An employee of RSRTC is considered a 'consumer' under the Consumer Protection Act, 1986, and is entitled to reimbursement for medical expenses incurred at a private hospital outside the state under emergent circumstances as per Section 10(3) of the Rajasthan Medical Treatment Ordinance, 2008.

ORDER

Dr. S.M. Kantikar, Member - The complainant, Mr. Ishwar Singh Rathore, a bus-conductor, suffered a heart-attack on 05.01.2012, during his duty, on route from Ajmer to Bhinay. He was taken to Narsirabad Hospital and then referred to Jawahar Lal Nehru Hospital at Ajmer. As there was no facility available for heart surgery, he went to Medanta Hospital, Gurgaon. He remained in the hospital from 06.01.2012 to 09.01.2012 and incurred expenditure to the tune of Rs. 2,68,079/-. He preferred the claim before the Rajasthan State Road Transport Corporation(RSRTC-the OP), which was rejected on the ground that he got himself treated in private hospital and under the general rules, the expenses incurred in private hospital cannot be reimbursed.

2. Both the fora decided this matter in favour of the complainant. Hence, aggrieved by the order of the State Consumer Disputes Redressal Commission, Jaipur (hereinafter referred to as "State Commission"), the OP preferred this revision petition.

3. We have heard learned counsel for both the parties. Counsel for the OP Mr. S.K. Bhattacharya vehemently argued that the complainant is not a 'consumer', within the definition of 'consumer' in the CP Act and he is not entitled to file a complaint against the RSRTC. Counsel further submitted that the treatment (heart surgery) facility was available in SMS Hospital, Jaipur. The complainant, instead of going to the nearest SMS Hospital at Jaipur, on his own will, underwent heart surgery at Medanta Hospital, Gurgaon. The reimbursement of the medical expenses can be made only under the Rules of the Corporation framed, from time to time. As per Rules 6 & 7 of the Rajasthan reimbursement medical bills, if an employee gets himself treated outside Rajasthan, without proper permission, the employee is not entitled for reimbursement of medical expenses. The complainant did not seek permission for treatment outside Rajasthan, as provided under Rule 7(3) of the Rules. Under Rule 7(1), a Board of three expert Doctors, keeping in view the nature of disease, gives permission for treatment, outside Rajasthan. Therefore, there was no deficiency in repudiating the claim of complainant.

4. We have perused Section 10(3) of the Rajasthan Medical Treatment Ordinance, 2008, which is applicable to the instant case. It is reproduced here, as under:-

(1) .xxx.

(2) .xxx

(3) If a Government servant undertaking indoor treatment of life threatening diseases like kindly, heart and some sudden accident in a private hospital outside the State, without reference in case of emergent circumstances, Government may allow reimbursement of the medical expenses incurred upto the cost of treatment, that would have been incurred had the treatment been taken in S.M.S. Hospital, Jaipur and if facility of that treatment is not available in S.M.S. Hospital, Jaipur upto the cost of treatment at AIIMS, New Delhi, upon such emergent circumstances being explained satisfactorily. No travelling allowance shall be admissible in such cases."

5. We have perused another order of Govt of Rajasthan, No. F.6 (4)FD/Rules/2003 Pt. III Jaipur, dated 10.09.2010, which is reproduced here, as under:-

"Sub. Rajasthan Civil Services (Medical attendance) rules, 2008 - List of Referral Hospitals.

As per the provisions contained in item (ii) of rule 4 of Rajasthan Civil Services (Medical Attendance) Rules, 2008 on the recommendation of the Health Benefit Advisory Committee, the State Government have approved to include following three hospitals as "Referral Hospitals" as defined in Rule 3(8) of the aforesaid Rules, at serial number 10, 11, 12 in Appendix - II.

10. Institute of Liver and Biliary Science, New Delhi (for liver diseases only).

11. Medanta, the medicity, Gurgaon

(For cardiology, CT Surgery and Joint Replacements).

6. As per above order, Medanta Hospital is also one of referral hospital. The patient took treatment there during emergency. On perusal of sequence of events that patient suffered heart attack on 5.1.2012,