CONSUMER DISPUTES REDRESSAL COMMISSION-VII

DISTRICT: SOUTH-WEST

GOVERNMENT OF NCT OF DELHI

FIRST FLOOR, PANDIT DEEP CHAND SHARMA SAHKAR BHAWAN

CASE NO.CC/361/14

          Date of Institution:-    02.06.2014

          Order Reserved on:- 02.05.2024

                             Date of Decision:-      11.10.2024

IN THE MATTER OF:

SonalGoel

W/o Sh. VipulGoel

85, SukhdevVihar

New Delhi – 110025                          

.….. Complainant

VERSUS

1. The ESIC Dispensary

Through its incharge

Okhla Phase-I,

New Delhi

2. Directorate (Medical) Delhi

E.S.I.C. Scheme (Dispensary Complex)

TilakVihar, New Delhi - 110018

…..Opposite Parties

Suresh Kumar Gupta, President

1. The complainant has filed the complaint under section 12 of Consumer Protection Act, 1986 (hereinafter referred to as Act) with the allegations thatshe is covered under ESI scheme. She is working at Universal Public School, PreetVihar, New Delhi.She along with her family is covered under ESI scheme. Her mother in law is also covered under ESI scheme. On 26.06.2013, her mother in law
   Mrs.BimlaGoel had fallen illwho was taken in emergency to
   Bansal Hospital, New Friends Colony. She was admitted in ICU due to high grade fever, altered sensorium and burning miclusition infection etc. On 27.06.2013, CT scan was done and patchy area of hypo densityseen involving left high frontal and parietalcortex was seen in scan as well as right parietal cortex. On 28.06.2013, she was put on ventilator. It was difficult to transfer her to any other hospitaldue to her condition and emergency certificate was given by the hospital to this effect. On 04.07.2013, her mother in law has expired. The hospital has raised a bill of Rs.1,32,429/- which was duly paid. The intimation was given to OP-1 and claim was lodged. She has given in affidavit in February, 2014 that her family is dependent upon her. The OP vide letter dated 21.04.2014 has repudiated the claim. Her mother in law was enrolled in the identity certificate and due insurance was paid so she was entitled for claim under Rule 55 of ESI Act. The rejection of claim tantamounts to deficiency in service. Hence, this complaint.

2. The OPs have filed the joint reply to the effect that section 2 (11) of ESI Corporation Act excludesmother in law of an insured even if widowed and dependent and her father in law even if dependent. The employer her wrongly included the name of mother in law in the list of the family members. The mother in law is not covered in the definition of “family” so complainant is not entitled to claim sickness benefit of her mother in law.The complainant was duly informed that she is not entitled for reimbursement of the claim of her mother in law. The claim has been rejected as per rules. The allegations of the complainant are wrong.

3. The complainant has filed their rejoinder wherein she has reiterated the stand taken in the complaint and denied the averments made in the written statement.

4. The parties were directed to lead the evidence.

5. The complainant has filed her own affidavit in evidence wherein she has corroborated the version of complaint and placed reliance on the documentsEx.C1 to C12.

6. The OPs have filed the affidavit of Dr. P.L. Chaudhary in evidence wherein he has corroborated the version of written statement.

7. We have heard Ld. Counsel for the OP as complainant did not turn up on date fixed to address the arguments.

8. The complainant is an employee of Universal Public School, PreetVihar, New Delhi. ESI temporary identity certificate Annexure-C1 has issued to her which shows the details of the family including her mother in law BimlaGoel.The family members are entitled for the benefits under ESIC from 01.01.2013 – 31.12.2013 as per Annexure-C2.

9. The mother in law of the complainant had fallen ill who was admitted to Bansal Hospital, New friends Colony where she was treated and ultimately expired. The hospital has raised a bill of Rs.1,32,429/- which was paid by the complainant. The complainant lodged the claim with OP which was rejected on the premise that mother in law is not covered under the definition of family as provided in ESI Act.

10. Section 2 (11) of the ESI Corporation Act, 1948 says that family means:

1. Spouse i.e. wife of the insured person Or husband of an insured woman (whether dependent or not);
2. a minor legitimate or adopted child, dependent upon the insured person:
3. a child who is wholly dependent on the earnings of the insured person and who is:

a) receiving education, till he or she attains the age of 21 years.

b) an unmarried daughter,

4. A child who is infirm by reason of any physical or mental abnormality or injury and is wholly dependent on the earnings of the insured person, so long as the infirmity Continues:
5. Dependent parents, whose monthly income from all sources is less than Rs.1500/- and who normally reside with the insured person.

11. The above definition excludes the following:
    1. Children who have attained majority.
    2. Married daughter even if minor.
    3. Minor brothers and sisters even if dependent.
    4. Parents who are not dependent.
    5. Grand children, even if dependent.
    6. Mother in law of an insured woman even if widowed and dependent and her father in law even if dependent."

12. The deceased is mother in law of the complainant. The complainant is entitled for the benefit under ESI Act only if mother in law is covered under the definition of “family”. Mere entry of the name of the mother in law of the complainant in the identity card does not entitle the complainant to claim the benefits under ESI for her mother in law.

13. The definition specifically excludes the mother in law of the insured i.e. complainant. The claim has been rightly rejected by the OPs as mother in law is not covered under the term family. There is no deficiency of service on the part of the OPs in rejecting the claim.

14. In view of the above said discussion, the complaint of the complainant is dismissed with no order as to costs.

• A copy of this order is to be sent to all the parties as per rule.
• File be consigned to record room.
• Announced in the open court on 11.10.2024.