BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, JALANDHAR.

Complaint No.340 of 2016

Date of Instt. 03.08.2016

Date of Decision: 06.06.2018

Chander Parkash Ohri son of Sh. Dina Nath Ohri, resident of 117 A/4, Kamal Vihar, Near Shiv Mandir, Jalandhar.

..........Complainant

Versus

1. The General Manager, Northern Railways, Baroda House, New Delhi.

2. Northern Railways, through its Divisional Manager, Ferozepur Division, Ferozepur.

3. Station Superintendent, Northern Railways, Railway Station, Jalandhar.

….….. Opposite Parties

Complaint Under the Consumer Protection Act.

Before: Sh. Karnail Singh (President)

Smt. Harvimal Dogra (Member)

Present: Sh. Arun Gupta, Adv Counsel for the Complainant.

Sh. RK Saddi, Adv Counsel for the OP No.1 to 3.

Order

Karnail Singh (President)

1. This complaint is presented by the complainant, wherein alleged that the complainant was working as Railway Guard and he retired from the service on 31.12.2013. A sum of Rs.37,127/- was recovered from the complainant out of the death-cum-retirement gratuity, vide No.729E/29/857 Pen for issuance of Medical Card under RELHS for whole life of the complainant and his family members and medical card No.052136 to this effect was issued to the complainant. That on 25.11.2013, the complainant along with his wife Pratibha while going on Scooter, met with a road accident and sustained head injury and immediately the complainant along with his wife were admitted in the Hospital namely NIMS Pvt. Ltd, Adarsh Nagar, Kapurthala Chowk, Jalandhar. Due to head injury, Smt. Pratibha, wife of the complainant remained admitted in the Hospital from 25.11.2013 to 27.11.2013 and the complainant remained admitted in the Hospital till 11.12.2013 and was discharged on 11.12.2013. After discharging from the hospital, the complainant informed the OPs about the treatment got in the hospital namely NIMS Pvt. Ltd., Jalandhar and submitted the reimbursement claim for a sum of Rs.21,618/- of his wife along with all the medical bills and treatment prescriptions. Thereafter, the OP No.1 granted sanction of Rs.14,611/- against the claim of Rs.21,618/- on account of reimbursement claim of the complainant. The complainant wrote a letter to the Chief Medical Superintendent Northern Railway, Ferozepur for reimbursement of the remaining amount i.e. Rs.7007/-. That the OP No.2 issued a letter dated 16.06.2016 to the complainant stating that it was a case of non-referred to Non-recognized Hospital, the reimbursement claim has been calculated as per CGHS 2010 Chandigarh rates for Non-NABH Category.

2. That the wife of the complainant remained admitted in the hospital for 3 days and spent a sum of Rs.21,618/- for his treatment and only a reimbursement of Rs.14,611/- has been allowed by the OPs and denied the reimbursement of the remaining amount of Rs.7007/- thus the OPs have resorted to unfair trade practice. Due to the non-reimbursement of the remaining amount of treatment, the OPs are jointly and severally liable to reimburse the remaining amount of Rs.7007/- alongwith compensation for mental agony suffered by the complainant and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to reimburse the remaining amount of Rs.7007/- alongwith interest @ 18% per annum and further OPs be directed to pay compensation of Rs.20,000/- on account of mental agony and harassment suffered by the complainant and further OPs be directed to pay litigation expenses of Rs.5500/-.

