State Consumer Disputes Redressal Commission
Chief Managing Director, Bharat ... vs Santokh Singh S/O Tara Singh on 7 November, 2013
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No. 1171 of 2011
Date of institution: 3.8.2011
Date of Decision: 7.11.2013
1. Chief Managing Director, Bharat Sanchar Nigam Limited,
Statesman House, 148-B, Bara Khamba Road, New Delhi.
2. Chief General Manager Telecom, Bharat Sanchar Nigam Limited,
Plot No. 2, Sector 34, Chandigarh.
3. General Manager, Telecom, Bharat Sanchar Nigam Limited,
Telephone Bhawan, Patiala.
.....Appellants/Opposite Parties.
Versus
Santokh Singh S/o Tara Singh R/o House No. 498-A, Street No. 9,
Ghuman Nagar, Sirhind Road, Patiala (since deceased) through legal
heirs:-
1. Surinder Kaur, aged 56 years, widow of Late Sh. Santokh Singh,
2. Baljinder Kaur aged 36 years, daughter of Late Sh. Santokh
Singh,
3. Amarjit Singh, aged 34 years, son of Late Shri Santokh Singh,
All residents of House No. 810, Ward No. 19, Near Tehsil Shakti Nagar,
Tohana, District Fatehabad (Haryana).
.....Respondents/Complainants
Argued By:-
For the appellants : None.
For respondents No.1 to 3: Ex.-parte.
For respondent No. 2 : Sh. Shashi Kant, Advocate for
Sh. L.M. Gulati, Advocate.
First Appeal against the order dated 10.6.2011
passed by the District Consumer Disputes
Redressal Forum, Patiala.
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Shri Piare Lal Garg, Member Shri Jasbir Singh Gill, Member Gurcharan Singh Saran, Presiding Judicial Member The appellants/opposite parties (hereinafter called "the opposite parties") have filed the present appeal against the order dated 10.6.2011 passed by the District Consumer Disputes FIRST APPEAL NO. 1171 OF 2011 2 Redressal Forum, Patiala (hereinafter called "the District Forum") in consumer complaint No. 344 dated 3.9.2007 vide which the complaint filed by the complainant was allowed to reimburse the medical expenses to the tune of Rs. 1,70,000/- with interest @ 10% per annum w.e.f. 10.6.2011 and compensation for deficiency in services to the tune of Rs. 20,000/-.
2. The complaint was filed by Santokh Singh through his legal heirs under Sections 11 to 14 of the Consumer Protection Act, 1986 (in short 'the CP Act') on the allegations that the complainant retired as Sub Inspector on superannuation after rendering 39 years service with the opposite party and is getting pension from the Ops. The complainant is consumer as the opposite party had been deducting amount as a part of Provident Fund and other benefits and the same were to be paid to the complainant on his superannuation. In the month of July, 2006, the complainant suddenly suffering a heart attack and he was immediately, rushed to Fortis Hospital, Mohali and the Doctors gave an estimate of Rs. 2,89,000/- and its intimation given by his son to the opposite party for according approval. On 26.8.2006, the Accounts Officer of the Ops inquired for furnishing information to process the case of reimbursement, which were supplied to the opposite party. However, the then Divisional Manager Phones (Admn.) issued letter No. E-1/Genl/Medical/1/D/51 dated 15.9.2006 for furnishing some clarification for processing the case and those were given. It was processed and sent to G.M.T. BSNL, Punjab Circle, Chandigarh duly recommended for approval for payment of the claim. However, the CGMT, BSNL Punjab Circle put FIRST APPEAL NO. 1171 OF 2011 3 some inquiries vide his letter No. Genl.G-3/Mid/453/Sh. Santokh Singh S.I. Retd./PA/5 dated 19.1.2007 and G.M.T. BSNL, Patiala submitted the reply to those queries. Ultimately, the case of the complainant was rejected by CGMT, which was conveyed to the complainant by Accounts Officer (Cash) O/o GMT Patiala vide letter dated 27.3.2007. The complainant submitted a request for review of the claim of the complainant, however, his claim and appeal was dismissed by CGMT, Punjab Circle, Chandigarh vide letter dated 9.8.2007, which was conveyed to GMT, Patiala. After hearing the rejection of the claim, he again suffered a heart attack. Since the Ops had not processed his claim in time, therefore, they are liable to pay interest @ 18% per annum, hence, the complaint.
