State Consumer Disputes Redressal Commission
Senior State Medical Commissioner vs Roopa Devi on 1 April, 2015
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No. 290 of 2015
Date of institution: 13.3.2015
Date of Decision: 1.4.2015
1. Senior State Medical Commissioner, ESIC, Sector 19-A,
Chandigarh.
2. Social Security Officer, ESIC Local Office, Phase VII, industrial Area,
Mohali.
Appellants/OP Nos. 2 & 3
Versus
1. Roopa Devi R/o C-48, Industrial Area, Phase III, Distt. Mohali.
Respondent No.1/Complainant
2. S.M.O., ESIC Hospital, Phase - VII, Industrial Area, Mohali.
Performa Respondent/OP No.1
First Appeal against the order dated 30.1.2015
passed by the District Consumer Disputes
Redressal Forum, SAS Nagar (Mohali).
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Shri Jasbir Singh Gill, Member
Shri Harcharan Singh Guram, Member
Present:-
For the appellants : Sh. Ravi Inder Singh, Advocate
2nd Appeal
First Appeal No. 291 of 2015
Date of institution: 13.3.2015
1. Senior State Medical Commissioner, ESIC, Sector 19-A,
Chandigarh.
2. Social Security Officer, ESIC Local Office, Phase VII, industrial Area,
Mohali.
Appellants/OP Nos. 2 & 3
2
FIRST APPEAL NO. 290 OF 2015
Versus
1. Vipin Kumar R/o # 51, Astha Independent Duplex, Sector 4,
Mundi Kharar, Mohali.
Respondent No.1/Complainant
2. S.M.O., ESIC Hospital, Phase - VII, Industrial Area, Mohali.
Performa Respondent/OP No.1
First Appeal against the order dated 30.1.2015
passed by the District Consumer Disputes
Redressal Forum, SAS Nagar (Mohali).
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Shri Jasbir Singh Gill, Member
Shri Harcharan Singh Guram, Member
Present:-
For the appellants : Sh. Ravi Inder Singh, Advocate
3rd Appeal
First Appeal No. 292 of 2015
Date of institution: 13.3.2015
1. Senior State Medical Commissioner, ESIC, Sector 19-A,
Chandigarh.
2. Social Security Officer, ESIC Local Office, Phase VII, industrial Area,
Mohali.
Appellants/OP Nos. 2 & 3
Versus
1. Shiv Kumar R/o House No. 182/5, Adarsh Nagar, Dera Bassi, Distt.
Mohali (Pb.)
Respondent No.1/Complainant
2. S.M.O., ESIC Hospital, Phase - VII, Industrial Area, Mohali.
Performa Respondent/OP No.1
First Appeal against the order dated 30.1.2015
passed by the District Consumer Disputes
Redressal Forum, SAS Nagar (Mohali).
3
FIRST APPEAL NO. 290 OF 2015
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Shri Jasbir Singh Gill, Member
Shri Harcharan Singh Guram, Member
Present:-
For the appellants : Sh. Ravi Inder Singh, Advocate
4th Appeal
First Appeal No. 293 of 2015
Date of institution: 13.3.2015
1. Senior State Medical Commissioner, ESIC, Sector 19-A,
Chandigarh.
2. Social Security Officer, ESIC Local Office, Phase VII, industrial Area,
Mohali.
Appellants/OP Nos. 2 & 3
Versus
1. Suresh Kumar R/o House No. 783, Village Badmajra, Distt. Mohali.
Respondent No.1/Complainant
2. S.M.O., ESIC Hospital, Phase - VII, Industrial Area, Mohali.
Performa Respondent/OP No.1
First Appeal against the order dated 30.1.2015
passed by the District Consumer Disputes
Redressal Forum, SAS Nagar (Mohali).
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Shri Jasbir Singh Gill, Member
Shri Harcharan Singh Guram, Member
Present:-
For the appellants : Sh. Ravi Inder Singh, Advocate
5th Appeal
First Appeal No. 294 of 2015
Date of institution: 13.3.2015
4
FIRST APPEAL NO. 290 OF 2015
1. Senior State Medical Commissioner, ESIC, Sector 19-A,
Chandigarh.
2. Social Security Officer, ESIC Local Office, Phase VII, industrial Area,
Mohali.
