Delhi

New Delhi

CC/590/2015

Sheojee Tewary - Complainant(s)

Versus

Union Of India - Opp.Party(s)

26 Sep 2017

ORDER

 

 

CONSUMER DISPUTES REDRESSAL FORUM-VI (DISTT. NEW DELHI), ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN,

I.P.ESTATE, NEW DELHI-110002.

 

Case No.CC./590/2015                                    Dated:

In the matter of:

Sheojee Tewary,

R/o C-3-S, Delhi Police Apartments,

Mayur Vihar Phase-1,

New Delhi-91                                                                       ……..COMPLAINANT

     

VERSUS

 

1. Union of India,

Through Secretary health,

Ministry of Health and Family Welfare,

Nirman Bhawan,  C- Wing, New Delhi-110001.

 

2. Additional Director,

East Zone, CGHS,

Wellness Centre Laxmi Nagar Building,

Laxmi Nagar, Delhi.

 

3. Director General Health Services,

Ministry of Health and Family Welfare,

Nirman Bhawan, New Delhi-110001.

 

4. Delhi Police,

Through its Commissioner,

Police Headquarters,

ITO, New Delhi.                                          ………. OPPOSITE PARTIES

 

ORDER

H.M. VYAS, MEMBER

 

                  The gist  of  the complaint is that the complainant is a CGHS card holder  bearing No. 2506507 issued on 5/6/09.  He visited his daughter who is staying in USA in February, 2014, where he fell down from the stairs and sustained multiple injuries in left ribs, lung injury and on the back.  Owing to such serious injuries, urgent treatment was necessary and was immediately admitted to the emergency ward of nearest Fredrick Memorial Hospital where he was diagnosed with multiple rib fracture with associated pulmonary contusion.  He incurred  treatment expenses of Rs. 409640/-  ( 6618.84 Dollars).  The complainant got well and returned to India and applied for reimbursement of the amount in prescribed format alongwith affidavit dated 22/11/14 before the concerned authority.  The OP2 in disregard of the guidelines of OP1 & 3 rejected the  claim  vide letter dtd. 5/12/14 by taking a ground  that “ vide F.No. 12/165/90 Co-od dated 21/9/1991 ;  one of the facilities not permissible to pensioner is treatment outside India. Hence your claim is regretted.”  It is stated by the complainant that it was clearly mentioned to the concerned authorities that the case of the complainant is that he sustained  injuries accidentally/ suddenly on the fateful day  in USA where he went to his daughter.  The complainant has filed the copy of Pass Port and the documents showing the treatment in the hospital.  It is alleged that the arbitrary ground of rejection of his reimbursement claim  is uncalled for.  It is also stated that reimbursement for specialized treatment in non-empanelled hospital is permissible as per the OPs circular in chapter 6 and the complainant is entitled for such reimbursement of the medical expenses incurred in emergency.  Following prayer is made :-

1. To reimburse the medical claim amounting Rs. 4,09640/-( Four Lac Nine Thousand Six Hundred Forty Rupees only)along with interest @ 18% since 5^th December, 2014 till the date of payment incurred on the medical expenses of the complainant.
2. To pay a sum of Rs. 3,00,000/- ( three lacs only) as compensation/damages on account of harassment and mental agony as suffered by the complainant due to the negligence of the opposite parties.
3. To pay a sum of Rs. 55,000/- ( Fifty thousand) towards the cost of litigation  expenses.
4. Pass any order/orders in favour of the complainant and against the opposite parties as per deem fit to meet the ends of  justice.

 

                   The OP were proceeded ex-parte on 28/10/15 after notice.  The complainant filed ex-parte evidence and also addressed oral arguments.  The text of the complainant have remained un-rebutted as the OP proceeded ex-parte.

 

                  We have considered the material placed before us and the arguments addressed with relevant provisions of law.   It is evident from the documents of medical treatment placed before us by the complainant that he sustained injuries caused due to accidentally falling from the stairs.  The  medical reports / treatment clearly so mention.  The  ground of rejection of the claim  is   that the pensioner is not entitle for treatment outside India . As per the record before us it is not the case where the pensioner went abroad for some treatment, but the emergency  medical treatment was the necessity of the time due to the accidental injuries caused as he fell down from the stairs.  We hold that the rejection of the claim is unjustified and there is apparent deficiency in services on the part of the OP.  The claim was filed before OP2 and the rejection letter dated 05/12/14 was also issued  with instructions to the complainant to contact OP2 for further quarries While holding the OP2 to be deficient in services,  we direct the OP2 to  pay  the amount of Rs. 409640/-  with  10 % p.a. simple interest  from the date of filing of this complaint i.e. 04/09/15 till the date of payment  and compensation  including the litigation cost of Rs. 30,000/- within 30 days from the date of receipt of this order.   

Announced in open Forum on ________________.

The orders be uploaded on www.confonet.nic.in.

Cop[y of the orders be sent to the complainant by post free of cost as per statutory requirement.

File be consigned to record room.

 

                      (S K SARVARIA)

                        PRESIDENT

 

                           (H M VYAS)                                                                      (NIPUR CHANDNA)

                                  MEMBER                                                                                MEMBER