The fact of the case of the complainant is that the complainant is a bonafide Insuline dependent diabetes heart patient and under treatment of Dr.A.K.Saha of the Hospital as OPD patient and the complainant also was a State

Govt. employee. The complainant while in service was a member of the West Bengal Health Scheme having policy no.2007701 and thus entitled to the benefit of the scheme even after retirement. The complainant after retirement from his service from February 2015 to November, 2015 submitted bill month to month but he did not get those bill. The complainant is entitled to the benefit of the reimbursement vide Finance (Audit) Notification no.7287-F-09-2008 sub-clause (iv) and (v) of clause 7. Hence, this complaint.

            The OP contested the case by filing Written version denying inter alia all material allegations. The positive case of the Op is that Mr.Das had drawn reimbursement bill of WBHS 2008 upto January 2015 and all such bills required to be scrutinized to find out whether such claims were justified or not. Be it mentioned here that out of 9 bills submitted by Mr.Das since February 2015 till November, 2015, 7 bills were submitted in wrong format and one such bill was subject to objection from Treasury Officer of Hooghly Treasury Mr. Das is entitled for reimbursement of the Medicines bills for heart disease only although not clear from some prescription and claim forms vide Finance (Audit Notification) no.7287-F-09-2008 against Sub clause of Clause 7 of W.B.Health scheme 2008. Be it noted that bills of Mr.Das does not qualify for reimbursement against sub

clause IV of clause 7 of WBHS 2008.However, the oP has got no intention to cause harassment to a senior citizen through non payment of health bills. The OP being a doctor and DDO will take all care and responsibility during passing a bill so that Govt. money is not wasted. Two bills out of 9 bills has been processed and reimbursed. The OP prays for dismissal of the case.

            Complainant filed lawyer’s notice dated nil, Photo copy of West Bengal Health Scheme, 2008 and photocopy of some other documents, photo copy of some prescriptions. Photocopy of one notification published by Finance Dept.  Complainant also filed Evidence in chief and Written Notes of Argument. OP on the other hand filed Written version, Evidence in chief and W.N.A.

POINTS FOR DECISION :

1)Whether the complainant is a consumer ?                                        

2)Whether there is any deficiency in service on the part of the oP ?                                                                                               

3)Whether the complainant/petitioner is entitled to get relief as prayed for ?

DECISION WITH REASONS :

   All the points are taken together for easiness of discussion.

            It is admitted by the Op that complainant was suffering from different ailments and this complainant was employee under the oP. Regarding treatment

of disease as per allegation of complainant is not disputed. But Op has adopted the reason that Type 2 Diabetes Mellitus for which he is not entitled to any benefit under W.B.H.S. 2008, Govt. Notification no.7287-F dated 19.9.2008. The above said circular no. as stated by the Op the short title and commencement of the Act states this scheme may be called the West Bengal Health Scheme, Section 2 is states this scheme shall apply to the employees and his/her beneficiaries . The total reading of this 8 section it construed as per ambit of this notification shows the employee shall be entitled to get reimbursement of the cost of his or his beneficiaries , medical attendants and treatment as an indoor patient in a hospital or an institution . Section 7 states some diseases but does not state that Mellitus 2 patient is not entitled to get any relief under this Act. This Act has been brought for the welfare of the Govt. servant’s treatment including his family members . Section 7 shows , there is no mention in the Notification that D.M. patient is not entitled to get any reimbursement. Till this date there is no concrete definition and reason which can create Diabetes Mellitus for which the treatment is also varies in different direction. This notification on which, the oP has based reason to pass two bills of the complainant and some bills have been disallowed by the oP. Moreover, the oP requested the complainant to resubmit the nine bills in correct

format (BNA para 4) . Op has duty upon his employee to show how the bills should be filed and there is no legal bar to disallow the medicine cost of the complainant as per his petition and the relevant Rules and Act. By not allowing the prayer of the complainant the OP has done deficiency in service to the complainant. The ambit of the Rules framed by the Govt. is to help the Govt. servant by giving the cost of treatment of any disease whatsoever in nature and by not doing so the oP miserably failed to discharge his duty without due care and attention of the existing law and its impact on the society. 

            So after going through the record, allegation and counter allegation of both sides and arguments advanced therein we find no reason to disallow the prayer of the complainant by the said Act and which the complainant is legally entitled to get.  Hence it is –

                                                                        Ordered

            That the CC no. 13 of 2016 be and the same is allowed on contest. The OP is directed to make payment of the bills for February to November, 2015 to the complainant. The OP is further directed to pay Rs.1,000/- towards compensation to the complainant. The OP is also directed to pay Rs.5,000/- to the complainant towards litigation cost.

            The OP shall comply the above orders within 30 days from the date of this order i.d. after 30 days ,  Rs.300/- per day  shall be imposed upon the oP and that amount will be deposited to the Consumer Legal Aid Fund till full realisation.

            Let a copy of this order be made over to the parties free of cost.