Rajasthan

StateCommission

A/494/2021

Rajya Chikitsa Ayukt EPFO - Complainant(s)

Versus

Smt. Bhagwati Devi - Opp.Party(s)

Praveen Kumar Bhatnagar

14 Jul 2022

ORDER

BEFORE THE RAJASTHAN STATE CONSUMER DISPUTES REDRESSAL COMMISSION,JAIPUR

FIRST APPEAL NO: 494/2021

 

State Medical Commissioner, State Employees Insurance Corporation ( Ministry of Labour & Employment, Govt. of India) Employees State Insurance Corporation, Panchdeep Bhawan, Bhawani Singh Marg, Jaipur & ors.

Vs.

Smt.Bhagwati Kanwar w/o Late Narendra Singh Rajawat r/o 28 Bapu Nagar, Senty, Chittorgarh Tehsil & Distt. Chittorgarh Rajasthan.

 

Date of Order 14.7.2022

Before:

Hon'ble Mr. Atul Kumar Chatterjee- Acting President

Hon'ble Mr. Ramphool Gurjar- Member

Present:

Mr.Praveen Kumar Bhatnagar learned counsel for the appellants

Mr. Ravindra Pal Singh learned counsel for the respondent

BY THE STATE COMMISSION ( PER HON'BLE MR.ATUL KUMAR CHATTERJEE, ACTING PRESIDENT )

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This appeal has been filed by the appellants /opponents against the order of learned District Consumer Commission, Chittorgarh dated 30.9.2021 passed in Complaint Case No 195/2018 whereby the learned DCC has allowed the complaint filed by the respondent complainant.

 

Briefly stated the relevant facts of this case are that the respondent /complainant filed a complaint before the learned DCC Chittorgarh with the averment that her husband Late Narendra Singh Rajawat was working as Manager in M/s. Tagore Public School, Senty, Chittorgarh w.e.f. 2013 during his life time and he was insured under the ESI Scheme by the school concerned. Under the policy the complainant's husband was entitled to get reimbursement of the medical expenses on his treatment. In the complaint the complainant has alleged that her late husband was taken for treatment to Ahmedabad in October 2015. He expired on 31.10.2015. In his treatment an amount of Rs. 448763/- was incurred and the complainant applied for reimbursement through the doctor of ESI Hospital but the doctor did not show any interest in the matter whereupon she appeared before the appellant/opponent no.1 who also declined to reimburse the amount. Thereafter the

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complainant filed the complaint for granting the medical expenses of Rs. 448783/- alongwith Rs. 50,000/- as compensation and Rs. 15,000/- as litigation expenses.

 

The appellants/opponents in their reply admitted the fact that the complainant's husband was insured under the ESI Insurance Scheme but denied other allegations. In their reply they have pleaded that the prescribed procedure has not been followed as such the complaint is premature. They have also pleaded that the learned DCC did not have jurisdiction u/s 75 of the State ESI Act, 1948.

 

The learned DCC Chittorgarh has passed the impugned order after hearing the final arguments of either side on the basis of their pleadings and evidence.

 

During the arguments both the learned counsels of either side have consented that the impugned order is right to the extent that the learned DCC has ordered reimbursement of the medical bills as per rules. As such on merits both did not object to the findings of the learned DCC.

 

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The main objection of the learned counsel for the appellants/opponents is regarding the following portion of the effective part of the judgment-

“ foi{kh la- nks ds dk;kZy; ls ekg tqykbZ] 2016 ls igys tks Hkh izHkkjh fpfdRld ftldk fpfdRlk iquZHkj.k ds fcyksa dks izkIr djus o mu ij dk;Zokgh djus dk nkf;Ro gks mldks fpfdRlk fcyksa dh okftc jkf'k ij ekax i= izLrqr djus dh fnukad 06-04-2018 ls psd tek djkus rd 6 izfr'kr okf"kZd lk/kkj.k C;kt o 2]500@&:;s ifjokn O;;] 2]500@&:i;s vf/koDrk O;; o 2]500@&:i;s ekufld larki lfgr rhu ekg esa ifjokfn;k dks O;fDrxr :i ls lank; djuk gksxk vkSj ;g Hkqxrku djkuk lqfuf'pr djus dk nkf;Ro foi{kh la[;k ,d dk gksxkA^^

 

The learned counsel contends that in the above part of the impugned order the direction relating to taking action against the erring Incharge Medical Officer be expunged. The learned counsel for the respondent/ complainant does not object to this request and leaves the matter for the decision by this Commission.

 

In our humble view the above portion of the impugned

 

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order wherein the learned DCC has given a direction to impose the liability on the erring Incharge Medical Officer is unsustainable because the appellants/opponents have pleaded that the complainant did not follow the prescribed procedure for reimbursement. Besides this there is no concrete evidence regarding lapse/inaction on the part of any medical officer therefore, the personal liability so imposed upon the erring medical officer as stated above is hereby set aside. So far as the payment of Rs. 2500/- as litigation expenses, Rs.2500/- as advocate fee and Rs.2500/- as compensation for mental agony are concerned these shall remain as such. The liability to pay this amount shall lie on the appellants/opponents jointly as well as severely.

 

Based on the above discussions, the appeal is partly allowed and the impugned order dated 30.9.2021 passed by the learned DCC Chittorgarh is modified as above.

 

The appeal stands disposed of with no costs.

 

(Ramphool Gurjar) (A.K.Chatterjee)

Member Acting President

 

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