National Consumer Disputes Redressal
Punjab National Bank vs Anil Puri on 12 January, 2009
REVISION PETTION NO NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION No. 504 OF 2004 (From the Order dated 15.01.2004 in FA No 794 of 2002 of the Rajasthan State Consumer Disputes Redressal Commission, Jaipur) Punjab National Bank 7 Bhikaji Cama Place Petitioner New Delhi versus Anil Puri Son of M. M. Puri Respondent 44 Naginabagh Ajmer, Rajasthan BEFORE: HONBLE MR. B. K. TAIMNI PRESIDING MEMBER HONBLE MR. ANUPAM DASGUPTA MEMBER For the Petitioner Mr Jagdeep Kishore, Advocate For the Respondent In Person Dated the 12th January 2009 ORDER
ANUPAM DASGUPTA The respondent in this revision petition was the complainant (hereafter referred to as the complainant) before the District Consumer Disputes Redressal Forum (hereafter, the District Forum), Ajmer, Rajasthan. His case was that as an Assistant Manager of the petitioner (Punjab National Bank, hereafter referred to the as the PNB), he was in the PNBs officers cadre and as such entitled to the medical benefits admissible under the PNBs (Officers) Service Regulations, 1979. The PNB introduced, some time during the relevant period, a scheme called the Hospitalisation Contributory Benefit Scheme for Officers (hereafter called the Scheme), which the complainant joined. The detailed terms and conditions of the Scheme provided, inter alia, that an officer of the PNB covered by any other hospitalisation scheme would not be entitled to the benefits of this Hospitalisation Scheme and the maximum amount payable to an officer in a calendar year shall not exceed Rs. 20,000/-. The Scheme also laid down a very detailed list of benefits, specifying the types of treatment eligible for reimbursement, monetary ceiling for each item per illness, etc., apart from the overall maximum limit noted above. 2. The complainant underwent treatment for kidney ailment during November December 2000. In November 2000, he was hospitalised for 6 days (07.11 to 12.11) in a hospital at New Delhi and treated for the ailment with the insertion of a stent from one of the kidneys to the bladder, for which he submitted a bill of Rs. 42,469.47. He was, however, actually reimbursed Rs. 32,464/- though, according to him, the Medical Officer concerned of the PNB had recommended the full amount. As advised, he again went back to the hospital on 11.12.2000 for removal of the said stent for which he was charged Rs. 14,890/-. He, however, did not receive any reimbursement of this expenditure.
3. The District Forum allowed the complaint, by its order dated 05.06.2002, and directed the PNB to pay to the complainant Rs. 10,005/- as well as Rs. 14,890/- along with interest @ 12 per cent per annum from three months after the filing of the respective claims till payment and costs of Rs. 1,000/-. The PNB went up in appeal before the Rajasthan State Consumer Disputes Redressal Commission (hereafter, the State Commission), which dismissed the appeal by its order dated 15.01.2004. Hence this revision petition.
4. We have heard the learned counsel for the parties and considered the documents placed before us, including the detailed circular issued by the PNB on its Hospitalisation Scheme.
5. In support of the petition, the learned counsel for the PNB has urged mainly two grounds. The first is that the complainant is not a consumer under the Consumer Protection Act, 1986 (hereafter, the Act) inasmuch as the Hospitalisation Scheme is a welfare for which the complainant did not pay any consideration. This is patently not so. By its very nomenclature, the Scheme is contributory and the complainant made the annual payment of Rs. 300/- for the period in question. Therefore, this contention is without basis.
6. The second ground is that the maximum reimbursement permissible under the Scheme was Rs. 20,000/- per year for any single ailment and that the expenditure incurred by the complainant for his treatment at the hospital was a day care treatment for which no reimbursement was admissible. However, as rightly held by the State Commission in the impugned order, the term day care treatment does not feature any where in the detailed circular of the PNB on the Scheme. Secondly, if the ceiling on reimbursement was indeed Rs. 20,000/- per ailment per calendar year, the question that arises is: how did the PNB pay the complainant Rs. 32,464/- towards reimbursement of his hospitalisation bill of Rs. 42,469/- in the first place, which the PNB repeatedly asserted in its written version before the District Forum as having been correctly paid? Clearly, the limit of Rs. 20,000/- referred to in the Scheme was only under the said Scheme. This is also clear from the wording of the following clause under the heading, Provisions:
8. While passing the claim, the amount admissible to the officer under the provisions of the PNB (Officers) Service Regulations, 1979 shall be debited to expenditure account of the Bank and the balance payable under the scheme shall be debited to the fund created by the subscriptions of the officers opting for it. In no case, the limits prescribed in the scheme and the maximum amount payable in a calendar year, i.e., Rs. 20,000/- shall be allowed to cross.
From this it would appear that, in reimbursing of Rs. 32,464/-, the PNB allowed Rs. 12,464/- to be debited to the relevant head of expenditure under the PNB (Officers) Service Regulations, 1979 and the balance to the Hospitalisation Scheme. However, nowhere in the pleadings and evidence placed before the District Forum has it been shown how this precise amount was arrived at. As there is no evidence on record to show that the reduction of Rs. 10, 005/- was done validly, we are inclined to agree that the complainant was ab initio entitled to its reimbursement. As regards disallowance of the claim of Rs. 14,898.95 for the treatment at the hospital on 11.12.2000, the revision petition contends that that it is clear from the claim form of the complainant that he was not hospitalised on that day and that ... admission to a hospital/nursing home entails taking of steps admitting the patients and then discharging him/her subsequently. The document filed by the PNB before the District Forum as Annexure 3 to its own written version, however, clearly shows it to be a Discharge Slip, issued by the hospital, viz., Maharaja Agarsain Hospital, New Delhi though it also notes, DAY CARE PATIENT. Thus, even going by the unduly technical distinction, there was a discharge slip and obviously, a patient could not be issued such a slip if he had not been admitted to the hospital in some sense of the latter term. The hospital or the treating doctor was surely not expected to anticipate this fine technical analysis that the officers of PNB would resort to in allowing/disallowing the reimbursement claim nor could the complainant. In our view, therefore, the complainants claim for this reimbursement was also admissible ab initio.
7. However, the rate of interest of 12 per cent per annum awarded by the District Forum is somewhat excessive. We feel it would be reasonable to award the two sums of Rs. 10, 005/- and Rs. 14,899/- (rounded off), i.e., or Rs. 24,904/ - or, Rs. 24,905/- (rounded off) to the complainant along with interest @ 9 per cent per annum from the date falling 90 days after the date of his submission of the respective claims till their composite payment. The impugned order of the State Commission is modified only to this extent, leaving, however, the awarded cost of Rs. 3,000/- unchanged. Further, we direct the PNB to settle the claim with interest as ordered above, within four weeks of the date of this order.
8. The revision petition is disposed of in the above-mentioned terms.
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[B. K. TAIMNI] PRESIDING MEMBER ..........................................
[ANUPAM DASGUPTA] MEMBER