Delhi

StateCommission

A/10/445

NORTHERN RAILWAY & ORS. - Complainant(s)

Versus

K.R. MAHAJAN - Opp.Party(s)

05 Mar 2019

ORDER

IN THE STATE COMMISSION: DELHI

(Constituted under Section 9 of the Consumer Protection Act, 1986)

                                                             Date of Decision: 05.03.2019

First Appeal No. 445/2010

(Arising out of the order dated 26.04.2010 passed in complaint case No. 60/2008 by the District Consumer Disputes Redressal Forum, Institutional Area, Qutub Minar, New Delhi-110016) 

In the matter of:

1. General Manger,

Northern Railway Head Quarter’s Office,

Baroda House, New Delhi

 

2. Chief Medical Director

Northern Railway Head Quarter’s Office,

Baroda House, New Delhi.

 

3. Mrs. Achla Sinha,

Appellate Authority

CTM/ New Delhi (DRM). ….......Appellants

 

Versus

 

                  Sh. K.R. Mahajan

                   S/O- Late Sh. Saudagar Mal,

             Retd. SPO/HQ/ Central Railway,

                   Delhi-110032                                                ........Respondent

                                                                  

                                                                  

CORAM

 

JUSTICE VEENA BIRBAL                 -                       PRESIDENT

SALMA NOOR                                    -                       MEMBER

 

1.             Whether reporters of local newspaper be allowed to see the judgment?                                   

2.             To be referred to the reporter or not?                                                                                                     

 

 

SALMA NOOR            -           MEMBER

 

