FIRST ADDITIONAL BENCH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH Date of Institution : 07.04.2021 Date of Reserve : 28.04.2023 Date of Decision : 09.05.2023 District Education Officer Elementary Education Mansa, District Mansa.

….Appellant/Opposite party No.4 Versus

1. Baljit Sharma, Peon, O/o District Education Officer (EE)

Mansa, District Mansa through its Legal Heirs:

i) Santosh Kumari Widow of Baljit Sharma S/o Babu Ram ii) Gauri Sharma minor D/o Baljit Sharma S/o Babu Ram through her guardian mother Santosh Kumari iii) Darshana Kumari Sharma, mother of Baljit Sharma S/o Babu Ram All residents of Ward No.8, House No.82, Dheer Wali Gali, Mansa.

……Respondent/Complainant

2. M.D.India Health Insurance (TPA) Pvt. Ltd., Mohali Tower, 1^st Floor, Phase-8B, Branch Mohali 160071 through its Managing Director.

3. The Oriental Insurance Company Limited, Divisional Office, Bank Street, Bathinda, through its Divisional Manager.

…..Respondents/Opposite parties No.1 & 2

4. Punjab Health System Corporation through its M.D. State Institute of Health & Family Welfare, Phase –VI, Near Civil Hospital, SAS Nagar, Punjab.

…..Proforma respondent/opposite party No.3 First Appeal under Section 41 of the Consumer Protection Act, 2019 against the order dated 15.02.2021 passed the District Consumer Disputes Redressal Commission, Mansa.

Quorum:-

Mr.Harinderpal Singh Mahal, Presiding Judicial Member Mrs. Kiran Sibal, Member Present:-

For the appellant : Sh.Gurlabh Singh, Deputy D.E.O.

For respondent No.1 : Sh.P.K.Kapila, Advocate For respondent No.2&3: Sh.Sahil Abhi, Advocate For respondent No.4 : Service dispensed with vide order Dated 28.09.2021.

HARINDERPAL SINGH MAHAL, PRESIDING JUDICIAL MEMBER This appeal has been preferred by the appellant/opposite party–D.E.O. Elementary Education, against the order dated 15.02.2021 passed by the District Consumer Disputes Redressal Commission (in short ‘District Commission’), Mansa, whereby the complaint filed by the complainant under Section 12 of the Consumer Protection Act, 1986 (in short ‘the Act’) was partly accepted with costs and compensation of Rs.10,000/- against opposite party No.4. Opposite party No.4 was further directed to reimburse the amount of four bills sent by deceased Baljeet Sharma to opposite party No.4 by following the policy of the State Government along with interest @9% per annum from the date of filing of the complaint till realization. It was further directed that complainant No.3 (mother of the deceased) shall get ½ of the awarded amount and complainants No.1 & 2 shall share rest ½ of the awarded amount.

It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Commission.

2. The facts of the complaint are that the Government of Punjab introduced a Cashless Work Insurance Scheme, vide its Notification dated 20.10.2015, Chandigarh, PGEPHIS and was compulsory to all the service employees and pensioners, who are covered under the existing Punjab Medical Attendant [CS(MA)] Rules 1940. As per the agreement between the Insurance Company and Government, the policy was to start from 01.01.2016 and initially upto 31.12.2016 and enrollment was to start from 31.12.2015. The complainant (now deceased), who was serving as Class IV employee in the office of District Education Officer (Ele. Edu.) Mansa, also sent his enrolment form along with other staff members. The Insurance Scheme was to provide coverage for meeting all expenses relating to the hospitalization of beneficiary member upto Rs.3 lacs per family per year in any of the empanelled hospital/nursing home and if the sum insured of Rs.3 lacs per family is exhausted, the coverage of the family shall be met from the sum insured of Rs.25 crore available to each and every beneficiary of the group on group floater basis, maintained by the Insurance Company. In May, 2016, the complainant (now deceased) got admitted in Amar Hospital, Patiala due to breathing disease, where he rem