IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION Date of Institution: 01.05.2023 Date of hearing: 05.04.2023 Date of Decision: 19.05.2023 FIRST APPEAL NO.-7/2023 IN THE MATTER OF

1. CHIEF MEDICAL SUPERINTENDENT, NORTHERN RAILWAY DIVISIONAL HOSPITAL, S.P.M. MUKHERJEE MARG, DELHI-110006

2. The DIVISIONAL RAILWAY MANAGER, (MR. S.C. JAIN)

NORTHERN RAILWAY DIVISIONAL OFFICE, ESTATE ENTRY ROAD, NEW DELHI-110055

3. THE CHIEF MEDICAL DIRECTOR, (DR. N.K. YADAV), NORTHERN RAILWAY HEAD QUARTER OFFICE, BARODA HOUSE, NEW DELHI-110001

4. THE GENERAL MANAGER, (MR. ASHUTOSH GANGAL), NORTHERN RAILWAY HEAD QUARTER OFFICE, BARODA HOUSE, NEW DELHI-110001

5. THE CHAIRMAN/CEO, (MR. VINOD KUMAR YADAV), RAILWAY BOARD/MINISTRY OF RAILWAY, RAIL BHAWAN, NEW DELHI-110001.

(Through: Ms. Sareeka Sharma, Advocate)

…Appellants VERSUS POORAN CHAND AGARWAL, S/o LATE MR. SHANKAR LAL, R/o A-3/98, JANAKPURI, NEW DELHI-110058.

(Through: Respondent in person)

…Respondent CORAM:

HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)

HON’BLE PINKI, MEMBER (JUDICIAL)

Present: Ms. Sareeka (Enrl.D/892/2001), counsel for appellant, along with Dr.

S.K. Nagar in person, Northern Railway, Divisional Hospital, Delhi.

Respondent in person along with Mr. Om Prakash (Mob. 9891358325), AR/one of the neighbors of the respondent.

PER : HON’BLE JUSTICE SANGITA DHINGRA SEHGAL, PRESIDENT

JUDGMENT

1. The facts of the case as per the District Commission record are as under:

“The complainant was retired employee from the designation Parcel Supervisor with the Northern Railways, retired from PS Delhi Main, N. Railway. Holding Medical Card under RELHS- 97. His wife namely Smt. Shakuntla Devi Agarwal, under regular treatment for Thyroid-Cardiac Ailments continuous knee pain for the last fifteen years. She felt sever pain & swelling over both knees. After sudden fall unable to Stand and walk at her own, taken to BLK Hospital on 06.08.2019, after examination & diagnoses on spectral CT. scan shows minimally displayed condyler fracture in right femur.

2. It is stated that on 07.08.2019 she completely became bed- ridden taken to SIR Ganga Ram Hospital, New Delhi, on an emergency and admitted on 07.08.2019 and discharged on 19.08.2019. The treatment entailed hospital expenses of Rs.5,02,632/- paid by the complainant and a sum of Rs. 2,00,000/- from OIC. The wife of complainant further admitted on 06.09.2019 and discharge on 10.09.2019, further the hospital entailed total bill of Rs.1,20,843/-.

3. It is stated that the wife of the complainant Smt. Sakuntala Devi Agrawal having PNB Oriental Mediclaim Policy of Oriental Insurance Company Ltd for bank account holder only. Policy no. 2729000/48/2019-15918, period of insurance start from 14.11.2018 to 13.11.2019 as sum insured Rs.2,00,000/-from OIC / MEDI-ASSIST Share has already paid the sum insured of Rs.1,99,998/- directly to the hospital as adjusted in the first bill dated 07.08.2019. It is stated that a sum of Rs.4,23,477/- paid by the complainant to the hospital spending for reimbursement claim.

4. It is stated that complainant filed claim form RELHS Scheme-97 along with one bill no. 2019/2020/CR/I/0011573, for a sum of Rs.5,02,632/- and second subsequent bill no. 2019/2020/CR/1/0031806 for a sum of Rs.1,20,843/- alongwith relevant documents. It is stated that the complainant claims total sum of Rs.5,02,634 &Rs.1,99,980/- paid by MEDI - ASSIST SHARE directly paid to the hospital and a sum of Rs.3,02,634/- paid by the complainant and a sum of Rs.1,20,843/- remaining from the subsequent bill dated 06.09.2019. The complainant claims total sum of Rs.4,23,477/-

from the OP's under RELHS -97 Scheme.

5. The complainant claims reimbursement of the aforesaid payment from the Chief Medical Superintendent of the Northern Railways/OP's. It is stated by the complainant that OP's seeking reasons for entertaining reimbursement bills exceeding its empowerment (SOP) of Rs.2,00,000/- part payment of Rs.1,98,064/-on 17.08.2020 had been reimbursed. It is alleged that the OP illegall