Appellants/OP Nos. 2 & 3
Versus
1. Bir Singh R/o Village Hafizpur, Malikpur Khadel, Chhachhrouli,
Yamuna Nagar (Haryana).
Respondent No.1/Complainant
2. S.M.O., ESIC Hospital, Phase - VII, Industrial Area, Mohali.
Performa Respondent/OP No.1
First Appeal against the order dated 30.1.2015
passed by the District Consumer Disputes
Redressal Forum, SAS Nagar (Mohali).
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Shri Jasbir Singh Gill, Member
Shri Harcharan Singh Guram, Member
Present:-
For the appellants : Sh. Ravi Inder Singh, Advocate
6th Appeal
First Appeal No. 295 of 2015
Date of institution: 13.3.2015
1. Senior State Medical Commissioner, ESIC, Sector 19-A,
Chandigarh.
2. Social Security Officer, ESIC Local Office, Phase VII, industrial Area,
Mohali.
Appellants/OP Nos. 2 & 3
Versus
1. Akhildev Pandey, House No. 10, Azad Nagar, Village Balongi, Distt.
Mohali.
Respondent No.1/Complainant
2. S.M.O., ESIC Hospital, Phase - VII, Industrial Area, Mohali.
Performa Respondent/OP No.1
5
FIRST APPEAL NO. 290 OF 2015
First Appeal against the order dated 30.1.2015
passed by the District Consumer Disputes
Redressal Forum, SAS Nagar (Mohali).
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Shri Jasbir Singh Gill, Member
Shri Harcharan Singh Guram, Member
Present:-
For the appellants : Sh. Ravi Inder Singh, Advocate
Gurcharan Singh Saran, Presiding Judicial Member
ORDER
This order will dispose of all the above referred six appeals because all these appeals have been filed similar facts and in all the six appeals similar dispute is involved. For the convenience, the facts are taken from First Appeal No. 290 of 2015. This appeal has been filed by OP Nos. 2 & 3 against the order dated 30.1.2015 passed in Consumer Complaint No. 418 dated 10.6.2014 by the District Consumer Disputes Redressal Forum, SAS Nagar (Mohali) (in short the District Forum) vide which the complaint filed by the respondent/complainant(hereinafter referred as 'the complainant') was allowed with a direction to OP Nos. 2 & 3 jointly and severally pay to the complainant a lumpsum compensation of Rs. 10,000/- for deficiency in services, causing mental tension, harassment and cost of litigation.
2. The complaint was filed by the complainant under the Consumer Protection Act, 1986 (in short 'the Act') by stating that she 6 FIRST APPEAL NO. 290 OF 2015 is working as Helper with the Veeco Fabricators, Mohali since 4.11.2010 with insurance No. 1210801598. She had been regularly depositing her contribution @ 1.75% from her salary alongwith employer's contribution at the rate of 4.75%. She fell sick and got treatment and submitted a bill for reimbursement on 29.8.2013 but it was not reimbursed despite her best efforts till date. Hence, the complaint was filed with a direction to the Ops to pay this bill alongwith interest, compensation and litigation expenses.
3. In the reply filed by OP No. 1, it has been stated that out of bill of Rs. 4,698/- a sum of Rs. 3,366/- had already been paid to the complainant, therefore, the complaint deserves to be dismissed.
4. Whereas OP Nos. 2 & 3 had taken the plea that complaint was bad for non-joinder of Director, Health Services and that the maximum time was taken by Director, Health Services and cheque issued on 30.5.2014, therefore, these Ops were not deficient in their services and the complaint be dismissed qua them.
5. The parties were allowed by the learned District Forum to lead their evidence.
6. In support of his allegations, the complainant had tendered into evidence her affidavit Ex. CW-1/1 and documents Exs. C-1 to C-7. On the other hand, Op No. 1 had tendered into evidence affidavit of Dr. Daljit Kaur Ex. Op-1/1 and OP Nos. 2 & 3 had tendered into evidence affidavit of Ranjana Goswami, SSO ESIC Ex. Op-2/1 and documents Exs. Op-1 & 2.
