KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

VAZHUTHACAUD, THIRUVANANTHAPURAM

APPEAL No. 295/2021

JUDGMENT DATED: 05.11.2024

(Against the Order in C.C. 135/2019 of DCDRC, Kasaragod)

PRESENT:

HON’BLE JUSTICE SRI. B. SUDHEENDRA KUMAR            : PRESIDENT

SRI. AJITH KUMAR D.                                                                 : JUDICIAL MEMBER

SRI. RADHAKRISHNAN K.R.                                                     : MEMBER

APPELLANT:

The Medical Officer, Beedi Workers Welfare Fund Dispensary, Manjeshwar.

(By Adv. Rajagopalan A.& Adv. Narayan R.)

                                                Vs.

RESPONDENTS:

1. Jayalakshmi, W/o Raghurama, Anugraha Quarters, Near Bolukatta Ground, Upper Bazar, Badiadka, Perdala Post, Kasaragod Taluk, Kasaragod-671 551.

2. Dr. K. Mukund, Medical Officer, Omega Hospital (P) Ltd., Mahaveer Circle, Kankanady, Mangalore-575 002.

3. The Administrator, Omega Hospital (P) Ltd., Mahaveer Circle, Kankanady, Mangalore-575 002.

JUDGMENT

HON’BLE JUSTICE SRI. B. SUDHEENDRA KUMAR  : PRESIDENT

The appellant is the 3^rd opposite party, the 1^st respondent is the complainant and the 2^nd and 3^rd respondents are the 1^st and 2^nd opposite parties in C.C. No. 135/2019 on the files of the District Consumer Disputes Redressal Commission, Kasaragod (for short “the District Commission”).

2.  The 1^st respondent/complainant was a beedi roller.  Her mother was also a beedi roller.  The mother of the 1^st respondent/complainant was admitted in Carewell Hospital, Kasaragod on 18.03.2015 due to a heart attack.  The doctor, who consulted the mother of the 1^st respondent, referred her to Omega Hospitals (P) Ltd., Mangalore, which is the hospital recognized by the Beedi Workers Welfare Fund.  On 20.03.2015, the mother of the 1^st respondent was admitted in Omega Hospitals (P) Ltd., Mangalore.  After surgery, the mother of the 1^st respondent was discharged from the hospital on 10.04.2015.  As per the direction of the 2^nd and 3^rd respondents, the 1^st respondent and her husband paid Rs. 1,30,000/- (Rupees One Lakh Thirty Thousand only) towards the charge for the treatment in the hospital.  The said amount was raised by availing personal loan, pledging gold ornaments of the relatives etc.  The hospital authorities assured that the amount spent towards the treatment would be credited to the account of the 1^st respondent from the appellant, since the patient was a dependent of the 1^st respondent and she herself was also a beneficiary of the Welfare Fund.  The original of the medical bills were retained by the 2^nd and 3^rd respondents for reimbursement of the claim of the 1^st respondent.  Since the 2^nd and 3^rd respondents did not forward the application for medical reimbursement of the 1^st respondent to the appellant for a long time, the 1^st respondent and her husband sat on the floor in front of the doctor’s chamber.  Thereafter, on the same day, the 2^nd respondent sent a request to the appellant.  The request of the 2^nd respondent was denied by the appellant stating that there was delay in submitting the claim. 

3.  The 2^nd and 3^rd respondents remained ex-parte.

4.  The appellant filed version contending that the mother of the 1^st respondent was eligible for medical treatment for her disease under the scheme pronounced by the Government of India, Ministry of Labour and Employment, namely, “Scheme for Reimbursement of Expenditure as Financial Assistance to Cine/Mine and Beedi Workers suffering from heart diseases”.  The beedi workers and their dependent family members are entitled for medical treatment under the above scheme.  The treatment in this case was conducted only after getting permission from the office of the Welfare Commissioner, Kannur.  However, in the said permission letter, it was stated that the reimbursement of the expenditure incurred must be submitted in Form B and signed by the authorities concerned along with the documents mentioned in the annexure to the said permission letter.  No document was received from the 2^nd respondent by the appellant.  The 1^st respondent/complainant failed to submit application in Form B with required documents and original bills after completion of the treatment, for claiming the reimbursement.  There was a delay of four years in submitting the claim and that itself, without producing the required documents. 

5.  The 1^st respondent filed proof affidavit.  However, she was not cross-examined.  Exhibits A1 to A11 were marked for the 1^st respondent.  No proof affidavit or document was filed by the appellant. After evaluating the evidence, the District Commission directed the appellant to allow the re-imbursement of the medical claim of the mother of the 1^st respondent to the tune of Rs. 1,30,000/- (Rupees One Lakh Thirty Thousand only) as covered by the discharge summary issued by the 2^nd and 3^rd respondents with interest from the date of submission of claim till payment.  The District Commission further directed the appellant to pay costs of Rs. 5,000/- (Rupees Five Thousand only). Aggrieved by the said order, this appeal has been filed. 

