IMPORTANT POINT
If there is a medical facility available to an ex-employee or serving employee and the employer places certain hospitals on its panel, where the employee can go for treatment, however, in a life threatening situation or an emergency, the employee can rush to the nearby hospital even if it is not on the panel of the employer.

J.D. Kapoor, President—The short question arising in this appeal preferred against the order dated 9.10.2007 passed by the District Forum is whether there was an emergency for the operation of prostate and the respondent who was an old man and ex-employee of the appellant was thus rushed to an un-empanelled hospital?

2. As is apparent the claim for actual expenses of Rs.18,965 was not allowed because of his having obtained treatment from a hospital, which was not on the panel of the appellant.

3. In our view, at old age when a person suffers from such miseries and his urine stops he has to be taken immediately for treatment or operation of prostate or whatever as the case may be.

4. We have taken a view that even if there is a medical facility available to an ex-employee or serving employee and the employer places certain hospitals on its panel, where the employee can go for treatment, however, in a life threatening situation or an emergency, the employee can rush to the nearby hospital even if it is not on the panel of the employer. The object of the medical benefit to an employee is mainly to give treatment free of charge. If there is an arrangement of the employer and the hospital that are on the panel for a particular amount or package the employee is entitled for that amount but if that is a case of emergency then the employer has to reimburse the actual expenses incurred. This view we have taken in large number of cases particularly in cases falling under the Central Government Health Scheme, MCD, and Public Sector Undertakings, etc. where there are almost identical rules.

5. However, the learned counsel for the appellant has assailed the impugned order; whereby the District Forum has directed the appellant to pay the actual expenses of Rs. 18,965, Rs. 18,500 towards the entitlement for the block year 2003-04, 2004-05 and 2005-06 and Rs.20,000 as compensation for mental agony and Rs.5,000 as cost of litigation, mainly on the premise that firstly the contract of respondent was a contract of a personal service and was not within the purview of Consumer Protection Act. Secondly, since the payment of Rs. 18,965 in respect of hospitalization for the period from 24.8.2001 to 28.8.2001 was rejected on 1.4.2002 and again on 26.2.2003 and since the complaint was filed after three years, the same was barred by limitation. Thirdly, the respondent having acted against the principles and policy of the appellant company as contained in its circulars as despite being its Chief Legal Advisor he had advised certain clients of the appellant against the interest of the appellant company, which was against professional ethics in terms whereof, circular at page 22 of the appeal provides, for remedy of approaching the CMD of the appellant which was not resorted to by the respondent. However, the District Forum erred in not considering the said issues.

6. The aforesaid circular referred to by the learned counsel for the appellant was applicable to persons who are on the employment and not to ex-employees. The charges for providing medical benefits after retirement were consideration for providing medical services and, therefore, the respondent fell within the definition of “consumer” as defined by Section 2(1)(d) of the Act.

7. We have taken a view that every beneficiary legislation or beneficiary contract as in the instant case should be provided and receive a beneficiary interpretation. If there are two views possible the view which goes in favour of the consumer or employee who is the beneficiary should be applied because the inherent nature of the scheme or contract being it beneficial scheme.

8. As regards the allegations of respondent having given legal advice to the employees against the interest of the appellant company, this was applicable only if the respondent was indulging in this activity during service of the appellant. After having retired from the appellant organization, no rule prevented him from giving any advice or oth