Mr.K.K.Marwah son of Sh.Sant Ram, resident of H.No.547, Gali Gurdware Wali, Bhawani Nagar, Majitha Road, Amritsar.

Complainant

Versus

Union of India through Ministry of Railways having  its Divisional Office, Northern Railways at Ferozepur Service through Chief Railway Manager, Railway Station, Amritsar. Correct address: Union of India, through Ministry of Railways, Northern Railways, Baroda House, New Delhi.

Opposite Party

Complaint under section 12 & 13 of the Consumer Protection Act, 1986 (as amended upto date).

Present: For the  Complainant: Sh.Deepinder Singh, Advocate.       

              For the Opposite Party: Mrs.Neena Kapoor, Advocate.             

Coram

Sh.Anoop Sharma, Presiding Member

Ms.Rachna Arora, Member.   

Order dictated by:

Sh.Anoop Sharma, Presiding Member

1.       The complainant  has brought the instant complaint under section 12 & 13 of the Consumer Protection Act, 1986 on the allegations that the complainant is a retired employee of Opposite Party and is entitled for medical reimbursement of medical treatment for himself and his family members, the wife of the complainant underwent total knee replacement and preferred the claim for the reimbursement to Opposite Party and the complainant is a consumer as provided under the Act and is competent to invoke the jurisdiction of this Forum.  The wife of the complainant Ramesh Rani had an acute problem in her knees and could not bear the pain and movement was totally restricted and she had to underwent the emergency treatment by way of surgery of total knee replacement and to remain hospitalized from 26.2.2014 to 5.3.2014 at Satyam Hospital, Jalandhar and before getting the said treatment she had to undergone the cardiac investigations at Tagore Hospital, Jalandhar. The total treatment cost came to Rs.2,67,395/- and Rs.10,826/-, the complainant preferred the claim with Opposite Party and they rejected the claim of the complainant finally with their letter dated 23.6.2015 on frivolous grounds that the claim is not payable as the said treatment was not taken in emergency from the non recognized private hospital. Said repudiation against the principles of natural justice and against the law of the land and no such circulars were made known to the complainant before hand by the Opposite Party. The aforesaid acts of the Opposite Party in repudiating the genuine claim of the complainant is an act of deficiency in services, unfair trade practices, mal practices and is not sustainable in the eyes of the law and has caused lot of mental tension, agony and harassment to the complainant besides financial loss to the complainant and for which the Opposite Party is liable to pay the compensation. Vide instant complaint, the complainant has sought the following reliefs.

a)       Opposite Party be directed to pay the claim of Rs.2,78,211/- alongwith interest @ 12% per annum thereon from the date of payment till realization.

b)      Opposite Party be directed to pay the compensation of Rs.50,000/- to the complainant.

c)       Opposite Party be directed to pay the adequate cost of the present litigation.

d)      Any other relief to which the complainant is found under the law, equity and justice be also allowed.       

Hence, this complaint.

2.       Upon notice, Opposite Party appeared and contested the complaint by filing  written statement taking preliminary objections therein inter alia that  the complainant has not come to the court with clean hands and has t tried to conceal the material facts from this Forum. The complainant has not complied with the conditions and schedule of Railway Board Government of India, Ministry of Railway, there was no emergency in the present case as emergency shall mean any condition or symptom resulting  from any cause arising suddenly and if not treated at the early convenience be detrimental to the health of the patient or will jeopardise the life of the patient e.g. road accidents acute heart attack etc. under such circumstances when railway beneficiary feels that there is no scope of reporting to his/ her authorised Railway Medical Officer and avails treatment in the nearest and suitable private hospital, hence in the set of circumstances mentioned above, it is clear  that there is no cause of action and there is no question of deficiency and lapse on the part of Opposite Party. On merits, it is submitted that  in reference to the treatment mentioned Railway Board considered the reimbursement on merit. Claim presented by the complainant before the Opposite Party has been rejected on the ground that emergency has not been justified as patient was suffering from B/L knee pain from many years. Hence patient’s treatment at non Railway AND NON RECOGNISED Private Hospital in emergency under the above circumstances is considered unjustified  in terms of Railway Board Letter No.2005/H/6-4/Policy-II dated 31.1.2007 and 22/6 that is  why the claim could not be reimbursed.    Further the Opposite Party took the same and similar pleas as taken up by them in the preliminary objections. Remaining facts mentioned in the complaint are also denied and a prayer for dismissal of the complaint with cost was made.