6.  Heard.  Perused the records. 

7.  It is not disputed that the 1^st respondent is a beedi roller.  It is also not disputed that the mother of the 1^st respondent is also a beneficiary of the welfare scheme pronounced by the Government of India.  It is further not disputed that the mother of the 1^st respondent was treated in Omega Hospitals (P) Ltd., Mangalore from 20.03.2015 to 10.04.2015 after getting permission from the appellant.  It was admitted by the appellant that the mother of the 1^st respondent was entitled to get the treatment expenses for her disease.  However, the claim was repudiated on two grounds.  The first ground was that there was a delay of four years in submitting the claim.  The second ground was that the original documents were not submitted along with the claim application.

8.  Exhibit A2 discharge summary issued from the Omega Hospitals (P) Limited would show that coronary angiogram and coronary angioplasty were successfully conducted in the hospital during the period of treatment from 20.03.2015 to 10.04.2015.  Exhibit A9 is the forwarding letter whereby the claim of the mother of the 1^st respondent was forwarded to the appellant from the hospital.  Exhibit A9 would show that all original medical bills and Form B were forwarded to the appellant from the Omega Hospitals (P) Ltd., where the mother of the 1^st respondent was treated.  Exhibit A10 letter, sent by Omega Hospitals (P) Ltd. to the appellant, would show that one set of original documents, already sent to the appellant, was lost in transit.  Therefore, another set of original claim documents had been forwarded to the appellant for considering the claim of the 1^st respondent.  Exhibit A11 is the letter whereby the claim of the 1^st respondent was declined stating two reasons, which have been already mentioned above.  It is evident from Exhibit A9 that the 1^st respondent had submitted all documents required and Form B before the Omega Hospitals (P) Ltd. for the purpose of transmitting the same to the appellant for considering the claim of the 1^st respondent.  Exhibit A10 would show that another set of documents was also sent to the appellant from the hospital.  From Exhibits A9 and A10, it is clear that the 1^st respondent had already submitted all documents required as per law to the appellant, through the Omega Hospitals (P) Ltd., for the purpose of considering the claim of the mother of the 1^st respondent.  Therefore, the contention of the appellant and the argument of the learned counsel that the original documents were not submitted along with the claim application cannot be sustained. 

9.  As regards the delay of four years in submitting the claim, the 1^st respondent had clearly stated the reason.  The 1^st respondent contended that the 2^nd and the 3^rd respondents assured that the claim form would be forwarded to the appellant through the hospital.  However, since there was inordinate delay in transmitting the claim form submitted by the 1^st respondent to the appellant, the 1^st respondent had resorted to protest and sat on the floor in front of the room of the doctor as part of the protest.  On the very same day, the application form and relevant documents were forwarded by the respondents 2 and 3 to the appellant.  The 1^st respondent had filed proof affidavit in lieu of his examination-in-chief, wherein the 1^st respondent had reiterated the contentions in the complaint.  The 1^st respondent was not cross-examined by the appellant.  The respondents 2 and 3 were already set exparte since they did not file any version before the District Commission.  Since the 1^st respondent was not cross-examined, her evidence in this regard remains as unchallenged testimony.  Having gone through the relevant inputs, we do not find any reason to disbelieve the evidence of PW1 in this regard, particularly when Exhibits A9 and A10 would corroborate the evidence of PW1 in all material aspects.  It is to be noted that the 1^st respondent and her mother are beedi rollers and beneficiaries of Beedi Welfare Scheme pronounced by the Central Government.  It is a benevolent legislation.  It is not disputed that the disease for which the mother of the 1^st respondent was treated was covered under the scheme.  Since it is a beneficial legislation, we are of the view that the denial of claim by the appellant was not justified on the reason that there was delay of four years, particularly when Exhibits A9 and A10 would show that the 1^st respondent had duly submitted the claim to respondents 2 and 3 for being transmitted to the appellant.  This being the situation, we are of the view that there was deficiency in service on the part of the appellant in repudiating the claim of the 1^st respondent.  For the said reason, we do not find anything to interfere with the direction issued by the District Commission to the appellant to allow the reimbursement of medical claim of the mother of the 1^st respondent to the extent of Rs. 1,30,000/- (Rupees One Lakh Thirty Thousand only) as covered by the discharge summary issued by the respondents 2 and 3 with interest and costs. The costs ordered by the District Commission also does not appear to be harsh or excessive calling for interference by this Commission.

In the result, this appeal stands dismissed and the order dated 30.07.2021 passed by the District Commission in C.C. No. 135/2019 stands confirmed. 

The statutory deposit made by the appellant shall be given to the 1^st respondent, to be adjusted/credited towards the amount ordered by the District Commission, on proper acknowledgement.

JUSTICE B. SUDHEENDRA KUMAR: PRESIDENT

                                                                  AJITH KUMAR D. : JUDICIAL MEMBER

jb                                                                     RADHAKRISHNAN K.R.  : MEMBER