ESIC penalised Rs 41, 000 for refusing medical reimbursement

Imran Sidiq Shawl of Bemina Srinagar had filed a complaint before the consumer forum in 2012 after ESIC had refused to reimburse him the costs of medical treatment incurred on his father’s surgery.

MUDASIR YAQOOB
Srinagar, Publish Date: Dec 17 2017 12:06AM | Updated Date: Dec 17 2017 12:06AM
ESIC penalised Rs 41, 000 for refusing medical reimbursementRepresentational Pic

District Consumer Protection Forum, Srinagar has asked Employees’ State Insurance Corporation (ESIC) to pay Rs 41, 454 as penalty for refusing to pay medical reimbursement and causing ‘mental agony’ to a beneficiary after finding the corporation ‘deficient of services’.

Imran Sidiq Shawl of Bemina Srinagar had filed a complaint before the consumer forum in 2012 after ESIC had refused to reimburse him the costs of medical treatment incurred on his father’s surgery.

The consumer forum in its decision has directed ESIC to pay Shawl Rs 41, 454 as penalty, which includeRs 14,454 as expenses incurred by the complainant on his father's surgical operation, Rs 20,000 as compensation for causing him mental pain, agony and harassment and Rs 7,000 as litigation charges.

The decision was given after the forum presided over by Muhammad Ashraf Malik, Principal District and Sessions Judge examined the evidence and witnesses, and found ESIC guilty of ‘deficiency of service’.

In its detailed order, the forum said that the complainant (Shawl) being an authorised associate of Adecco Flexione Workplace Solutions Limited and working with Dishnet Wireless Limited had secured insurance cover under ESIC under insurance number 1900176211.

“It is alleged that in the month of January, 2012, complainant's father developed Cataract (B) with his left eye. Accordingly complainant approached opposite parties who advised him to approach government hospital for treatment of his father,” the forum said.

“It is alleged that complainant accordingly approached SKIMS Medical College, Bemina where at the date for surgery of the left eye of his father was given as 6 August 2012. Since the date for surgery scheduled on August 6, 2012 was too late, as such, complainant again approached opposite parties with request to allow him to perform the surgery in some private hospital, which was acceded and complainant was told to approach florence hospital for the purpose,” it added.

Again, the administration at Florence Hospital due to some internal differences with the corporation denied such surgery upon the father of the complainant, as a result whereof with every passing date, the problem of vision was aggravating.

It was further alleged that after facing denial from the Florence Hospital complainant again approached opposite party and requested for some other private clinic, which was again acceded subject the complainant shall submit the requisite documents before the opposite party for reimbursement of his claim.

Accordingly, complainant took his father to private eye clinic for the surgery of his cataract. However, ESIC later denied the reimbursement, which lead litigant to register a complaint at district consumer forum. 

After finding ESIC guilty of deficient of services, the forum directed it to pay Rs 14,454 as expenses incurred by the complainant on his father's surgical operation, Rs 20,000 as compensation for mental pain, agony and harassment and Rs 7,000 as litigation charges.

It added that the order shall be complied within thirty days from the date of receipt of its certified copy, failing which the amounts shall carry interest at 12 percent from the date of default till actual payment or realisation.

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