3. The complaint was contested by the Ops, who filed written statement taking preliminary objections that the complaint is not maintainable; the complainant is not a consumer of the opposite parties as defined under the Act; the complainant has not come to the Hon'ble Forum with clean hands; he has been getting the pensionery benefits at Tohana, District Fatehabad and as per the address given in the complaint, he is residing at Patiala and in his representation he has disclosed his address at Mohali and all the places have different jurisdiction to file the complaint, since he has got the treatment from Mohali, therefore, the territorial jurisdiction lies with Mohali; as per Para 1.3 of the BSNL MRs Card shall contain the registration of the self and dependent members and particulars of SSA office, whereas the complainant failed to comply with this condition; the complainant intentionally and wilfully had not submitted the BSNL MRs Card FIRST APPEAL NO. 1171 OF 2011 4 alongwith his application dated 18.7.2006; the complainant has failed to comply with the mandatory provisions of Annexure-K i.e. para No. 1.3(ii) which states that advices of the Doctor registered in the Allopathic System of Medicine for hospitalization and copy of BSNL MRs card have to be submitted for submitting documents for issuing of authorisation letter; as per letter dated 17.11.2006 issued by the office of OP No. 2 that before taking admission in the hospital approval of the CGMT is required except in the case of emergency and that Fortis Hospital, Mohali is not approved on the list of hospitals of Patiala SSA. On merits, it has been admitted that the complainant retired as Sub Inspector from the office of G.M. Telecom, BSNL, Patiala. It has been further stated that the complainant under a pre- planned scheme and legal guidance has concocted a false story to get unjustified medical reimbursement claim. It has been denied that in the month of July, 2006 to see his son Amarjit Singh at Mohali in fact he might have shifted there to get his treatment from Fortis Hospital, Mohali. It has been denied that he suffered heart attack and he has shifted to Fortis Hospital, Mohali. He get the treatment from Fortis Hospital, Mohali inspite of the fact that PGI, Chandigarh is reputed hospital is adjoining to Mohali. As per the letter dated 17.7.2006 issued by Dr. Jagmohan Varma, Fortis Hospital, it was mentioned that the complainant was under treatment but it has not been mentioned that the patient was extremely emergent case. Moreover, the estimate given is at the higher rate than the approved rates of the BSNL. It has been denied that the complainant had given immediately intimation through his son to opposite party at Patiala FIRST APPEAL NO. 1171 OF 2011 5 alongwith estimate and pre-authorization letter issued by Fortis Hospital, Mohali for according approval. From the perusal of the record it can be observed that it is not an emergency case rather it has been mentioned that "he needs coronary angiography and AVR"
but the complainant has mentioned wrong facts in his application dated 18.7.2006. However, it has been admitted that medical bill of the complainant dated 25.8.2006 was received by the Ops and the same was returned back to the complainant for supply of necessary documents within 7 days. Following observations were made as under:-
"1. Copy of BSNLMRS health card identifying the patient there is by the signatures of concerned Doctor (in case BSNLMRS Photo card not issued then joint photograph of the employee and the patient identifying the patient therein by the signatures of concerned Doctor countersigned by the controlling officer) Not attached.
2. Emergency Certificate is not on the letter head of the concerned Hospital/Doctor.
3. Referral Certificate (in case treatment has been taken from outside normal place of residence/duty of the employee) not attached.
4. Claim is submitted in duplicate with pages of both the sets having the same Sr. No.
5. The approval from Circle Office for treatment from private Hospital may be submitted pl.
6. Authorisation letter for treatment in hospital not attached.
7. Discharge slip not attached.
8. Visiting certificate by BSNL Officer not received.
9. Annexure D and Annexure D-1 not fill up."
4. It is correct that the complainant again submitted his bill with some documents. It has also been admitted that Divisional Engineer Phones (Admn.) had written a letter to the complainant dated 15.9.2006 for furnishing the clarification for processing the case FIRST APPEAL NO. 1171 OF 2011 6 and that the clarification was furnished by the complainant. It has been admitted that Patiala Office had recommended the claim of the complainant, however, it was rejected by CGMT, Punjab Circle, Chandigarh. The case of the complainant was processed properly in the light of rules and regulations governing the claim of the complainant and was rightly rejected on account of non-compliance of the rules and regulations, therefore, it was stated that there is no merit in the complaint filed by the complainant and the same be dismissed.
