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2. The complainant brought the complaint U/s 12 of The Consumer Protection Act, 1986 (in short, "the Act") against the OPs on the averments that he retired under rank CRS LUD on 30.09.1993 at Ludhiana. He hired the services of OPs under liberalized health scheme, known as RELHS, for himself and his wife with regard to reimbursement of medical treatment claim. The Ferozepur office of OP issued card dated 19.04.2005 with CBS/FZR on receiving Rs.7816/-, vide MR No.964135 dated 19.04.2005 for providing its services under the RELHS, which was later on registered with Ludhiana office, as per endorsement dated 05.02.2013 bearing serial no.1072/207, which was renewed from time to time. The OPs had not allowed the reimbursement of medical expenses, incurred by the complainant on his treatment under the above scheme. The complainant has been suffering from hernia since 1990 on left side of organic genital i.e. below the stomach, during night, air used to slip away and during walking in daytime, air was lifted out without giving any extra pain. Before the operation on right side, hernia also came up and started paining, thus, both side of organic genital were involved. On 28.02.2014, the complainant suffered severe pain, which was unbearable. There was no arrangement H/unit in Ludhiana nor any recognized hospital for such an emergency operation was there, hence the complainant approached the nearest best hospital Khosla Hospital at Ludhiana for his above health problem and Sr. DMO Dr. Chetna Kapoor was duly informed about the same by him. The complainant submitted the claim for expenses of Rs.29,000/- for medical reimbursement, at above said hospital for the period 28.02.2014 to 02.03.2014 against b/l inguinal hernia. OP no.1 rejected his claim, vide repudiation letter dated 03.11.2014 on the ground that "patient was diagnosed as a case of bilateral inguinal hernia and underwent bilateral hermioplasty with mesh under spinal anaesthesia. He was symptomatic of this disorder for two months prior to his admission, which was enough time to report to his authorized medical officer at HU/LDH to arrange for his treatment. His vitals were also stable at the time of admission. As such, inguinal hernia is not an emergency condition and hernioplasty is not an emergency procedure. Moreover, the surgery is being routinely done at DH/FZR. Since, emergency could not be justified in this case for complainant, as per Railway Board letter no.205/H/6-4/Policy-II dated 31.01.2007, hence his medical claim has been rejected by the competent authority." OP no.5, vide letter dated 23.03.2015 also rejected his appeal on the same ground, as taken by OP no.1. The act and conduct of OPs caused mental tension and harassment to him, as he is senior citizen 80 years of age. He served Railway department for more than 39 years, but OPs did not provide any relief to him in a wrong manner. The complainant further pleaded that there was no treatment for the surgery of bilateral inguinal hernia available at Railway hospital Ludhiana, due to this reason, as well as due to unbearable pain, he rushed to nearby Khosla hospital Ludhiana to get rid of the pain. The OPs ignored this fact and resultantly repudiated his claim. The complainant, thus, prayed that OPs be directed to pay reimbursement claim of Rs.29,000/- alongwith interest @18% per annum till realization from the date of lodging the claim, besides Rs.30,000/- as compensation for causing him mental harassment, Rs.5500/- as cost of litigation and Rs.2500/- as miscellaneous Expenses.

