ORDER

(Passed on 20 /07 / 2023) The following order of the Commission was delivered by Shantanu S. Kemkar, J :

This appeal under Section 41 of the Consumer Protection Act, 2019 has been filed by the appellant – Employees State Insurance Co rporation (for short the ‘ESI’) challenging the order dated 31.1.2023 passed by the District Consumer Disputes Redressal Commission, No.1, Indore (for short the ‘District Commission’) in CC No.183/2015.

2. Briefly stated, the respondent’s son working on t he post of Manager at Shriram Fortune Solution Company, Indore got himself and his family including the respondent – complainant insured with the appellant. On 19.4.2003 the respondent – complainant fell ill and was being taken to Dr. Rupesh Modi, on whose advice he was admitted in Unique Hospital, Indore. However, on the next day he was taken to ESI Hospital, Rajmohalla, Indore but since the facilities relating to heart treatment were not available at ESI Hospital and considering the emergency he was taken to Gokuldas Heart Hospital, Indore at 1:10 P.M. where he was immediately treated for coronary angiography unstable angina. Seeking reimbursement of the expenses of Rs.2,29,665/- incurred by him the claim was submitted to the appellant. However, the claim for compensation was repudiated by the appellant on 20.1.2015.

3. Feeling aggrieved the respondent had approached to the District Commission by filing a complaint case No.183/2015, which was dismissed by the District Commission vide order dated 16.3.2016 holding that the respondent – complainant will not fall within the definition of ‘consumer’. Aggrieved the respondent - complainant had filed an appeal No.449/2016 before this Commission and this Commission vide order dated 27.10.2022 after considering the definition of term ‘consumer’ as defined under Section 2 (1) (d) of the Consumer Protection Act, 1986 held the respondent – complainant to be covered under the term ‘consumer’ and remanded the matter to the District Commission for deciding it on merits in accordance with law.

4. After the aforesaid order of remand passed by this Commission, the District Commission vide impugned order allowed the complaint and granted the relief of reimbursement of the expenses incurred by the respondent in his treatment with interest.

Feeling aggrieved the appellant –ESI has filed this appeal.

5. The only ground raised by the appellant – ESI in the memo of appeal is to the effect that in view of provision contained in Section 75 of the Employees’ State Insurance Act, 1948 (for short the ‘ESI Act’) the jurisdiction lies to the Employees Insurance Court (for short ‘ ESI Court ’) and not to the District Commission under the Consumer Protection Act, 1986 (for short the ‘Act of 1986’). Learned counsel for the appellant fairly stated that except this ground no other ground is raised in the appeal memo.

- 4 - 6. On the other hand, learned counsel for the respondent has placed reliance on the judgement passed by the Supreme Court in the case of Kishorlal Vs. Chairman, State Insurance Corporation, II (2007) CPJ 25 (SC) in which it has been held that the jurisdiction of the Consumer Forum is not ousted by virtue of sub-section (1) or (3) of Section 75 of the ESI Act.

7. In order to appreciate the ground raised by the appellant that the respondent – complainant ought to have approached the ESI Court by invoking provisions contained in Section 75 of the ESI Act and the complaint as was filed before the District Commission was not maintainable, it would be appropriate to extract relevant provisions of the ESI Act and the Consumer Protection Act, 1986.

Section 74 and 75 of the ESI Act “ 74 . Constitution of Employees’ Insurance Court . — (1) The State Government shall, by notification in the Official Gazette, constitute an Employees’ Insurance Court for such local area as may be specified in the n