3.       In his bid  to prove the case, complainant tendered into evidence  affidavit Ex.C-1 in support of the allegations made in the complaint and also produced copies of documents Ex.C2   to Ex.C6  and closed his evidence.

4.       On the other hand, to rebut the evidence of the complainant, the Opposite Party tendered into evidence the affidavit of Dr.Amarendra Chatterji, Chief Medical Supdt. Ex.OP1 alongwith copies of documents Ex.OP2 to Ex.OP5 and closed the evidence on behalf of the Opposite Party.

5.       We have heard the ld.counsel for the parties and have carefully gone through the evidence on record.

6.       The complainant has submitted his affidavit Ex.C1 in which he has reiterated the facts as detailed in the complaint and contended that the complainant is a retired employee of Opposite Party and is entitled for medical reimbursement of medical treatment for himself and his family members, the wife of the complainant underwent total knee replacement and preferred the claim for the reimbursement to Opposite Party and the complainant is a consumer as provided under the Act and is competent to invoke the jurisdiction of this Forum.  The wife of the complainant Ramesh Rani had an acute problem in her knees and could not bear the pain and movement was totally restricted and she had to underwent the emergency treatment by way of surgery of total knee replacement and to remain hospitalized from 26.2.2014 to 5.3.2014 at Satyam Hospital, Jalandhar and before getting the said treatment she had to undergone the cardiac investigations at Tagore Hospital, Jalandhar. The total treatment cost came to Rs.2,67,395/- and Rs.10,826/-, the complainant preferred the claim with Opposite Party and they rejected the claim of the complainant finally with their letter dated 23.6.2015 on frivolous grounds that the claim is not payable as the said treatment was not taken in emergency from the non recognized private hospital. Said repudiation against the principles of natural justice and against the law of the land and no such circulars were made known to the complainant before hand by the Opposite Party. The aforesaid acts of the Opposite Party in repudiating the genuine claim of the complainant is an act of deficiency in services, unfair trade practices, mal practices and is not sustainable in the eyes of the law and has caused lot of mental tension, agony and harassment to the complainant besides financial loss to the complainant and for which the Opposite Party is liable to pay the compensation.

7.       On the other hand, ld.counsel for the Opposite Party  has repelled the aforesaid contention of the ld.counsel for the complainant on the ground that the complainant has not come to the court with clean hands and has ttried to conceal the material facts from this Forum. The complainant has not complied with the conditions and schedule of Railway Board Government of India, Ministry of Railway, there was no emergency in the present case as emergency shall mean any condition or symptom resulting  from any cause arising suddenly and if not treated at the early convenience be detrimental to the health of the patient or will jeopardise the life of the patient e.g. road accidents acute heart attack etc. under such circumstances when railway beneficiary feels that there is no scope of reporting to his/ her authorised Railway Medical Officer and avails treatment in the nearest and suitable private hospital, hence in the set of circumstances mentioned above, it is clear  that there is no cause of action and there is no question of deficiency and lapse on the part of Opposite Party. The only contention of the Opposite Party was that there complainant has not complied with the conditions and schedule of Railway Board Government of India, Ministry of Railway, there was no emergency in the present case as emergency shall mean any condition or symptom resulting  from any cause arising suddenly and if not treated at the early convenience be detrimental to the health of the patient or will jeopardise the life of the patient e.g. road accidents acute heart attack etc. under such circumstances when railway beneficiary feels that there is no scope of reporting to his/ her authorised Railway Medical Officer and avails treatment in the nearest and suitable private hospital. On the other hand, the wife of the complainant Ramesh Rani had an acute problem in her knees and could not bear the pain and movement was totally restricted and she had to underwent the emergency treatment by way of surgery of total knee replacement and to remain hospitalized from 26.2.2014 to 5.3.2014 at Satyam Hospital, Jalandhar and before getting the said treatment she had to undergone the cardiac investigations at Tagore Hospital, Jalandhar. In such a situation, it will be in the interest of justice and both the parties that the claim of the complainant may be paid according to the railway board entitlement.

8.       In view of the aforesaid facts and circumstances of the case, the Opposite Party is directed to make the payment of claim amount of the complainant as per the entitlement of the Railway Board of the Opposite Party. Opposite Party is also directed to pay Rs.2000/- as compensation to the complainant on account of causing him mental tension and harassment besides Rs.1000/- as costs of litigation.    Compliance of this order be made within 30 days from the receipt of copy of the order; failing which, the complainant shall be at liberty to get the order enforced through the indulgence of this Forum. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.

Announced in Open Forum

Dated: 24.10.2017.