State Consumer Disputes Redressal Commission
Chief Medical Superintendent, ... vs Mr. Lalloo Singh on 15 July, 2009
D R A F T State Consumer Disputes Redressal Commission West Bengal BHABANI BHAVAN (GROUND FLOOR) 31, BELVEDERE ROAD, ALIPORE KOLKATA 700 027 S.C. CASE NO. : FA/09/145 DATE OF FILING : 13.04.2009 DATE OF FINAL ORDER: 15.07.2009 APPELLANT Chief Medical Superintendent Kasturba Gandhi Hospital Chittaranjan Locomotive Works Chittaranjan, Burdwan. RESPONDENTS Mr. Lalloo Singh S/o Late Mathura Singh Qrs. No. 129, Old Colony, Hindusthan Cables Ltd. Rupnarayanpur, Burdwan. BEFORE : MEMBER : MR. P.K.CHATTOPADHYAY MEMBER : MR. S.COARI FOR THE PETITIONER / APPELLANT : Mr. A.Ghosh, Ld. Advocate FOR THE RESPONDENT / O.P.S.: In person. : O R D E R :
MR.
P.K.CHATTOPADHYAY, LD. MEMBER This Appeal arose out of judgement and order in DCDRF, Burdwan, Case No. 96/2007 where the complainant, Mr. Lalloo Singh, was a retired railway employee who joined Retired Employees Liberalised Health Scheme, under the Ministry of Railways, Government of India, w.e.f. 21.8.02. Mr. Singh was required to be admitted in Kasturba Ganghi Railway Hospital on sudden and emergent necessity on 15.8.02 and was discharged from the hospital on 26.8.02 with medical advice for continuing treatment. Subsequently he submitted a claim for an amount of Rs. 23,730.76 towards reimbursement for given treatment as admissible to him, when the OP namely the Chief Medical Superintendent, Kasturba Gandhi Hospital, CLW, Burdwan, paid reimbursement cost to the tune of Rs. 750/- only against such claim. Mr. Singh filed the complaint case alleging deficiency of service on the part of the OP in regard to the given disposal of reimbursement claim and prayed for the remainder amount of the claim namely Rs. 19,923.76.
The OP entered appearance and argued inter alia that from 15.8.02 to 20.8.02 Mr. Singh was extended treatment against cash payment when he was not covered by RELH Scheme, his contribution having been effective only from 21.8.02. From 21.8.02 to 26.8.02, the date of his discharge from the hospital, his entire treatment was done under the said RELHS cover. Any claim subsequent to the discharge date, i.e. 26.8.02, was not covered by the said scheme and, therefore, he was not entitled to the given claim in the complaint when Rs. 750/- as was due for the course of his treatment in the hospital was duly paid and received.
The matter was heard from respective sides when the Ld. Forum passed its order and judgement as under :-
That the case be allowed on contest. The O.P. is directed to reimburse the amount as incurred by him towards physiotherapy and C.T. Scan for his treatment within 30 days from the date of the order as admissible to him under retired Railway Employees Liberalised Health Scheme. We do order of no cost.
Being aggrieved and dissatisfied with the impugned judgement and order the OP in the Forum namely Chief Medical Superintendent, Kasturba Gandhi Hospital, filed this Appeal when it reiterated the fact of the case and contended that apart from legal objections of maintainability, limitation and jurisdiction, the main defence relied by the Appellant was that the Respondent/Complainant never disclosed that he was covered by RELHS during the course of his treatment or for that matter, never produced documents in support thereof. The claim of the Respondent was duly examined and Rs. 750/- was reimbursed to him as per his entitlement.
His claim for cost of L T Score was not admissible as this was done prior to joining the scheme and as for payment towards physiotherapy expenses done outside the railway hospital, the same was not admissible under the scheme and rules. Stating that the question of reimbursement of medical expenses raised by the retired railway employee was not a consumer dispute and that the complainants claim is time-barred, the Appellant prayed for setting aside of the impugned judgement and order and for passing of such other orders as deemed fit.
The Respondent, Mr. Lalloo Singh, entered appearance and filed written statement when he stated inter alia that it was unfortunate that in stead of paying the decretal amount the authorities chose to file this Appeal. The Ld. Forum below passed its judgement and order only after due consideration of the merit of the case. Stating that the expenditure claimed towards reimbursement was actually made on express medical advice from the treating doctors of the hospital issued prior to his discharge from the spell of medical treatment he underwent for the period from 15.8.02 to 26.8.02, it was argued that the claim was accompanied by appropriate supporting papers duly placed in evidence. Referring to payment of Rs.
750/- since received by him, it was pointed out that this amount against the aforesaid reimbursement claim was made after several years subsequent to innumerable visits and reminders to the authorities, which was an extremely harrowing experience for a retired person of his age with past medical background of paralysis and fainting.
The Respondent accordingly prayed for affirmation of the judgement and order of the Ld. District Forum.
The matter was heard from respective sides.
DISCUSSION :-
A. The Appellants argument relating to the complaint not being maintainable on account of limitation or jurisdiction has simply no basis. This was not properly argued in the Forum below or for that matter, no revision application was filed in regard to such on the findings of the Forum. We, therefore, hold that the complaint was perfectly maintainable in the Forum.
B. As for the claim amount of Rs. 23,730.76 preferred immediately after the complainants undergoing treatment at Kasturba Gandhi Railway Hospital, the Ld. Forum below after critical examination of evidence as was filed, was satisfied that the given claim on CT Scan and for charges towards Physiotherapy was admissible to him, being supported by proper documents and in terms of appropriate medical advice of the treating doctors at the Railway Hospital subsequent to the discharge from the hospital. The evidence of the complainant in the Forum, not being challenged, was absolute which the Ld. Forum below also accepted as proved beyond doubt. We find no incongruity in foregoing acceptance of the evidence by the Ld. Forum below. In such view, the finding of the Ld. Forum below that the Complainant/Respondent was entitled to get reimbursement of the expenditure towards physiotherapy and C.T. Scan is deemed to be in order.
C. In above view, the Appeal is liable to be dismissed on contest being without substance or merit.
Since, however, the Respondent had to suffer some delay on account of this Appeal, we deem it proper to award an amount of cost of Rs. 500/- to the Appellant to be paid to the Respondent along with the decretal dues.
O R D E R Hence, it is ordered that the Appeal is dismissed on contest with cost of Rs. 500/- (Rupees five hundred only) to be paid by the Appellant to the Respondent. The impugned judgement of the Ld. Forum below is affirmed. The Appellant is directed to pay the decretal dues along with the above cost to the Respondent within 30 (thirty) days from the date of communication of this judgement, failing which the decretal amount will accrue interest @ 10% (ten per cent) per annum for the period of default.
MEMBER MEMBER