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STATE CONSUMER DISPUTES REDRESSAL COMMISSION

U.T., CHANDIGARH

[ADDITIONAL BENCH]

Appeal No. : 199 of 2025

Date of Institution : 13.06.2025

Date of Decision : 31.12.2025

Additional Director, Central Government Health Scheme, Kendriya Sadan,

4th Floor, Sector 9-A, Chandigarh - 160009

….Appellant/Opposite Party

Versus

1] Ravinder Singh S/o S. Jaswant Singh R/o House No.50, Good Earth

Colony, Patiala – 147001, Punjab

2] Uttam Kaur W/o Sh. Ravinder Singh R/o House No.50, Good Earth

Colony, Patiala – 147001, Punjab

….Respondents/Complainants

BEFORE: MRS. PADMA PANDEY, PRESIDING MEMBER

SH. RAJESH K. ARYA, MEMBER

ARGUED BY :-

Ms. Komal Preet Chauhan, Advocate (on video conferencing) alongwith

Ms. Muskan, Advocate for the appellant

Sh. Devinder Kumar, Advocate for the respondents alongwith Sh. Ravinder

Singh, Respondent No.1 in person

PER RAJESH K. ARYA, MEMBER

The instant appeal has been filed by the opposite party – The

Additional Director, Central Government Health Scheme (appellant herein)

for setting aside order dated 28.02.2025 passed by District Consumer

Disputes Redressal Commission-II, U.T., Chandigarh (hereinafter to be

referred as ‘District Commission’) vide which, Consumer Complaint bearing

No.290 of 2024 filed by the complainants – Sh. Ravinder Singh and his wife

Smt. Uttam Kaur (respondents herein) has been partly allowed against the

appellant by granting following relief:-

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“12] In view of the above discussion, the complaint of

the complainants is partly allowed and the OP is directed

as under: -

i) To reimburse the claim amounts of Rs.6640/- &

Rs.22023/- (Annexure C-VIII) and Rs.36839/- &

Rs.127118/- (Annexure C-IX) to complainants No.1

& 2 respectively alongwith interest @ 9% per annum

from the date of denial of claim till the date of its

actual realization.

ii) To pay Rs.25000/- to the complainants as

compensation for the harassment caused as well as

litigation expenses.

The above said order shall be complied with by the

OP within a period of 60 days from the date of receipt of

certified copy of this order.

13] With regard to the reimbursement of medical claim

of Rs.22,799/- in respect of complainant No.1 for the

period 22.07.2024 to 25.12.2024 and Rs.54,812/- in

respect of complainant No.2 for the period 28.03.2024 to

25.12.2024, which have been subsequently claimed by

complainants in their replication and written arguments,

seem not to have been submitted to the OP for

reimbursement. Hence, the same fall outside the purview

of this Commission. Complainants are at liberty to submit

Medical Reimbursement Claim for the said amounts

Rs.22,799/- and Rs.54,812/- with the OP for of

reimbursement. The original medical bills attached with

the replication be returned to the complainants against

receipt after retaining photocopies thereof.”

2] In brief, the case of the complainants before the District

Commission was that complainants No.1 and 2 are husband and wife.

Complainant No.1 retired from the Central Reserve Police Force, while

Complainant No.2 retired from Punjab Government service. At the time of

retirement, Complainant No.1 subscribed to the Central Government Health

Scheme (CGHS) by paying ₹60,000/- and opted to forego the fixed medical

allowance of ₹1,000/- per month with pension. Complainant No.2 also opted

to forego the fixed medical allowance of ₹1,000/- per month to avail OPD

and IPD medical facilities under CGHS. Complainant No.1 suffered a stroke

and remained under treatment at PGI in OPD and was also admitted in PGI

from 11.12.2017 to 17.12.2017 in the Cardiology Department. Thereafter,

he remained under treatment at Govt. Rajindra Hospital, Patiala and Fortis

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Hospital, Mohali for emergent cardiac problems. He also suffered from

Covid-19 on 06.04.2021. In view of his deteriorated health condition,

doctors restricted his movements and advised continuation of medicines.

Being resident of Patiala, he purchased medicines locally and underwent

tests from time to time under emergent conditions. Complainant No.2,

Uttam Kaur, also covered under CGHS for OPD