Reducing Medical Reimbursement Without Disclosing Policy Terms Is Deficiency In Service: Chandigarh Commission

The District Consumer Disputes Redressal Commission-II, Chandigarh (Amrinder Singh Sidhu, President and B.M. Sharma, Member) held the Punjab Government authorities guilty of deficiency in service for restricting the medical reimbursement of a retired Deputy District Attorney without establishing that he had been informed of the applicable policy conditions, and directed them to pay the balance amount of ₹2,90,201 along with 9% interest and ₹20,000 towards compensation and litigation costs. Brief facts of the Case: The complainant, Ajaib Singh, a retired Deputy District Attorney from Punjab, was diagnosed with prostate cancer in 2018. He underwent treatment at Fortis Hospital, Mohali, incurring medical expenses of ₹4,01,951. He applied for reimbursement of the said amount under the applicable government rules. However, the authorities sanctioned only ₹1,11,750, which was significantly lower than the actual expenses incurred.The complainant contended that despite submitting all necessary documents and bills, the full amount was not reimbursed. Aggrieved by the partial reimbursement, the complainant approached the Consumer Commission alleging deficiency in service, seeking payment of the remaining amount along with interest, compensation, and litigation costs. Contentions of the Opposite Parties The opposite parties contended that the reimbursement was processed strictly in accordance with the Punjab Services (Medical Attendance) Rules, 1940 and the rates prescribed by the Government. They argued that the complainant had voluntarily furnished an undertaking agreeing to accept reimbursement as per government-approved package rates and was therefore bound by those conditions.It was further submitted that the sanctioned amount was as per policy and there was no deficiency in service. The authorities also maintained that the complainant had failed to produce any rule or provision entitling him to full reimbursement of the claimed amount.Observations and DecisionThe Commission observed that although the opposite parties relied on the Punjab Services (Medical Attendance) Rules, 1940 to limit the reimbursement, they failed to establish that the complainant was properly informed about the applicable package rates or the conditions restricting reimbursement. It noted that mere submission of an undertaking or affidavit would not bind the complainant unless it was shown that he had given informed consent after understanding the implications. The Commission further observed that the complainant had undergone treatment for a serious and life-threatening disease, and the expenses incurred were genuine and supported by valid documents, which were not disputed by the opposite parties. In such circumstances, restricting the reimbursement without proper disclosure of policy terms amounted to deficiency in service. Accordingly, the Commission partly allowed the complaint and directed the opposite parties to pay the remaining amount of ₹2,90,201 along with interest at 9% per annum from the date of filing of the complaint till realization. Additionally, a compensation of ₹20,000 was awarded to the complainant for mental agony and litigation expenses. Case Number: CONSUMER COMPLAINT NO. DC/AB1/44/CC/529/2021 Case Title: Ajaib Singh v. Director Prosecution and Litigation & Ors. Click Here To Read/Download Order

Reducing Medical Reimbursement Without Disclosing Policy Terms Is Deficiency In Service: Chandigarh Commission

Praveen Mishra

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