7. On the basis of evidence led by the parties, the District Forum allowed the complaint as referred above. 7 FIRST APPEAL NO. 290 OF 2015
8. In the appeal, it has been contended that the learned District Forum has failed to appreciate that there are number of channels through which the bill of insured person is passed whereas the Director, Health Services, Punjab had a major role and the District Forum has failed to appreciate Section 58 of the ESI Act.
9. Section 58 of the ESI Act, reads as under:-
"58. Provision of medical treatment by State Government.--(1) The State Government shall provide for insured persons and (where such benefit is extended to their families) their families in the State reasonable medical, surgical and obstetric treatment:
Provided that the State Government may, with the approval of the Corporation, arrange for medical treatment at clinics of medical practitioners on such scale and subject to such terms and conditions as may be agreed upon. (2) Where the incidence of sickness benefit payment to insured persons in any State is found to exceed the all-India average, the amount of such excess shall be shared between the Corporation and the State Government in such proportion as may be fixed by agreement between them:
Provided that the Corporation may in any case waive the recovery of the whole or any part of the share which is to be borne by the State Government.
(3) The Corporation may enter into an agreement with a State Government in regard to the nature and scale of the medical treatment that should be provided to insured persons 8 FIRST APPEAL NO. 290 OF 2015 and (where such medical benefit is extended to the families) their families (including provision of buildings, equipment, medicines and staff) and for the sharing of the cost thereof and of any excess in the incidence of sickness benefit to insured persons between the Corporation and the State Government. (4) In default of agreement between the Corporation and any State Government as aforesaid the nature and extent of the medical treatment to be provided by the State Government and the proportion in which the cost thereof and of the excess in the incidence of sickness benefit shall be shared between the Corporation and that Government, shall be determined by an arbitrator (who shall be or shall have been a Judge of the [High Court] [of a State] appointed by the Chief Justice of India and the award of the arbitrator shall be binding on the Corporation and the State Government.
(5) The State Government may, in addition to the Corporation under this Act, with the previous approval of the Central Government, establish such organisation (by whatever name called) to provide for certain benefits to employees in case of sickness, maternity and employment injury:
Provided that any reference to the State Government in the Act shall also include reference to the organization as and when such organisation is established by the State Government.] 9 FIRST APPEAL NO. 290 OF 2015 [(6) The organization referred to in sub-section (5) shall have such structure and discharge functions, exercise powers and undertake such activities as may be prescribed.]"
10. The abovesaid provision will make it clear that there is an arrangement between the Corporation and the State Government, how the medical treatment is to be provided to the workers registered under the scheme. No doubt that there may be some role of the State Government in the form of sanction from the Director, Health Services but ultimately it is the appellants, who are responsible to make the payment under the Act. In case any medical bill has been submitted to the District Health Services then it was also the duty of the Officers of the Corporation to supervise that the same are passed within the shortest possible time so that petty workers, who are covered under the scheme and had spent sufficient amount from their pocket are reimbursed at the earliest possible. Therefore, even if there is some arrangement between the State Government and the Corporation how to provide the treatment to the workers registered under the Scheme even then the Corporation cannot absolve its liability to clear the bills in time. It is worth mentioning that in these days, the Governments are boosting to give good governance to the public and in case a medical reimbursement bill of a petty employee remains pending for want of sanction for a sufficient long time then what type of good governance it is? Therefore, the Government or the Corporation is required to nail its officers/officials to clear the bills within a reasonable time.
10FIRST APPEAL NO. 290 OF 2015
11. Further it was contended by the counsel for the appellants/OP Nos. 2 & 3 that according to Section 75(3) of ESI Act, 1948, the Consumer Fora did not have the jurisdiction. This point was discussed by the Hon'ble Supreme Court in case "Kishore Lal Vs. Chairman, Employees State Insurance Corporation" Civil Appeal No. 4965 of 2000 decided on 8.5.2007 wherein one of the question before the Hon'ble Supreme Court was whether the complaint under the CP Act is maintainable. The Hon'ble Apex Court after discussing the various judgments held that the jurisdiction of the Consumer Fora would not be barred and the power of the Consumer Fora to adjudicate the dispute could not be negated. No contrary judgment was referred by the counsel for the appellants, therefore, we do not agree with the plea raised by the counsel for the appellants that the Consumer Fora did not have the jurisdiction to entertain this complaint.