1.  Present appeal is preferred against the order dated 26.04.2010 passed by Consumer Disputes Redressal Forum (in short ‘Ld. District Forum’) Institutional Area, Qutub Minar, New Delhi in CC No. 60/2008 wherein the complaint was allowed.
2.  Brief facts of the case are that the respondent/complainant was senior officer in the Central Railways and was superannuated on 31.01.1994. On 03.02.2006, the respondent/complainant’s wife, Smt. Urmila Mahajan all of a sudden got severe pains in her stomach and immediately in the extreme emergency a local doctor was called and treatment was given but nothing could control the pains in the upper abdominal portion. Hence, the doctor, on 05.02.2006 suggested some tests i.e. ECB, LFT, US (Upper abdominal) and Chest P.A. view etc. On 06.02.2006 the aforesaid tests were conducted at Star Imaging and Path Lab, Tilak Nagar, Delhi and she was diagnosed with AC Cholecyslistic with cholelithiasis. Immediate operation was suggested to her. On 07.02.2006 wife of respondent/complainant was taken to nearby Swastic Hospital, Gopal Nagar, Jail Road, Delhi for further check-up and treatment where she was declared a patient of Hyper elusive, diabetic and diffuse subrachnoid and haemorrhage and was kept under observation for three days i.e. upto 10.02.2006. She was operated on 12.02.2006 at aforesaid hospital and was discharged on 14.02.2006. The total expenditure incurred was Rs.24,530/- of which Star imaging Bill was Rs.1,490/- and Swastic Hospital bill was Rs.23,040/-. It was alleged that in view of the urgency the respondent/complainant’s wife could not be taken to the Railway Hospital and local treatment was the only alternative for her serious illness. Thereafter on 12.05.2006, the respondent/complainant collected all the bills, reports and prescription letters and filed one application before the Chief Medical Superintendent, Northern Railway, Delhi for reimbursement of the expenditure. The proposal was turned down on 15.05.2006 without proper consideration. It was alleged that despite the repeated requests, nothing was done by appellants/OPs. Aggrieved by the deficiency in service on the part of appellants/OPs, respondent/complainant filed a complaint seeking reimbursement of the claims amounting to Rs.24,530/- with costs and incidental charges.
3. Reply was filed by appellants/OPs wherein it was alleged that wife of the respondent/complainant, Smt. Urmila Mahajan was having disease of Cholelithiasis for past 20 years and the respondent/complainant never consulted the Railway Hospital for treatment of the said disease routinely, therefore, the same shows that the respondent/complainant never had faith in the Railway Medical Services. It was also denied that she got sudden and severe pains on 03.02.2006 in her stomach. It was alleged that there was no extreme emergency that the local doctor had to be called. It was denied that there was need for the tests as mentioned by the respondent/complainant. It was further alleged that respondent/complainant had not mentioned the qualifications of the local doctor. It was stated that she was not admitted in Railway Hospital where all the facilities were available. The appellants/OPs were liable to reimburse the bills only when there was an extreme emergency and urgency which had not been shown by the respondent/complainant, therefore, the respondent/complainant was not entitled to claim any amount of the reimbursement of the claim.
4.  Rejoinder was filed by respondent/complainant wherein the facts as stated in the complaint case were reiterated.
5. Both parties filed evidence by way of affidavit as well as written arguments.
6. After hearing the parties, the District Forum held that appellants/OPs had deliberately withheld the claim of Rs.24,530/- of respondent/complainant and had to suffer mental agony and harassment. The District Forum directed OP to pay the amount of reimbursement of bill and pay Rs.25,000/- as compensation for mental agony, harassment to the respondent/complainant.
7.  Aggrieved by the aforesaid order of the Ld. District Forum present appeal is filed by the appellants/OPs.
8. The appellants/OPs have contended that the Ld. District Forum totally overlooked and ignored policy of reimbursement by the Railway Board’s letter bearing No. 2005/H/6-4 dated 31.01.2007 issued by Ministry of Railways while passing the impugned order. It is contended that the doctors of appellants/OPs like Sr. D.M.O., CMS, CMD, G.M. had rejected the claim of respondent/complainant since it was not an emergency case. It is further contended that the District Forum in its impugned order directed the (appellant-2/OP-2) i.e. GM to institute an inquiry against the authority who had rejected the  claim and ordered that severe punishment should be awarded and the result of such enquiry be also informed to the District Forum. It is contended that the District Forum has acted beyond its jurisdiction and power under the Act.
9.  Respondent/complainant has submitted that his wife was suffering from chronic diseases like cholelithias, sub-arachnoids haemorrhage and the appellants/OPs have themselves admitted in the evidence by way of affidavit that it is a Neurological Emergency. It is submitted that respondent/complainant’s wife went to their daughter’s house where she fell ill and in a situation of emergency the son-in-law had to save the life of the patient who was groaning with severe pain and other chest troubles. It is submitted that regarding the emergency situation respondent/complainant had filed the detailed documents before the Ld. District Forum. It is further contended that respondent/complainant was out of station for his personal visit and when he came back home he came to know about the emergency treatment taken and for further treatment he shifted the patient to Railway Hospital.
10. We have heard the counsel for parties and perused the material on record.
11.  There is no dispute regarding the fact that respondent/complainant is a retired officer of Railways. It is also not disputed that in absence of the respondent/complainant his wife was admitted to Swastic Hospital, Gopal Nagar, Jail Road without any referral from the railway hospital. It is also not disputed that wife of the respondent/complainant as advised by the local doctor had undergone various medical tests and was diagnosed a case of AC Cholecyslistic with Chole-lithiasis and was advised immediate operation. It is also not disputed that she is a known case of hyper elusive, diabetic and diffuse sub-arachnoid haemorrhage and was operated in the aforesaid hospital on 12.02.2006 and was discharged on 14.02.2006. The respondent/complainant had filed an application before the Chief Medical superintendent of the Northern Railway for reimbursement of the medical expenses on 11.05.2006 which was turned down by the appellants/OPs on 15.05.2006 on the ground of him not informing the concerned Authorized Medial Officer at the earliest.
12. On the other hand as per appellants/OPs wife of the respondent/complainant was having the disease of Cholelithiasis for past 20 years and respondent/complainant never consulted the Railway Hospital for getting treatment of this problem. It is also denied that it was a case of extreme emergency for which she has to go to a local doctor and there was a need for certain tests as mentioned by the respondent/complainant. It is further stated that appellants/OPs are liable to reimburse the expenses only when there is extreme emergency/urgency, which is not shown in the case of respondent/complainant. To verify the contention of the appellants/OPs that wife of the respondent/complainant had never consulted the Railway Hospital, record of District Forum was requisitioned and it was found that respondent/complainant had filed various medical papers which clearly show that prior to the aforesaid disease, wife of the respondent/complainant was examined number of times at appellants/OPs (Railways hospital). Hence it cannot be said that the respondent/complainant overlooked the Railway Hospital facilities as alleged by the appellants/OPs.
13. The main contention of the appellants/OPs is that the case of the respondent/complainant is not the case of emergency and therefore, he is not entitled to claim any reimbursement of the bill and has relied on Railway Board letter No. 2005/H164/Policy II Dated 31.01.2007 which pertains to the cases for considering the reimbursement of the claim. On the other hand it is contended by the respondent/complainant that it is true that there is a rule but in case of the emergency and urgency it is not incumbent on part of the patient to immediately rush to the hospitals maintained by the appellants/OPs but the medical facilities can be availed from nearby doctors. The relevant rule is reproduced as under:-

