Back
RAJASTHAN STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, JAIPUR
Hon’ble Mr. Justice M.A.A. Khan, President &
Mrs. Sushma Tanwar, Member
GENERAL MANAGER, PUNJAB NATIONAL BANK & ORS.—Appellants
versus
ANIL PURI—Respondent
Appeal No. 794 of 2002—Decided in 15.1.2004
Counsels for the Parties :
For the Appellant :Mr. Rajendra Arora, Advocate.
For the Respondent:Mr. Vibhor Gaur, Advocate.
The central legal point established is the interpretation of the scope of the appellant's beneficial scheme and the lack of clarity in defining the 'Day Care' provision.
Headnote:
C.P. Act, 1986 - Medical Reimbursement - The court upheld the District Forum's order directing the appellant to reimburse the respondent for medical expenses and pay additional costs, finding that the treatment fell within the scope of the appellant's beneficial scheme.
Fact of the Case:
The respondent, an employee of the appellant Bank, sought reimbursement for medical expenses incurred for kidney infection treatment. The appellant refused reimbursement for a portion of the expenses, citing non-coverage under the 'Day Care' provision.
Finding of the Court:
The court found that the treatment was within the scope of the appellant's beneficial scheme and upheld the District Forum's order for reimbursement and additional costs to the respondent.
Issues: Dispute over reimbursement of medical expenses under the appellant's 'PNB HOSPITALISATION CONTRIBUTORY BENEFIT SCHEME FOR OFFICERS' and the interpretation of the 'Day Care' provision.
Ratio Decidendi: The court held that the treatment received by the respondent fell within the scope of the appellant's beneficial scheme, and the 'Day Care' provision was not clearly defined in the scheme.
Final Decision: The appeal was dismissed, and the appellant was directed to reimburse the respondent for medical expenses and pay additional costs.
Mr. Justice M.A.A. Khan, President—This appeal under Section 15 of the C.P. Act, 1986 (the Act) is directed against the order of the District Forum, Ajmer dated 5.6.2002 made in respondent’s Complaint No. 79/2002. By its said order the D.F. has directed the appellant to reimburse the respondent for the medical expenses amounting to (i) Rs. 10,005/- (Rs. 42469.47 — Rs. 32464.97) and (ii) Rs. 14,898/- with interest @ 12% payable from the date three months after the date of submission of the medical reimbursement claim by him and further to pay to him a sum of Rs. 1,000/- as cost of litigation.
2. We heard the parties at considerable length and went through the material, our attention was invited to.
3. The respondent had undisputedly got himself treated and operated upon thrice for his kidney infection ailment at Maharaja Agarsain Hospital, New Delhi during the period from 7.11.2000 to 12.11.2000 in the first instance and on 11.12.2000 in the second occasion, while he was in the employment of the appellant Bank as Assistant Manager and as such entitled to the benefit of appellant’s “PNB HOSPITALISATION CONTRIBUTORY BENEFIT SCHEME FOR OFFICERS” (`the Scheme’ under PNB OFFICERS SERVICE REGULATIONS, 1979). It is also not in dispute that in respect to his treatment during the first period of his hospitalisation, he had submitted a claim for Rs. 42,469.47 which was duly recommended by appellant’s own Medical Officer, after due verification, for re-imbursement but the accountant had passed the same for Rs. 32,464.97 only. On going through the order of the accountant, we find no reasons or grounds for disallowing reimbursement of the balance amount of Rs. 10,005/-.
4. For his treatment on 11.12.2000 the respondent had claimed reimbursement of medical expenses amounting to Rs. 14,898/-. But the appellant refused reimbursment thereof on the sole ground of the same not being covered by “Day Care”. Nowhere in the scheme, as amended from time-to-time, do we find this term explained. Nor was the term explained to us at the time of hearing the appeal. On going through the relevant document we gather that the respondent was checked up on 11.12.2000 at the aforesaid Hospital, was prescribed certain medicines and then advised to get checked up after a week. He was, therefore, sent to his home at 11 a.m. But he again appeared on 13.12.2000 and was again checked up and was prescribed some medicines. Such course of treatment was well within the scope of the beneficial scheme of the appellant. The claim of the respondent has thus rightly been allowed by the D.F. [See Surjeet Singh v. State of Punjab and Ors., 1996 S.C. 1388, Navratan Mal Mehta v. State of Rajasthan & Ors., (S.B. Civil Writ Petition No. 2255/1993 decided on 20.7.2000 and our order dated 26.4.2002 in Appeal No. 216/2001, Member Secretary, Board of Trustees, Rajasthan State Pensioners and Medical Concession Scheme & Ors. v. Shri Ram Chander Chauhan].
5. In view of the above, we find no force in this appeal and dismiss it accordingly with cost at Rs. 3,000/- to the respondent.
Appeal dismissed.
