STATE CONSUMER DISPUTES REDRESSAL COMMISSION PUNJAB, DAKSHIN MARG, SECTOR 37-A, CHANDIGARH Date of Institution : 13.03.2025 Date of Decision : 18.03.2025

1. Pooja Jain aged about 50 years wife of Sh. Rohit Jain, 2. Aaditree Jain aged about 24 years D/o Sh. Rohit Jain, 3. Rakshita Jain aged about 26 years D/o Sh. Rohit Jain, All residents of Dr. Daya Kishan Jain Street, Near Post Office, Sadar Bazar, Malerkotla, District Malerkotla.

……..Appellants/Complainants Versus

1. Employee State Insurance Corporation, Karbala Road, Near Dr.

Zakhir Hussain Stadium, Malerkotla, District Malerkotla, through its Manager.

2. Employee State Insurance Corporation, Madhya Marg, Sector-

19-A, Chandigarh, through its Deputy/Regional Director.

3. Medical Officer, Incharge ESI Dispensary, Lal Bazar, Malerkotla, District Malerkotla.

4. Medical Superintendent, Deputy Director Zonal, ESI Model Hospital, Bharat Nagar Chowk, Ludhiana, District Ludhiana.

5. Director Health Service (SI) Punjab, Privar Kalyan Bhawan, Sector 34-A, Chandigarh.

…..Respondents/Opposite Parties Appeal under Section 41 of Consumer Protection Act, 2019 to challenge the order dated 23.12.2024 passed by the District Consumer Disputes Redressal Commission, Malerkotla in Consumer Complaint No.08 of 2023.

Quorum:-

Hon’ble Mrs. Justice Daya Chaudhary, President Mrs. Simarjot Kaur, Member Mr. Vishav Kant Garg, Member Present:-

For the Appellants : Sh. Anil Kumar Garg, Advocate

1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No

2) To be referred to the Reporters or not? Yes/No

3) Whether judgment should be reported in the Digest? Yes/No JUSTICE DAYA CHAUDHARY, PRESIDENT:-

The Appellants/Complainants i.e. Pooja Jain, Aaditree Jain and Rakshita Jain have filed the present Appeal under Section 41 of the Consumer Protection Act, 2019 (in short the ‘Act’) for setting aside the impugned order dated 23.12.2024 passed by the District Consumer Disputes Redressal Commission, Malerkotla (in short the “District Commission”) in Consumer Complaint No.08 of 2023.

2. Briefly, the facts of the case of the Complaint which are necessary for disposal of this Appeal are that Complainant No.1 was issued ESI IP No. 1213261024 by the OPs. The Complainants were insured under ESI Scheme. Complainant No.1 is the mother and Complainants No.2 & 3 are the daughters of Complainant No.1. It was further mentioned that Complainants No.2 & 3 had taken treatment from the private hospital and got conducted some tests from the private hospitals in emergency and on lodging the claim with the OPs, the same was refused. The Complaint was filed by the Complainants before the District Commission with the following prayer :-

1) The OPs be directed to pay amount of medical bills of Rs.71,089/- alongwith interest @ 24% per annum from

3.11.2014 till payment.

2) To pay the amount of Rs.4,00,000/- on account of mental agony and harassment.

3) To pay Rs.25,000/- on account of litigation expenses.

4) Any other relief to which the CC found entitled.

3. Upon issuing notices to the OPs, OPs No.1 and 2 appeared and they filed their written versions, wherein certain preliminary objections were raised. The other averments made in the Complaint were denied. Similarly, OPs No.3 to 5 had also filed their written version and certain preliminary objections were also raised like non-joining of necessary parties and suppression of material facts from the Commission. Other averments made in the Complaint were also denied. It was also mentioned in the reply that the Complainants had taken treatment from private hospital and had not submitted the bills within prescribed time as such they were not entitled to any benefit under scheme.

4. By considering the contents of Complaint, reply thereof filed by the OPs and on considering the oral arguments and other documents available on file, the Complaint filed by the Complainant was dismissed vide order dated 23.12.2024. The relevant part of the order as mentioned in para No.20 of the order is reproduced