5. Rejoinder was filed by the complainant to the written statement filed by the opposite party in which the averments of the opposite party have been contradicted and stand taken in the complaint was reiterated.
6. The parties were allowed by the learned District Forum to lead their evidence.
7. In support of his allegations, the complainant had tendered into evidence affidavits of Santokh Singh Ex. CW-1 & CW- 2/A, photocopy of pension form Ex. CW-1/A, copy of estimate Ex. CW-1/B, copy of pre-authorization letter Ex. CW/1-C, letter issued by GMT BSNL, Patiala Ex. CW-1/D, Documents required form Ex. CW- 1/E, photocopy of letter dated 15.9.2006 Ex. CW-1/F, receipt No. 108 Ex. CW-1/G, reply Ex. CW-1/H, letters Ex. CW-1/I&J, endorsement Ex. CW-1/K, copy of claim rejection letter Ex. CW-1/L and CW-1/L1, copy of letter Ex. CW-1/M, copy of health card Ex. CW-1/N, copy of certificate dated 17.7.2006 Ex. CW-1/O, original postal receipt Ex. CW-1/P, copy of lab report Ex. CW-1/Q, copy of treatment slip Ex. FIRST APPEAL NO. 1171 OF 2011 7 CW-1/R, copy of discharge form Ex. CW-1/S, copy of discharge summary Ex. CW-1/T, copy of certificate Ex. CW-1/U. On the other hand, the opposite parties had tendered into evidence affidavit of Himat Singh, SDE Ex. R-1, copy of letter dt. 17.11.06 Ex. R-2, copy of letter dated 5.4.2005 Ex. R-3.
8. After going through the allegations in the complaint, written statement, replication, evidence and documents brought on the record, the learned District Forum vide impugned order observed that on 17.7.2006 the complainant suffered Heart Attack near Mohali. He was got admitted in Fortis Hospital, Mohali and was under
treatment of Dr. Jagmohan Varma, who advised immediate admission for operation and issued a certificate dated 24.7.2006 and approximate expenditure to be incurred vide pre-authorization letter Ex. CW-1/C as Santokh Singh was suffering from Aortic Vascular Disorder. CW-1/K is the copy of letter dated 22.9.2006 issued by Assistant Director General (Admn.) stating procedure for reimbursmenet of the medical claim for retired employees. Clause 3.0 pertains to the indoor treatment. Sub Clause (iv) of the same provides that retired employee or his dependent may take indoor treatment from empanelled hospital in case of emergency and that the designated Officer of BSNL may be informed immediately. However, the reimbursement shall be restricted to prevailing CGHS rates only and that the designated Officer of the BSNL was informed by the complainant through his son whereas the counsel for the Ops have contended that it was not a case of emergency. However, this plea was not admitted by the learned District Forum, it has been stated by FIRST APPEAL NO. 1171 OF 2011 8 GM, BSNL, Patiala that it was a case of emergency and the case of the complainant was recommended and it has been so stated by the complainant to the Ops vide letter Ex. CW-1/B, therefore, the objections of the Ops that the story put forward by the complainant is concocted one is not acceptable since the complainant retired as Sub Inspector on superannuation from the office of Patran under the jurisdiction of GMT, Patiala, therefore, the learned District Forum has the jurisdiction to entertain the complaint. The complainant has been treated as a 'consumer' in view of the judgment of the Hon'ble National Commission in "Jawahar Lal Nehru Hospital & Ors. Vs. Harnath Singh", 11(2007) CPJ 313 NC and judgment of the Hon'ble Apex Court in "Laxman Thamappa Kotgiri vs. G.M. Central Railway & Ors.", 11 (2005) SLT 387:III (2006) CPJ 6 (SC) that the pensioner would be fall within the category of consumer. The claim amount submitted by the complainant is Rs. 2,27,787/- whereas in CW-1/U the total amount of the bill amounted to Rs. 2,38,957/-, which is inclusive of the valve cost. It has been further submitted that patient was of package category irrespective of actual cost, the patient had been charged for Rs. 1,70,000/- package cost of Aortic Valve Replacement, therefore, a sum of Rs. 1,70,000/- was charged from the complainant vide receipt Ex. CW-1/U, accordingly, the complaint of the complainant was allowed as stated above.
9. Aggrieved with the order passed by the learned District Forum, the appellants/opposite parties have filed the present appeal.
