The petitioner’s case is as follows: The petitioner is a worker in the Vijayalekshmi Cashewnut factory and has benefits of ESI Corporation and she was used to remit the instalments in the ESI Corporation. In the year of 2004 the petitioner was admitted in the Thrissur District Hospital for treatment and she was eligible to refund the medical expenses from the Corporation. The petitioner submitted the application and medical bills to be signed by the doctor who had treated her, but the second respondent refused to put signature. The first respondent did not reimburse the expenses even though application was signed by the doctor. Hence the complaint.

 

            2. The first respondent has filed version that the Forum has no jurisdiction to adjudicate the petition since according to Section 75 of the ESI Act the right of any person to any benefit as to the amount and duration thereof or any other matter which is in dispute between a person and the Corporation in respect of any contribution or benefit or other dues payable or recoverable under the Act is to be decided by Employees’ Insurance Court and the State Consumer Disputes Redressal Commission has held in an appeal that Section 75(1) and (3) of ESI Act specifically bar the jurisdiction of other Civil Court to entertain such cases. The first respondent has also added that an insured woman under the ESI Scheme is not a consumer as defined under the Consumer Protection Act. He has further stated that the responsibility of providing medical treatment to insured persons and their families is vested with the State Government. The Medical care to insured persons including reimbursement of medical expenses are dealt with the State Government through the Director of Insurance Medical Services, Thiruvananthapuram. Hence the first respondent prayed to exclude him and dismiss the petition. 

 

            3. The 2^nd and 3^rd respondents have filed counter stating same contentions. They have stated that there is no cause of action against these respondents. In the complaint there is no details regarding the treated doctor, date or I.P. number. These respondents never refused to countersign the medical reimbursement bills. The complaint is not maintainable. Hence dismiss.

 

            4. The points for consideration are:

 

(1)   Is the complaint is maintainable?

(2)   Is there any deficiency in service?

(3)   If so, reliefs and costs.

 

            5. The evidence consists of Exts. P1 to P8 only.

 

            6. Point No.1: This is a complaint filed against ESI Corporation for reimbursement of medical expenses. Even though service deficiency of second respondent is alleged in the complaint, there is no relief sought against him. The relief sought is reimbursement of the medical benefits from the first respondent ESI Corporation. The first respondent contended that the complaint is not maintainable before the Fora because adjudication of disputes as to the right of any person to any benefit with the ESI Corporation is to be done by the Employees Insurance Court. In 2008(1) C.P.J. Page 13, the Hon’ble Supreme Court made it clear that since the ESI Corporation is rendering service on payment of charge their service will come under the service enshrined by the Consumer Protection act. In the present case the complainant had paid the instalments she had to pay in the ESI Corporation. The definition of ‘Consumer’ in the Consumer Protection Act is wide enough to include not only the goods but also the services, bought or hired for consideration. The definition aims at covering every man who pays money or the price or cost of goods and services. So the complaint is found to be maintainable.

 

            7. Point No.2: The next point is the service deficiency of the respondents. According to the complainant, she had treatment in connection with caesarian in the District Hospital, Thrissur and she is entitled to reimbursement of the benefits from the first respondent Corporation. In order to apply for the benefits a certificate from the treated Doctor and Superintendent of the hospital was necessary. But the Superintendent who is impleaded as the second respondent refused to put counter signature. The reason stated is some medicines were purchased from out of the hospital. According to the complainant, this was done due to the non-availability of the medicines in the hospital. Due to the refusal of 2^nd respondent, the first respondent Corporation made reluctance to allow the claim. According to the complainant this is a serious deficiency of respondents and she is entitled to get the benefits. In the counter of 2^nd and 3rd respondents it is stated that they never rejected any application to reimbursement of the medical expenses. They also contended that the complainant had not submitted any bills to them to consider the claim. In the counter they also stated that the complainant had suppressed material facts and the complaint has filed. But they did not disclose the facts, which they know. They simply alleged without any basis. The only contention put forward by the first respondent is maintainability of the complaint before the Forum. The point is found against the respondents. There is no other defence put by the Corporation. The eligibility of the complainant to avail the benefits is not disputed. The quantum sought by the complainant is not disputed. So a detailed discussion on this point is seen unnecessary, since they are admitted. The attitude of the 2^nd respondent to abstain from countersign the application is a grave deficiency. Ext. P6 is the copy of letter sent by the husband of complainant to D.M.O. alleging the above mentioned act of 2^nd respondent. The first respondent rejected the claim of complainant only on this ground as per the complaint. The first respondent did not disclose any reason to this act. So both the respondents are answerable to the complainant.

 

            8. In the result complaint is allowed and the first respondent is directed to pay Rs.2400/- (Rupees two thousand and four hundred only) to the complainant with interest at the rate of 12% per annum from 12.7.04 and 6% interest from today till realisation. The second respondent is directed to pay Rs.1000/- (Rupees one thousand only) towards costs. Comply the order within one month.