REGIONAL CENTRE (ECHS) CANTT & OTHERS Vs. RAM KUMAR SHARMA

JUDGEMENT

(1.) Appellants are aggrieved by the order dated 23.04.2012, of learned District Consumer Disputes Redressal Forum, Kangra, Camp at Nurpur, whereby a complaint, under Section 12 of the Consumer Protection Act, 1986, filed against them by respondent -Ram Kumar Sharma, has been allowed, and they have been ordered to pay Rs.2,14,408/ - within 30 days, failing which direction is there for payment of interest at the rate of 9% per annum from the date of the complaint to the date of actual payment, with further direction for payment of Rs.10,000/ - as compensation and Rs.5,000/ - as litigation expenses.

(2.) Respondent -Ram Kumar Sharma is an ex -serviceman. He is entitled to reimbursement of his medical expenses as member of Ex -Servicemen Contributory Health Scheme, nodal agency for which are the appellants. Admittedly, the appellants charge the members, to whom the said scheme applies, for providing the aforesaid service. Some reputed hospitals are empanelled with the appellants for providing health services/medical treatment. Liability of the appellants to reimburse the medical expenses arises only when the treatment is taken at one of the empanelled hospitals. However, in the case of emergency, appellants are under obligation to reimburse such expenses, even for the treatment taken at a hospital that may not be on the panel, and the reimbursement is to the full extent.

(3.) Respondent's case is that on 25.05.2010, when he was at Delhi, he had to seek treatment for his fractured Acetabulum (left) in emergency. He went to Escort Hospital and took the treatment there. He paid a sum of Rs.3,14,408/ -. Respondent claims that since he was admitted in emergency, he is entitled to the reimbursement of the entire amount of money, which he paid at Escort Hospital, but the appellants reimbursed only a sum of Rs.90,000/ -, on the plea that had he taken the treatment at some empanelled hospital, the expenditure would not have been higher than the aforesaid amount of money. Respondent felt aggrieved and filed a complaint, under Section 12 of the Consumer Protection Act, 1986, seeking issuance of a direction to the appellants to pay the remaining amount of Rs.2,14,408/ - and also to pay compensation and litigation expenses.