10. None was present on behalf of the appellants but we have gone through the grounds taken by the appellants in the FIRST APPEAL NO. 1171 OF 2011 9 grounds of appeal and have considered the same with the assistance of the respondent's counsel.
11. In the grounds of appeal, it has been stated that the complainant does not fall within the definition of the consumer as defined under Section 2(d) of the CP Act. The learned District Forum has gravely erred in not considering the fact that the claims of the employees have (not) been settled as per the Medical Rules of the Department and ignored para No. 1.3 with regard to production of BSNL MRs card containing the registration number and that it was not a case of emergency for which treatment was required from the Fortis Hospital.
12. With regard to the factum that the complainant is not a 'consumer', the counsel for the respondents has referred to the judgment "Jawahar Lal Nehru Hospital & Ors. Vs. Harnath Singh"
(supra) and "G. Kondala Rao versus The Board of Trustees", 2006 (3) CLT 22 of the Hon'ble National Commission wherein it has been mentioned 'that the employees of Vishakapatnam Port Trust and Government and other Department - Government servants who are entitled to free medical treatment as per their services conditions and these services were availed according to the service conditions of the employees available to them and his family Members on superannuation, thus, they are 'consumer'. Against this judgment, no contrary judgment has been referred by the counsel for the appellant that on the basis of claim claimed by the complainant to which he is legally entitled according to the rules of the Department, he is not a 'consumer'.FIRST APPEAL NO. 1171 OF 2011 10
13. The next question is whether there was emergency for admission of the complainant in the hospital for his admission. There is letter Ex. CW-1/O of Dr. Jagmohan Varma, MD, DM (Cardiology), Sr. Consultant & Head of Department Interventional Cardiology of Fortis Hospital that Santokh Singh is under his treatment and approximate cost of the treatment will be Rs. 2,89,000/- plus VAT. As per affidavit submitted by the complainant Santokh Singh, he was taken to Fortis Hospital on 17.7.2006 and Angiography was done on 19.7.2006. Pre-authorisation letter issued by the Hospital is CW-1/C. Since he was suffering from heart problem/attack, as such, there was emergency and there is no merit in the contention so raised by the counsel for the appellants/Ops that it is not a case of emergency treatment allowing him to get treatment in the Fortis Hospital.
14. With regard to para No. 1.3(iv) i.e. production of BSNL MRs card containing the registration number and other details, the complainant has placed on the record PPO Ex. CW-1/A. In case the BSNL MRs health card has not been produced by the complainant, he has produced the emergency certificate issued by the Hospital i.e. referral certificate and the treatment was given from Fortis Hospital is renowned hospital of this area, therefore, referral letter/pre- authorization letter and the treatment record placed on the record cannot be said to be fabricated one and the claim of the complainant cannot be rejected merely on this count whether on the fact that when he was admitted in the Fortis Hospital on 6.7.2006 and was discharged on 25.7.2006. All these documents have not been contradicted by the counsel for the appellants, therefore, the claim of FIRST APPEAL NO. 1171 OF 2011 11 the complainant cannot be dismissed merely because of non- production of BSNL MRs health card.
15. It is further contended that the reimbursement is to be paid according to the instructions of the appellants. The learned District Forum has allowed a sum of Rs. 1,70,000/- i.e. treatment payment given by the complainant to the hospital. The counsel for the appellant did not produce on the record that according to the instructions of the Department for the treatment taken by the complainant, he was entitled to a different amount, therefore, we are of the opinion that the findings so recorded by the learned District Forum are correct findings. We do not see any infirmity in the same and the same are hereby affirmed.
16. In view of the above discussion, we do not find any merit in the appeal and the same is dismissed with no order as to costs.
17. The arguments in this appeal were heard on 30.10.2013 and the order was reserved. Now the order be communicated to the parties as per rules.
18. The appellants had deposited an amount of Rs. 25,000/- with this Commission at the time of filing the appeal. This amount of Rs. 25,000/- with interest accrued thereon, if any, be remitted by the registry to the respondents in equal shares by way of a crossed cheque/demand draft after the expiry of 45 days under intimation to the learned District Forum and to the appellants.
19. Remaining amount shall be paid by the appellants to the respondents within 30 days from the receipt of the copy of the order. FIRST APPEAL NO. 1171 OF 2011 12
20. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(Gurcharan Singh Saran) Presiding Judicial Member (Piare Lal Garg) Member November 7, 2013. (Jasbir Singh Gill) as Member