12. It is next contended that the Social Security Officer(in short SSO) has no role to play with regard to the medical reimbursement bill. So far as Section 45 enumerates the duties of Social Security Officer, who is to help the employees falling in his jurisdiction to give assistance in getting all the benefits to them to which they are eligible. SSO is also working under the Corporation. It is special Officer, who has been designated to assist the employees to get their eligible benefits. However, in case SSO is not keeping the track and is not helpful to its employees then what is the necessity to create such a post under the Corporation. Certainly, there is deficiency in services on the part of the Ops because they took nine 11 FIRST APPEAL NO. 290 OF 2015 months in clearing the medical reimbursement bill of the complainant. All the points have been properly addressed by the learned District Forum.
13. No other point has been argued.
14. We are of the opinion that the counsel for the appellants was unable to make out any point on the basis of which the appeal could be admitted, therefore, we are of the opinion that the order passed by the learned District Forum is justified and we dismiss the appeal filed by the appellant in limine.
15. The appellants had deposited an amount of Rs. 5,000/- with this Commission at the time of filing the appeal. This amount of Rs. 5,000/- with interest accrued thereon, if any, be remitted by the registry to respondent No. 1 by way of a crossed cheque/demand draft after the expiry of 45 days, subject to stay, if any, by the higher Fora/Court.
16. Remaining amount shall be paid by the appellants to respondent No. 1 within 30 days from the receipt of the copy of the order.
FIRST APPEAL NO. 291 OF 2015
17. In this case, the bill of Rs. 14,560/- was submitted on 12.12.2012 but payment was made to the complainant on 25.7.2014 approximately after 1¼ years. Accordingly, deficiency in services on the part of the Ops was alleged.
18. Same is the defence taken by the Ops. On the basis of pleadings and evidence on the record, the learned District Forum 12 FIRST APPEAL NO. 290 OF 2015 allowed the complaint directing OP Nos. 2 & 3 to pay a lumpsum compensation of Rs. 10,000/-, which includes cost of litigation.
19. The order has been challenged by OP Nos. 2 & 3 on the same grounds as referred in F.A. No. 290 of 2015 and after discussing, our findings recorded in F.A. No. 290 of 2015 be also read in this appeal.
20. In view of the above discussion, we do not find any merit in the appeal and the same is dismissed in limine.
21. The appellants had deposited an amount of Rs. 5,000/- with this Commission at the time of filing the appeal. This amount of Rs. 5,000/- with interest accrued thereon, if any, be remitted by the registry to respondent No. 1 by way of a crossed cheque/demand draft after the expiry of 45 days, subject to stay, if any, by the higher Fora/Court.
22. Remaining amount shall be paid by the appellants to respondent No. 1 within 30 days from the receipt of the copy of the order.
FIRST APPEAL NO. 292 OF 2015
23. In this case, the bill of Rs. 13,484/- was submitted on 26.10.2013 but payment was made to the complainant on 17.7.2014 approximately after 9 months. Accordingly, deficiency in services on the part of the Ops was alleged.
22. Same is the defence taken by the Ops. On the basis of pleadings and evidence on the record, the learned District Forum allowed the complaint directing OP Nos. 2 & 3 to pay a lumpsum compensation of Rs. 10,000/-, which includes cost of litigation. 13 FIRST APPEAL NO. 290 OF 2015
24. The order has been challenged by OP Nos. 2 & 3 on the same grounds as referred in F.A. No. 290 of 2015 and after discussing, our findings recorded in F.A. No. 290 of 2015 be also read in this appeal.
25. In view of the above discussion, we do not find any merit in the appeal and the same is dismissed in limine.
26. The appellants had deposited an amount of Rs. 5,000/- with this Commission at the time of filing the appeal. This amount of Rs. 5,000/- with interest accrued thereon, if any, be remitted by the registry to respondent No. 1 by way of a crossed cheque/demand draft after the expiry of 45 days, subject to stay, if any, by the higher Fora/Court.
27. Remaining amount shall be paid by the appellants to respondent No. 1 within 30 days from the receipt of the copy of the order.
FIRST APPEAL NO. 293 OF 2015
28. In this case, the bill of Rs. 15,702/- was submitted on 3.5.2013 but payment was made to the complainant on 6.3.2014 approximately after 10 months. Accordingly, deficiency in services on the part of the Ops was alleged.
