Hon’ble Mrs. Rumpa Mandal, Member

The fact in brief of the case is that the petitioner of an employee of the Sattyemee Security service Cooch Behar since 01.04.2017 and her employer code No.41000659310000999. She got her name registered under Employees State Insurance Corporation(ESIC) having Insurance No.4116353185 which was registered on 25.02.18. She was suffering from illness and was checked up by Dr. P.K. Mitra at Cooch Behar. After diagnosis she was referred for Gallbladder operation in any private Nursing Home. Accordingly she got admitted to Podder Seva Sadan Private Nursing Home, Cooch Behar on 04.03.19 operation and was discharged therefrom on 06.03.19.

Thereafter the petitioner submitted all medical papers bills and vouchers etc. to the OP on 18.06.19 for reimbursement but the OP did not do anything. Finally she filed a written complaint with the OP on 23.07.20 through registered post. Though the OP got the complaint but did not disburse the amount to the Complainant. So the petitioner filed this case claiming several relief(s) as stated in the plaint.

The notice was duly served upon the OP but despite that he did not appear and contest the case.

So the case was heard ex-parte.

The point to be considered is if the Complainant is entitled to the relief(s) as claimed in his complaint.

Findings

In this case the petitioner is an employee of a security service and her name has been registered under Employees State Insurance Corporation, Government of West Bengal. She underwent Gall bladder operation as per advice of the OP at a private Nursing Home but she could not get back her Medical expenditure from the OP in accordance with the Insurance scheme for the employees. So this case is found to be maintainable.

The petitioner is found to have submitted documents in support of her contentions besides submitting her evidence on affidavit. The documents reveal that her name was registered under Employees State Insurance Corporation on 25.02.18 her Insurance No. is 4116353185.

It is found, initially the petitioner was examined by Dr. P.K. Mitra at Cooch Behar who was the Medical Officer under State Employees Insurance Corporation and on diagnosis the said doctor advised for surgery ( Gallbladder operation) and accordingly a reference being No.317 was issued on 18.02.19. The documents reveal that the Administrative Medical Officer of Employees State Insurance Scheme Government of West Bengal, Kolkata permitted the petitioner to undergo operation in any private Nursing Home.  Accordingly the petitioner underwent the operation at Podder Seva Sadan Cooch Behar where she was admitted on 04.02.19 and was discharged on 06.03.19. She had to incur on account of her treatment and surgery etc amounting to Rs.27640/-.  She claimed for reimbursement of the amount but it is alleged that the said amount was not disbursed to her by the OP though all the documents were submitted by her.

 Having gone through the materials on record including evidence as also the documents submitted on behalf of the petitioner we find that the petitioner, has been able to establish her claim and therefore entitled to relief in this case.

Hence,

Ordered

That the instant case is hereby allowed ex parte against the OP.

The petitioner is entitled to Rs.27,640/- being the amount of medical expenditure, Rs.5,000/- for mental pain and agony and Rs.2,000/- for cost of litigation. Thus, the OP directed to pay the said amount of Rs.34,640/- in total to the petitioner within 45 days from the date of this order failing which Complainant shall be at liberty to realize the same in accordance with Law. 

If the said amount is not paid within the stipulated time, the entire awarded sum shall carry interest @ of 6% p.a. until realization.

Let plain copy of this Order be supplied to the parties concerned by hand/by Post forthwith, free of cost for information & necessary action, if any.

The copy of the Final Order also available in the official Website: www.confonet.nic.in.

Dictated and corrected by me.