“As per extant rules, a railway beneficiary must report to Railway Medical Officer for his/her and dependents medical treatment. The authorized Medical Officer will make necessary arrangements for medical treatment through Railway Hospital/Government Hospital/Private Recognized Hospital. In exceptional situations, CMDs of Zonal Railways can obtain special permission from Railway Board for treatment in any Private Hospital on case to case basis. Hence, there is no scope available for any railway beneficiary to go to any private hospital himself/herself or their dependents on their own volition, except in case of real emergency situation.

Emergency shall mean any condition or symptom resulting from any cause, arising suddenly and if not treated at the early convenience, be detrimental to the health of the patient or will jeopardize the life of the patient. Some examples are- Road accidents, other types of accidents, acute heart attack, etc. Under such conditions, when the Railway beneficiary feels that there is no scope of reporting to his/her authorized Railway Medical Officer and avails treatment in the nearest and suitable private hospital, the reimbursement claims are to be processed for sanction, after the condition of the emergency is confirmed by the authorized Railway Medical officer ex-post facto.”

    

14. On bare reading of the aforesaid rule it is clear that in case of extreme emergency/urgency the medical facilities can be availed from a nearby doctor. It is case of respondents/complainants that prior to this the wife of the respondent/complainant was availing the medical facilities from the hospitals run by the appellants/OPs but on 03.02.2006 she got a sudden severe pain in her stomach and due to the emergency a local doctor was called in and on his advice she was taken to the Swastic Hospital, Delhi where she was operated upon and incurred an expenditure of Rs.23,530/. The stand of respondent/complainant is fully supported by documents on record. Considering the material on record the case of the respondent/complainant is fully covered under the definition of emergency given in the rule mentioned above. Thus, in our view appellants/OPs were negligent by not reimbursing the amount to the respondent/complainant as the wife of the respondent/complainant had to rush to the local hospital being a case of emergency. The wife of the respondent/complainant was taken to another hospital just to save her life. It appears that appellants/OPs have rejected the reimbursement of the bill of the respondent/complainant arbitrarily by reaching the conclusion that disease of the wife of the respondent/complainant was not a case of emergency. Even the compensation awarded is just and reasonable.
15. We agree with the reasoning given by Ld. District Forum in reimbursing the bill and awarding compensation. The directions given in this regard are upheld.
16. As regards direction of institution of inquiry against the authority rejecting the claim, we find that the same was not required in the facts and circumstances of the case. Accordingly the direction given in this regard is set aside.
17. In view of the above discussion, appeal stands partly allowed.
18. A copy of the order be sent to the parties free of costs as well as to Ld. District Forum for necessary information. File of the District Forum will also sent back forthwith. File be consigned to record room.  

 

 

                                                                                                                                                                                         (Justice Veena Birbal)

President

 

                                                                                                       

                                                                                                                                     (Salma Noor)

                                                                                                                  Member