3. Upon notice, OP nos.1 to 5 filed their joint written reply by raising preliminary objections that complaint is not maintainable in the present form. Any deficiency in service or unfair trade on the part of answering OPs was denied by the OPs. It was pleaded that complainant suffered from hernia since 1990 i.e. for the last 25 years. There was no question of any type of emergency whatsoever in the case of complainant. As per existing guidelines, reimbursement is awardable only in cases of emergencies. The complainant had ample time to report his medical officer health unit Ludhiana, so that his case could be referred to Divisional Hospital, Ferozepur, where such type of treatment of surgery is routinely performed. As per discharge slip, patient has been suffering from above said problem for the last 1-2 months, which was enough time for him to report authorized medical officer for arrangement of treatment at authorized hospital. The complainant has not come to the Forum with clean hands and is guilty of suppression of material facts. The complainant is not consumer, since he has not hired the services of OPs for consideration. The complaint is alleged to be without cause of action, being an abuse of process of law. On merits, OPs contested the complaint of the complainant on the ground that complainant himself admitted this fact that he was suffering from hernia since 1990, which was a period of 25 years. This fact was denied that there was no treatment of surgery available at Railway Hospital Ludhiana. This fact was also denied by OPs that complainant rushed to Khosla Hospital Ludhiana due to intolerable pain. This fact was denied by them that complainant informed Sr. DMO Dr. Chetna Kapoor about his admission in emergency due to severe pain. The complainant took treatment from private unrecognized hospital at Ludhiana with complaint of pain of bilateral inguinal hernia for the last 1-2 months. At the time of admission of complainant in above hospital, it is recorded his pulse was 84/mis, BP-152/94 mmhg, conscious-oriented, adequate urine output, no feature of shock and afebrile. He was diagnosed as a case of bilateral inguinal hernia and underwent bilateral hernioplasty with mesh under spinal anaesthesia. The complainant was symptomatic for two months prior to admission, which was enough time for him to report to his authorized medical officer at HU/LDH to arrange for his treatment. This type of surgery is being routinely done at DH/FZR. It was denied that terms and conditions of this aspect alongwith exclusion clauses at the time of insuring the complainant under the RELHS scheme have not been supplied to him. It was denied that letter no.2005/H/6-4/policy-II dated 31.01.2007 was not applicable to the case of complainant. The answering OPs prayed for dismissal of the complaint.

6. Now, we touch the main controversy of this case. The complainant was afflicted with bilateral inguinal hernia and he underwent bilateral hernioplasty with mesh under spinal anaesthesia with Khosla Hospital at Ludhiana. He stated that he informed Dr. Chetna Kapoor DM of OPs about this procedure. On the other hand, OPs have not admitted this fact that he informed Dr. Chetna Kapoor about above procedure. The complainant stated this fact in affidavit Ex.C-A. On the other hand, Dr. Chetna Kapoor denied this fact by filing affidavit Ex.R-A on the record. No such letter sent by the complainant and received by Dr. Chetna Kapoor about this intimation has been brought to our notice on the record by the complainant to substantiate this fact. The complainant stated in his affidavit Ex.C-A and pleaded in complaint that he suffered from hernia since 1990 on left side of organic genital i.e. below the stomach. On 28.02.2014, due to intolerable pain, he was taken to Khosla Hospital Ludhiana for procedure, because there was no recognized hospital of OPs for such an emergency situation at Ludhiana. He further stated that he submitted claim of Rs.29,000/- for reimbursement for his above surgery. OP no.1 repudiated the claim on the above referred grounds. The complainant relied upon ID card issued by OPs under above scheme Ex.C-1 on the record. Ex.C-2 is the appeal filed by the complainant before the Chief Medical Director (CMD), Northern Railway Baroda House, New Delhi against rejection of his claim by OPs. Ex.C-3 is the repudiation letter dated 03.11.2014. Ex.C-4 is the letter to the complainant rejecting his appeal. Ex.C-5 is the bill for Rs.29,000/- issued by Khosla Hospital at Ludhiana for the expenses incurred by complainant on his treatment thereat. Ex.C-6 is the certificate issued by Khosla Hospital to complainant. Ex.C-7 is the copy of response to OPs statement dated 10.06.2016.

10. Now, we have to conclude this point as to whether the case of complainant for surgery of hernia is an emergency condition, taking the case out of the purview of clause 648 of Indian Railway Medical, Manual 2000. We find that complainant himself admitted this fact in his pleading and affidavit that he was afflicted with the ailment of hernia since 1990. As per discharge slip, patient was having pain for 1-2 months, which was enough time to report to his medical officer of OPs, health unit Ludhiana for arranging the treatment, but he failed to do so. No record of treatment or names of medicines used in procedure and name of tests carried out have been produced by the complainant on the record. The complainant also failed to disclose the date of surgical operation. Withholding of all these material documents by complainant leads to this inference that the complainant though had sufficient time to contact the authorized medical officer of OPs, but he, instead chose to go to a private and unrecognized hospital at Ludhiana for the alleged procedure, which was not an emergent condition, as contemplated by the above manual and instructions. We are in agreement with the findings of the District Forum, as complainant has failed to prove on record that he got admitted in a private hospital in emergency condition for above said procedure to save his life.