29. Same is the defence taken by the Ops. On the basis of pleadings and evidence on the record, the learned District Forum allowed the complaint directing OP Nos. 2 & 3 to pay a lumpsum compensation of Rs. 20,000/-, which includes cost of litigation.
30. The order has been challenged by OP Nos. 2 & 3 on the same grounds as referred in F.A. No. 290 of 2015 and after 14 FIRST APPEAL NO. 290 OF 2015 discussing, our findings recorded in F.A. No. 290 of 2015 be also read in this appeal.
31. In view of the above discussion, we do not find any merit in the appeal and the same is dismissed in limine.
32. The appellants had deposited an amount of Rs. 10,000/- with this Commission at the time of filing the appeal. This amount of Rs. 10,000/- with interest accrued thereon, if any, be remitted by the registry to respondent No. 1 by way of a crossed cheque/demand draft after the expiry of 45 days, subject to stay, if any, by the higher Fora/Court.
33. Remaining amount shall be paid by the appellants to respondent No. 1 within 30 days from the receipt of the copy of the order.
FIRST APPEAL NO. 294 OF 2015
34. In this case, the bill of Rs. 1,84,939/- regarding the medical treatment of the father of the complainant were submitted on 7.2.2014 but payment was made to the complainant on 17.7.2014 approximately after 5 months. Accordingly, deficiency in services on the part of the Ops was alleged.
35. Same is the defence taken by the Ops. On the basis of pleadings and evidence on the record, the learned District Forum allowed the complaint directing OP Nos. 2 & 3 to pay a lumpsum compensation of Rs. 20,000/-, which includes cost of litigation.
36. The order has been challenged by OP Nos. 2 & 3 on the same grounds as referred in F.A. No. 290 of 2015 and after 15 FIRST APPEAL NO. 290 OF 2015 discussing, our findings recorded in F.A. No. 290 of 2015 be also read in this appeal.
37. In view of the above discussion, we do not find any merit in the appeal and the same is dismissed in limine.
38. The appellants had deposited an amount of Rs. 10,000/- with this Commission at the time of filing the appeal. This amount of Rs. 10,000/- with interest accrued thereon, if any, be remitted by the registry to respondent No. 1 by way of a crossed cheque/demand draft after the expiry of 45 days, subject to stay, if any, by the higher Fora/Court.
39. Remaining amount shall be paid by the appellants to respondent No. 1 within 30 days from the receipt of the copy of the order.
FIRST APPEAL NO. 295 OF 2015
40. In this case, three bills of Rs. 69,454/- were submitted on 2.5.2013, 21.8.2013 and 26.12.2013 but payment was made to the complainant on 12.5.2014 after delay. Accordingly, deficiency in services on the part of the Ops was alleged.
41. Same is the defence taken by the Ops. On the basis of pleadings and evidence on the record, the learned District Forum allowed the complaint directing OP Nos. 2 & 3 to pay a lumpsum compensation of Rs. 20,000/-, which includes cost of litigation.
42. The order has been challenged by OP Nos. 2 & 3 on the same grounds as referred in F.A. No. 290 of 2015 and after discussing, our findings recorded in F.A. No. 290 of 2015 be also read in this appeal.
16FIRST APPEAL NO. 290 OF 2015
43. In view of the above discussion, we do not find any merit in the appeal and the same is dismissed in limine.
44. The appellants had deposited an amount of Rs. 10,000/- with this Commission at the time of filing the appeal. This amount of Rs. 10,000/- with interest accrued thereon, if any, be remitted by the registry to respondent No. 1 by way of a crossed cheque/demand draft after the expiry of 45 days, subject to stay, if any, by the higher Fora/Court.
45. Remaining amount shall be paid by the appellants to respondent No. 1 within 30 days from the receipt of the copy of the order.
46. The arguments in these appeals were heard on 25.3.2015 and the orders were reserved. Now the orders be communicated to the parties as per rules.
47. Copy of this order be placed on F.A. Nos. 291, 292, 293, 294 and 295 of 2015.
(Gurcharan Singh Saran) Presiding Judicial Member (Jasbir Singh Gill) Member April 1, 2015. (Harcharan Singh Guram) as Member