State Consumer Disputes Redressal Commission
Board Of Trustee,State Of Raj. ... vs Prem Chand Benada on 25 March, 2009
BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION, RAJASTHAN, JAIPUR APPEAL NO: 935/2008 1. Board of Trustee, Rajasthan State Pensioners Medical Concession Scheme,Jaipur through Secretary & Director, Pension & Pensioners Welfare. 2. Directorate, Pension & Pensioners Welfare Deptt. Jaipur through Secretary & Director, Pension & Pensioners Welfare. Opposite parties- appellants Vs. Prem Chand Benada r/o Plot no. 44/111, Jai Jawan Colony, Tonk Road, Jaipur. Complainant-respondent Date of Judgment 25.3.2009 Before: Mr.Justice Sunil Kumar Garg-President Mrs.Vimla Sethia-Member Mr.M.L.Vyas counsel for the appellants Mr.R.C.Papriwal counsel for the respondent 2 JUDGMENT
BY THE STATE COMMISSION ( PER HON. MR.JUSTICE SUNIL KUMAR GARG, PRESIDENT) This appeal has been filed by the appellants against order dated 2.5.08 passed by the District Forum,Jaipur IInd in complaint no. 1048/2006 by which the complaint of the complainant respondent was allowed in the manner that the appellants were directed to pay a sum of Rs.88,175/- alongwith interest @ 9% p.a. w.e.f. 5.5.05 and further to pay Rs.2000/- as costs of litigation.
2. It arises in the following circumstances-
That the complainant respondent had filed a complaint before the District Forum, Jaipur IInd on 6.10.06 inter alia stating that he had retired from the government service of Govt. of Rajasthan on 30.6.92 and he is the member of Medical Relief Fund and he had got the pensioner diary. It was further stated in the complaint that on 18.3.05 when he was out of station, the condition of his wife Smt. Kamla Devi had become deteriorated and since he was out of station, therefore, the relatives had taken his wife to the nearest Jaipuria Hospital, Jaipur where Dr. Kailash Vijay had seen her and he had referred the case to the SMS Hospital, Jaipur in Cardiology Deptt. and thereafter she was taken to the SMS Hospital, Jaipur and on the same day i.e. 18.3.05 it was told that on friday there was no OPD of Cardiology and since the condition of Kamla Devi was not good, therefore she was taken to the Santokba Durlabhji Memorial Hospital (SDMH)Jaipur where she was admitted in the ICU and she remained admitted in that hospital forthe 3 period 18.3.05 to 25.3.05 and on 22.3.05 the Pace Maker was implanted in her heart and thereafter she was discharged on 25.3.05 and in getting the treatment in that hospital a sum of Rs.88,174.82 were incurred. Thereafter bills were submitted for reimbursement but the appellant no.2 had repudiated the claim of the complainant respondent through letter dated 5.5.05 Anx. 30 in the following manner-
"In this connection it is to inform you that as per provision of the scheme and also as per clarification received from the government no reimbursement in respect of treatment taken in private hospital is admissible.
It is therefore, regrated and inform that your case for grant of financial assistance for treatment of your spouse taken in S.D.M. Hospital, Jaipur cannot be considered."
Thereafter the present complaint was filed by the complainant claiming Rs.88,174.82 as amount incurred in the treatment and further some amount of compensation.
A reply was filed by the appellants before the District Forum on 16.1.07 inter alia stating that the complainant and his wife were entitled to receive free treatment in the government hospitals and the disease for which Smt. Kamla Devi, wife of the complainant was suffering could be treated in the SMS Hospital, Jaipur and since the complainant respondent had taken the treatment from the private 4 hospital, therefore, the complainant respondent was not entitled for getting the reimbursement of the amount incurred in the private hospital. It was further stated in the reply that it was wrong to say that on 18.3.05 the OPD of Cardiology of the SMS Hospital, Jaipur was closed. Hence, no case, complaint be dismissed.
