STATE CONSUMER DISPUTES REDRESSAL COMMISSION, MAHARASHTRA, MUMBAI Appeal No.A/19/235

1.Regional Director Ex-Servicemen Contributory Health Scheme, Regional Centre, ECHS, C/o.Fleet Mail Office Mumbai 400 001

2.Managing Director Ex-Servicemen Contributory Health Scheme, Central Organization, ECHS, Integrated Headquarters of MoD (Army), Adjutant General Branch ThimayyaMarg, Near Gopinath Circle Delhi Cantonment -110 010 ...........Appellants Versus Col.(Retd.) Vijander Bhandari Flat no.4, First floor, Abhay Co-op.CHS Plot no.40, Sector 29 Vashi, NaviMumbai 400 703 ............Respondent BEFORE: Justice S.P.Tavade President Smt.S.T.Barne, Judicial Member PRESENT: Advocate Tushar Bhavsar is present for appellant.

Advocate Manisha Bhosale is present for respondent.

Respondent is also present in person.

ORDER (20^th July, 2022)

Per Hon’ble Justice S.P.Tavade, President

1. Being aggrieved and dissatisfied with the judgment and order dated 11/09/2018 passed by the Learned District Consumer Disputes Redressal Commission, South Mumbai, in consumer complaint no.CC/17/197, original opponent/appellant has preferred this appeal.

2. The facts giving rise to the present appeal can be summarized as under:-

The complainant is a retired colonel from Indian Army. The Appellant no.1 is Regional Director of Ex-Servicemen Contributory Health Scheme (ECHS) for Western India.The Appellant no.2 is head of the organization (ECHS). The Complainant is member of ECHS since October 2004. On 02/02/2016, the respondent suffered acute chest pain. Hence, he was admitted in Sir H.N.Reliance Foundation Hospital at Girgaon, Mumbai. On 03/02/2016 he had open heart surgery under the treatment and supervision of Dr.Sudhansu Bhattacharyya.He was discharged on 14/02/2016. The hospital had issued final invoice dated 14/02/2016 for Rs.10,53,033.11 inclusive of Dr.Sudhansu Bhattacharyya’s fees of Rs.6,00,000/-. The respondent had private medical insurance for sum of Rs.2 lakhs with ICICI Lombard Insurance Co. He received reimbursement of Rs.2 lakhs from ICICI Lombard Insurance Co. on 16/03/2016. Hence, the respondent submitted remaining bill of Rs.8,53,033/- to appellant no.1. On 16/04/2016, appellant no.1 approved and reimbursed a sum of Rs.73,133/- to the complainant. The remaining amount of medical expenses was refused by the appellant. The respondent sent emails to the Regional Director of appellant no.2 on 01/09/2016 and 19/09/2016, but no action was taken in pursuance of said emails. Respondent requested that on the basis of order passed by Hon’bleBombay High Court in identical case, his claim be considered. Accordingly, he wrote letter to Lt.Gen.Rakesh Sharma, but there was no positive response from the appellant. The Secretary, Ex-Servicemen Welfare Department instructed appellant no.1 to take action on top priority but after multiple follow-ups and several emails, Head Quarter, ECHS took up the matter and reviewed and approved further claim of respondent to the extent of Rs.1,75,506/-. But the appellant failed and neglected to reimburse the amount of Surgeon fees to the extent of Rs.6 lakhs. As the fees of Surgeon was refused by appellant, respondent filed complaint and claimed Surgeon’s fees of Rs.6 lakhs and interest on delayed payment of Rs.1,75,506/-.

3. The notice of complaint was issued to the appellant/opponent. It was received by the Central Organization, ECHS, Delhi but none appeared on behalf of appellant.

Hence, the complaint proceeded ex-parte against appellant.

4. It is contended that the District Commission has erroneously held that the appellants have knowingly and purposefully denied the rightful reimbursement and caused delay. It is contended that the department had continuously kept the respondent updated of the development and had taken appropriate steps from time to time including follow-ups with the authorities with respect to the claim of the respondent. It is contended that the District Commission has erred in relying upon the judgment of Hon’ble Apex