3. Notice of the complaint was given to the OPs and accordingly, both the OPs appeared and filed joint written reply and contested the complaint by taking preliminary objections that the complaint is hit with the principal of mis-joinder and non-joinder of necessary parties, in case of dispute against Central Government where it relates to Railway, the Union of India is to be impleaded through the General Manager of the concerned Railway and further alleged that the present complaint is not maintainable against the answering OP as no notice u/S 80 CPC has been given before filing the present complaint and even no cause of action accrued against the answering OP and further averred that the complainant has not comply with the rules vide drafting the present complaint and even the complainant is barred, estopped and precluded from filing the present complaint by their own acts of admission, commission and omission and even this Forum has no jurisdiction to file the present complaint. It is further alleged that the complainant has not come to the Forum with cleans hands and has suppressed the material facts from the Forum and hence the present complaint is liable to be dismissed. The real fact is that the reimbursement claim was prepared by Sr. Divisional Medical Officer, Jalandhar and calculated as per CGHS 2010 Chandigarh rates for NON-NABH category. Since, this is a medical reimbursement claim of non-referred to non-recognized Hospital as per Railway Board Policy letter No.2005/H/6-4 policy 11 dated 31.01.2007 as such, only CGHS rates are admissible in such cases. On merits, the allegations as made by the complainant are categorically denied and lastly prayed that the complaint of the complainant is without merits and the same may be dismissed qua OP No.1.

4. In order to prove the case of the complainant, counsel for the complainant tendered into evidence affidavit of the complainant Ex.CA alongwith some documents Ex.C-1 to Ex.C-26 and closed the evidence.

5. Similarly, counsel for the OPs tendered into evidence affidavit Ex.OP/A and copy of letter of policy as Ex.OP/1 and closed the evidence.

6. We have heard the learned counsel for the respective parties and also gone the case file very minutely.

7. Precisely, the case set up by the complainant is that the complainant was working as a Railway Guard and retired from service on 31.12.2013 and after retirement medical card under RELHS for whole life of the complainant and his family members and medical card No.052136 was issued to the complainant. Thereafter, on 25.11.2013, the complainant and his wife Pratibha met with a road accident and sustained head injury and they remained admitted in the hospital and after discharge, the complainant submitted the reimbursement claim for the sum of Rs.21,618/- of his wife alongwith all medical bills and treatment prescriptions, but the OP No.1 sanctioned Rs.14,611/- against the claim of Rs.21,618/- on account of reimbursement claim of the complainant and thereafter, the complainant wrote a letter to the Chief Medical Superintendent, Northern Railway, Ferozepur for reimbursement of the remaining amount of Rs.7007/- and then OP No.2 issued a letter dated 16.06.2016 to the complainant stating that it was a case of non-referred to non-recognized hospital, the reimbursement claim has been calculated as per rates for Non-NABH category. The OP has denied the reimbursement of the remaining amount of Rs.7007/-, thus, the OPs have committed unfair trade practice and deficiency in service.

8. No doubt, the case of the complainant refuted by the OP on the ground that this Forum has no jurisdiction to entertain the present complaint, but in order to fortify this version, the counsel for the OP could not able to bring in our notice any law, notification or rule, whereby jurisdiction of this Forum is excluded. So, accordingly, we do not find any force in the submission of the learned counsel for the OP.

9. The next point raised by the OP is that the reimbursement claim was prepared and calculated as per CGHS 2010 Chandigarh rates for Non-NABH category and thus, the same was rightly paid to the extent of 14611 out of total amount of Rs.21,618/-.

10. First of all, in this complaint, the counsel for the complainant could not able to satisfy this Forum how the complainant is a consumer, no doubt, this question was considered by this Forum at the time of presentation of the complaint and observed that the complainant is a consumer, but on the basis of the pleading of the complainant and after getting an evidence from both sides, it has emerged that the question of consumer is still in dispute and accordingly, we considered this factor at this stage on the basis of the evidence produced by both the parties and find that the complainant has not paid any consideration to the OP for availing the services of medical facility, if so then, the relation of consumer and service provider is not established and if we considered the case in the light of that observation, then this complaint is not maintainable.

11. Further, we also find that the reimbursement of the medical expenses, like this case is not covered under 'The Consumer Protection Act', because it is covered under the 'Central Government Rules' or 'State Government Rules' and if there was any grievances of the complainant, then he can approach the appropriate Forum i.e. if there is any Tribunal of the Central Government or approached to the Civil Courts. So, in view of the above observation, we come to the conclusion that the complaint of the complainant is without merits and the same is dismissed no order of cost. Parties will bear their own cost. The complaint could not be decided within stipulated time frame due to rush of work.

12. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated Harvimal Dogra Karnail Singh

06.06.2018 Member President