After hearing the parties, the District Forum, Jaipur IInd through impugned order dated 2.5.08 had allowed the complaint of the complainant respondent inter alia holding -
(i) That as per the reply given by the Deptt. of Cardiology, though the cardiology services available around the clock all the seven days of the week but OPD remain open for four days in a week and the appellants had failed to prove the fact that on friday i.e. on 18.3.05 the OPD was opened.
(ii) That as per the record of SDMH the condition of the wife of the complainant respondent was serious and that is why she was being admitted in the ICU of that hospital.
(iii) That in case of emergency if treatment is taken by the pensioners from a private hospital, the amount incurred by him should be reimbursed and thus the complaint was decreed as stated above.
Aggrieved from the said order dated 2.5.08 passed by the District Forum, Jaipur IInd this appeal has been filed by the appellants.
53. In this appeal the main contention of the learned counsel for the appellants is that on 18.3.05 the OPD of the SMS Hospital, Jaipur was open one and there was no justification on the part of the complainant respondent to take Smt. Kamla Devi to a private hospital and further if for the sake of argument OPD was not opened on 18.3.05, the patient should have approach the Emergency Deptt. of the SMS Hospital, Jaipur. Hence,the findings of the District Forum decreeing the claim of the complainant are wholly illegal, erroneous and perverse one and therefore, the same could not be sustained and liable to the quashed and set aside and this appeal deserves to be allowed.
4. On the other hand, the learned counsel appearing for the respondent has supported the impugned order of the District Forum.
5. We have heard the learned counsel for the appellants as well as for the respondent and gone through the entire materials available on record.
6. In this case so far as the question that on 18.3.05 the OPD of Cardiology of the SMS Hospital, Jaipur was opened or not is concerned, this querry is being answered on the information received by the complainant respondent under the provisions of the Information Act and the answer had been given by the Professor and Head of the Cardiology Deptt. of the SMS Hospital, Jaipur on 13.1.09 in which it was clearly stated that there was no Cardiology OPD on friday 18th March 05.
7. When this being the position, it could be easily held that on friday i.e. 18.3.05 there was no cardiology OPD in the SMS 6 Hospital and thus the case of the appellant that there was OPD of cardiology in the SMS Hospital, Jaipur on 18.3.05 stands rejected.
8. It may be stated here that the fact that Pace Maker was implanted in the heart of the wife of the complainant respondent in Santokba Durlabhji Memorial Hospital, Jaipur further reveals that the condition of Smt. Kamla Devi was serious one and that is why she had been remained admitted in that hospital for the period 18.3.05 to 25.3.05.
9. Further from Anx. 5, a certificate dated 30.3.05 issued by Dr. Subhash C. Kala, the treating doctor of Kamla Devi, it is very much clear that her condition was not improved even after giving the drug treatment and therefore, Pace Maker was implanted in the interest of the life of the patient immediately on 22.3.05 as delay might have caused an adverse effect to her life and from that certificate the fact that implantation of Pace Maker in the heart of Smt. Kamla Devi, the wife of the complainant respondent was must is also clear and if for the treatment she was being taken to the private hospital, that would mean that the case of the wife of the complainant respondent was an emergency case.
10. In the facts and circumstances of the case just mentioned above, the next question is whether in case of emergency the complainant respondent was entitled to reimburse for the medical treatment which he had taken in the private hospital or not.
11. In our considered opinion, when there was no OPD of Cartiology in the SMS Hospital, Jaipur on 18.3.05 and taken into consideration the fact that state pensioners are entitled to free treatment in the government hospital and taken into consideration 7 that the complainant had taken the treatment from a local hospital which is known for its good services and that hospital is in the state not outside the state, therefore, refusal for reimbursement of medical bills of the complainant respondent was not justified and thus, the appellants had committed deficiency in service in rejecting the claim for reimbursement of medical expenses.
12. For the reasons stated above, it is held that the appellants were not justified in repudiating the claim of the respondent complainant and the appellants have repudiated the claim of the complainant respondent without any basis and on wrong assumption and in an arbitrary manner and in view of this, the findings of the District Forum decreeing the claim of the complainant respondent are liable to be confirmed as they are based on correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity, illegality or perversity and this appeal deserves to be dismissed Accordingly, this appeal filed by the appellants is dismissed.
Member President