Court finds that employee-related medical reimbursements fall under consumer protection provisions, establishing liability for deficient service.

1. This Revision Petition has been filed by the Petitioner against the order dated 10.7.2008 of State Consumer Disputes Redressal Commission, Delhi (in short ˜State Commission') passed in First Appeal No. 182 of 2007.

2. Case of the Complainants / Respondents is that respondent (since deceased) was an employee of the Petitioner / Opposite Party and retired from the post of Deputy Manager in the year 2001. He and his wife were covered under the Medical Reimbursement Scheme of the Petitioner / Opposite Party. His wife, who had already lost one eye, was taken to Centre for Sight on 18.12.2001, where she was advised emergency operation. Complainant was asked to deposit Rs. 16,000 and the surgery was conducted. He submitted the bills of Rs. 16,000 with the Opposite Party for reimbursement. The Opposite Party rejected the claim on the ground that the hospital where operation was conducted was not on the panel of the Opposite Party. Alleging deficiency on the part of the Opposite Party, the Complainant filed a Consumer Complaint before the District Forum.

3. The Complaint was contested by the Opposite Party on the ground that the hospital, where the operation of the wife of the Complainant was conducted, was not on the panel of the Opposite Party. Complainant was required to take his wife to a government hospital or to an empanelled hospital for treatment. Only on the reference of a Government hospital the patient could take his wife to the Centre for Sight. Since the Complainant had directly taken his wife to the hospital which was not empanelled, the Opposite Party was not liable to reimburse the amount incurred by the Complainant.

4. After hearing the Learned Counsel for the Parties and perusing the record, the District Forum allowed the Complaint with following observation:
We, thus, direct OP to pay a sum of Rs. 16,000 together with cost and compensation of Rs. 5,000 within a period of 30 days failing which the entire amount will carry interest at the rate of 9% from the date of order till realization.

5. Aggrieved by the order of the District Forum, the Opposite Party filed First Appeal No. 660/2005 before the State Commission. The State Commission, vide order dated 14.12.2005, remanded the matter to the District Forum with the observation that the Forum has not decided the issue as to whether the Complainant was a consumer or not since he has retired from service and the medical services provided to the representative are without any consideration. On remand, the District Forum, vide order dated 3.1.2007, allowed the Complaint and observed as follows:
As decided earlier by this Forum, O.P. is directed to pay a sum of Rs. 16,000, expenditure incurred by the complainant on emergent eye surgery of his wife. OPs were also directed by our earlier order to pay a compensation of Rs. 5,000 and cost of litigation etc. The OP is directed to pay the same to him as directed earlier (Rs. 16,000 + Rs. 5,000 : Rs. 21,000). Both these payment should be made within 30 days, failing which O.P. will be liable for action under S.25 and S.27 of the Consumer Protection Act .

6. Aggrieved by the order of the District Forum dated 3.1.2007, the Opposite Party filed First Appeal No. 07/182 before the State Commission. The State Commission, vide order dated 10.7.2008 dismissed the Appeal and upheld the order of the District Forum. Hence, the present Revision Petition has been filed by the Petitioner / Opposite Party.

7. Heard the learned Counsel for the Parties and carefully perused the record. Learned Counsel for the Petitioner submitted that at the relevant time the Respondent was not their e