the 1^st opposite party under Tamil Nadu Health Scheme, for which the said pensioner Smt. P.Vijayalakshmi was contributing premium while she was in service and after retirement until March 2011.  The said claim was made by the complainant to the 1^st opposite party on 14.6.2011.  Whereas the said claim was not settled by the opposite parties despite of several reminders and exchange of communications by the complainant with the opposite parties, as such the complainant has filed this complaint for the said recovery of the amount with compensation.

7.     Whereas the opposite parties have filed written version in this proceedings stating that the complainant cannot be considered as a consumer and complaint is not maintainable and further stated that since as per the Tamil Nadu Health Scheme for which the deceased Smt.P.Vijayalakshmi has made contribution while she was in service and after retirement as pensioner having already been reimbursed by insurance company (Third Party Administrator) the same claim cannot be reimbursed under the said scheme twice.  As such the opposite party department have suitably replied to the complainant with regard to the said claim made by him, as such the complainant is not entitled for any relief sought for in the complaint.   However the opposite parties have filed the above said written version resisting the complaint filed by the complainant, in the pending proceedings before this forum the opposite parties have represented that they have paid a sum of Rs.48,588/- as 75% of the claim amount towards the said claim made by the complainant mentioned in the complaint as per Tamil Nadu Health Scheme and also filed the copy of the proceedings dated 3.9.2015 passed in this regard by opposite party department and also the copy of the cheuqe issued to the complainant for the said amount dated 3.9.2015.    As per the said order and the Tamil Nadu Health Scheme provision restricted sanction amount of Rs.48,588/- as 75% of claim amount of  Rs.64,784/- made by complainant towards the medical expense, paid to the complainant by the opposite party is appear to be proper.   The complainant had not raised objection in this regard. 

8.     The complainant also admitted that as mentioned above he has received a sum of Rs.48,588/- towards the said claim from the opposite parties during the pending proceedings.   However the delay in settling the said amount by the opposite parties have caused him mental agony and hardship  and insisted  for payment of the other relief sought for in the complaint i.e. compensation as well as cost of litigation expenses against the opposite parties.

9.     Considering the facts and circumstances of the case that as contended by the complainant that the claim was made by the complainant on 14.6.2011 to the 1^st opposite party and further despite of several reminders and also exchange of communications since the opposite parties have not settled the claim made by the complainant, the complainant was compelled to file this compliant before this forum in the year 2012.  Even after filing of this complaint the opposite parties have filed written version stating that they denied the claim made by the complainant as it was appears to be that the claim made twice, as such not maintainable under the Tamil Nadu Health Scheme.  Then only on 3.9.2015 by the order of opposite parties department a sum of Rs.48,588/- towards the said claim was paid to the complainant.   Though the amount paid towards the claim of the complainant is proper as per provision of Tamil Nadu Health Scheme the said genuine claim made by the complainant was settled belatedly after more than two years from the date of claim that too without any payment of interest for the said amount.  

10.    Therefore as contented by the complainant that the complainant being a 74 years aged person, the claim made by the complainant for the reimbursement of balance medical expense incurred for his wife Smt. P. Vijayalakshmi who was a pensioner and entitled for the reimbursement of the said medical expense under the Tamil Nadu Health Scheme for which she had contributed till her death which caused hardship and mental agony to the complainant is acceptable.    Therefore we are of the considered view that the opposite parties are jointly and severally directed to pay reasonable compensation as well as cost of the proceedings to the complainant,   though they have settled the claim in the pending proceedings.

11.    Therefore we are of the considered view that the opposite parties are jointly and severally liable to pay a sum of Rs.10,000/- as just and reasonable compensation for mental agony and hardship and also to pay a sum of Rs.5,000/- as litigation expenses to the complainant and accordingly the points 1 & 2 are decided. 

In the result, the complaint is partly allowed.   The   opposite parties are jointly and severally directed to pay a sum of Rs.10,000/- (Rupees ten thousand   only) as compensation and also to pay  a  sum of Rs.5000/- (Rupees Five thousand only) as litigation expenses to the complainant within six weeks from the date of this order failing which the compensation amount of (Rs.10,000/) shall carry interest at the rate of 9% per annum from the date of order  passed till the date of realization. 

Dictated to the steno-typist transcribed and typed by her corrected and pronounced by us on this the 6^th    day of October   2015.

 

MEMBER-I                        MEMBER-II                             PRESIDENT.

Complainant’s side documents :

Ex.A1- 6.4.2011  - Copy of Hospital charges bills.

Ex.A2- 19.3.2011 – Copy of Receipts for cash  payment by complainant.

Ex.A3- 6.4.2011  -  Copy of receipts for cash payment by complainant.

Ex.A4- 8.6.2012 -  Copy of Check slip by DOP Chennai.

Ex.A5- 10.9.2012 – Copy of letter to DOP /Chennai.

Ex.A6- 10.9.2012 -  Copy of Final bill for Rs.64,784/- 

Ex.A7- 10.9.2012 -  Copy of TN Health Scheme appraisal Note

Ex.A8- 26.2.2013 -  Copy of Review Petition to DOP / Chennai.

Ex.A9- 26.4.2013 -  Copy of Check slip by DOP/Chennai.

Ex.A10- 22.8.2013- Copy of Letter to secretariat and Chennai South.

Ex.A11-26.5.2013 - Copy of News paper cutting Dina Malar.

Ex.A12-     -      -  Copy of Doctors Certificates. 

Ex.A13- 16.8.2011- Copy of Check slip by ATO/Tambaram.

Ex.A14- 10.4.2013- Copy of Interview – Request slip.

Ex.A15-11.7.1995 - Copy of G.O.Ms.562, dt. 11.7.1995.

Ex.A16- 21.9.2007- Copy of Excerpts of GO Ms.458

Ex.A17-     -      - Copy of contradictions

Ex.A18- 21.6.2013 - Copy of letter by the opposite party with postal

                                    Envelope.   

 

Opposite parties’ side  documents:

              .. Nil ..

 

MEMBER-I                        MEMBER-II                             PRESIDENT.