IMPORTANT POINT
Limited Scope of Second Appeal/Revisional Jurisdiction – Its jurisdiction to intervene in Second Appeals (akin to Revisional Jurisdiction) is extremely narrow. When the District Forum and State Commission have arrived at concurrent findings of fact based on evidence, the National Commission will not substitute its own view or interfere unless the lower orders suffer from illegality, material irregularity, or lack of jurisdiction.

ORDER (ORAL)

This Second Appeal has been filed under Section 51(2) of the Consumer Protection Act, 2019 (the “Act”) against the order dated 11.06.2025, passed by the State Consumer Disputes Redressal Commission, West Bengal (‘the ‘State Commission’) in First Appeal No. SC/19/A/358/2023 wherein the Appeal by the Appellant/ Complainant was dismissed, affirming the Order dated 05.09.2023, passed by the District Consumer Disputes Redressal, Hooghly (For short “District Forum”) in Consumer Complaint No. 70 of 2022, wherein the Complaint was partly allowed.

2. There was 30 days delay in the filing this Second Appeal. Heard learned counsel for the petitioner with respect to 30 days delay in filing this Second appeal and the same is condoned.

3. For convenience, the parties in the present matter are denoted as per their positions in the Consumer Complaint before the District Forum. Prasanta Basu Ray is identified as the Complainant (Petitioner herein). Meanwhile, The Additional Director, CGHS, is identified as Opposite Party (Respondent herein) in the present matter.

4. Brief facts of the case, as per the Complainant are that the complainant, a retired Central Government employee and pensioner, contributed Rs.39,030/- to avail lifetime medical services from the Opposite Party (OP), thereby becoming a beneficiary of the Central Government Health Scheme (CGHS) with a specific ID number. Severely indisposed, he was admitted to a nursing home in Chandannagore, Hooghly, on 17.01.2022, incurring treatment expenses of approximately Rs.87,000. The complainant was discharged on 23.01.2022. As a CGHS beneficiary, he submitted a medical reimbursement claim for Rs.86,206/-, which the wellness centre (KO10 at BBD Bagh, Kolkata-700069) received and forwarded to the Additional Director of CGHS on 15.02.2022 for processing. However, the claim remained pending even after 65 days. He cited a Supreme Court judgment directing that medical reimbursement claims for pensioners be settled within 30 days and a Ministry of Health and Family Welfare office Memo dated 14.05.2018 issued pursuant to the Hon’ble Supreme Court order in WP(C) No. 694/2015 (Shiva Kant Jha vs. Union of India). He viewed the delay as a disregard of the Apex Court’s order and caused mental agony and harassment. He approached the District forum seeking directions for full claim reimbursement, Rs.15,000 for mental agony, Rs.10,000 as costs, and penalty of Rs.3,000 per day for the period the claim was pending beyond the 30-day limit.

5. On being issued notice, OP contested the complaint by filing a written version and evidence and contended that the complaint is not maintainable. There is no cause of action and the Complainant has no right to file this complaint. The case is defective for non joinder & mis-joinder of parties and suppression of material facts. The OP contended that CGHS facilities are extended to pensioners on account of government service rendered and not provided to the public. CGHS is a service-related matter, not a consumer matter. As regards delay in reimbursing the claim, OP explained that after receiving the claim documents on 14.02.2022, they were forwarded to the Additional Director, CGHS Kolkata, on 22.02.2022 and the medical reimbursement bill was placed in the queue, as pensioners’ claims are processed serially on a first-come, first-served basis, once found correct. Against the backdrop of the pandemic, the number of such claims increased manifold. Additionally, a special relaxation allowed purchases of medicines from outside CGHS for reimbursement, leading to surge in such bills and delays in processing. However, the admissible amount of Rs.47,050 was credited to his account on 06.05.2022, followed by further Rs.5,485 as per revised calculation. Thus, OP attributed the delay to large volume of claims amid the COVID-19 pandemic and associated issues and that there was no wilful neglect in claim processing and no intention to disregard the Apex Court’s order. OP