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Jagdish Singh Chauhan Vs. the Additional Director - Court Judgment

LegalCrystal Citation
CourtDelhi State Consumer Disputes Redressal Commission SCDRC New Delhi
Decided On
Case NumberFirst Appeal No. 480 of 2011
Judge
AppellantJagdish Singh Chauhan
RespondentThe Additional Director
Excerpt:
.....v/s union of india and ors. 113 (2004) delhi law times 91, he has claimed full reimbursement of expenses incurred in his treatment in sir ganga ram hospital as well as ayushman hospital. besides, he has also requested for payment of interest, compensation and cost of litigation. in case of milap singh, petitioner was a retd. government servant aged 79 years. he was operated for coronary artery by pass grafting (cabg) in escorts heart institute and research centre. payment was made only to the extent of package deal. it was held that in case of emergency, ex post factosanction can also be granted for specialised treatment. patients are entitle to reimbursement of full amount of medical expenses and not only at the rates specified in circular of 1996. reimbursement of full payment of.....
Judgment:

S.A. Siddiqui, Member (Judicial):

1) Sh. Jadish Sindh Chauhan, complainant/appellant has filed this appeal against order dt. 17.08.2011 passed in Complaint No. 430/2000 by District Consumer Disputes Redressal Forum (Central) Maharana Pratap Bus Terminal, Kashmiri Gate.

2) Relevant Facts relating to this appeal are noted below:-

The complainant is Retd. Government Servant and claimed himself to be a consumer in connection with the medical facilities to be provided to him under CGHS Scheme. The Ld. District Forum through its impugned order dt. 17.08.2011 declined to hold him to be a consumer and dismissed the compliant. The Ld. State Commission was also of the opinion that the appeal had no merit and dismissed the same in limine on 19.04.2012. The appellant/complainant felt dissatisfied and preferred a revision petition before the Honble National Commission. Honble National Commission vide its order dt. 09.05.2013 set aside the order of the State Commission and remanded back the appeal to this Commission with a directions that the appeal be decided on merits treating the petitioner as a consumer under the Consumer Protection Act 1986 (hereinafter called the Act). The Honble National Commission was of the view that as held in Jagdish Kumar Bajpai V/s Union of India IV (2005) CPJ 197 (NC), Six Members Bench decision, petitioner being a Retd. Government Employee who had already contributed towards CGHS Scheme, falls within preview of consumer and the Ld. District Forum as well as Ld. State Commission committed error in dismissing the appeal.

3) In compliance of the order dt. 09.05.2013 passed by Honble National Commission the appeal was admitted. A copy of the appeal papers were supplied to the counsel for the respondent with a direction for filing reply. However, respondent did not file any reply. Consequently, appellant Jagdish Singh Chauhan and Rajat Gor Counsel for the Respondents were heard on 09.05.2014.

4) It has not been disputed that complainant was a Retd. Government Servant and a life pensioner, CGHS Card Holder bearing No. P-80205. He contributed Rs. 18,000/- towards CGHS Scheme, which is a welfare scheme for Retd. Government Central Servant.

5) During the intervening night of 29/30 January, 2008 complainant, a heart patient was got admitted in the emergency ward of Sir Ganga Ram Hospital through his friends. He was examined there. His was a case of 100% heart artery blockage. A sum of Rs. 3,03,209/- was paid by the complainant/appellant towards expenses of the hospital in his treatment. Again in the morning of the 12.05.2008, the complainant felt acute chest pain/congestion, suffocation and was having difficulty in breathing. He was taken to Ayushman Hospital, Dwarka and was admitted in ICU. He got treated there and had to pay a sum of Rs. 21,933/- towards expenses. Relying upon the judgment of Honble Delhi High Court in Milap Singh V/s Union of India and Ors. 113 (2004) Delhi Law Times 91, he has claimed full reimbursement of expenses incurred in his treatment in Sir Ganga Ram Hospital as well as Ayushman Hospital. Besides, he has also requested for payment of interest, compensation and cost of litigation. In case of Milap Singh, Petitioner was a Retd. Government Servant aged 79 years. He was operated for Coronary Artery by Pass Grafting (CABG) in Escorts Heart Institute and Research Centre. Payment was made only to the extent of package deal. It was held that in case of emergency, ex post factosanction can also be granted for specialised treatment. Patients are entitle to reimbursement of full amount of medical expenses and not only at the rates specified in circular of 1996. Reimbursement of full payment of expenses incurred was ordered and the OP was directed to make payment of balance amount within a period of one month.

6) The Ld. Counsel for the respondent argued that there was no evidence to show that complainant/appellant was hospitalised twice under emergency situation however, out of Rs. 3,03,209/-, total expenses incurred in treatment in Escort Hospital and Research Centre, a sum of Rs. 2,85,285/- and out of total expenses of Rs. 21,933/- incurred in Ayushman Hospital, Dwarka a sum of Rs. 11,503/- has already been paid by the respondent to the complainant/appellant. The Ld. Counsel further argued that the Hospital recognised as CGHS are liable to charge only at rates prescribed under the office memorandum dt. 18.09.1996, the amount can be reimbursed only to the extent of the package deal as per office memorandum dt. 11.06.1997.

7) In view of the judgment of the Honble Delhi High Court in Milap Singh V/s Union of India 113 (2004) Delhi Law Times 91, the complainant/appellant was entitled to reimbursement of full amount of medical expense incurred in two hospitals and not only at the rates stated in circular of 1996. In case of emergency, ex post facto sanction can be granted. There was no doubt that the complainant/appellant a heart patient was admitted twice in the Hospital mentioned above under emergency situation and was therefore entitle to reimbursement of full medical expenses incurred by him in his treatment. It was also not disputed that, he was a Retd. Pensioner and CGHS Card Holder. He had contributed Rs. 18,000/- towards this beneficial/welfare scheme, he was therefore undoubtedly a consumer. The Consumer Protection Act 1986 is a socially beneficial legislation and its provisions have to be construed liberally. The findings of the Ld. District Forum was erroneous and therefore, cannot be sustained. It is liable to be set aside.

8) Accordingly, appeal is allowed impugned judgment and order dt. 17.08.2011 passed by Ld. District Forum in Complaint Case No. 630/08 is set aside. The OP/respondent is directed to fully reimburse and make payment of the actual amount incurred in treatment at both the occasions i.e. Rs. 3,03,209 and Rs. 21,933/-. However, the amount already paid will be adjusted and the balance amount shall have to be paid by the OP/respondent within a period of 30 days from the date of the order, failing which, OP/respondent will have to pay interest @ 9% p.a. from the date of judgment till the date of actual payment. The OP/respondent will also pay a sum of Rs. 10,000/- towards cost.

9) Let a copy of the judgment be provided to the parties free of cost as per rule. A copy of the judgment be also sent to the District Consumer Forum concerned for placing the same on record and thereafter consigning the file to record room.

10) FDR if any deposited by the appellant shall be released as per rule.


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