The District Consumer Disputes Redressal Commission-II has instructed director prosecution and litigation, additional secretary,Punjab; district attorney, Sangrur and director of health and family welfare, Punjab to reimburse majority of medical expenses to a retired deputy district attorney incurred during his cancer treatment, holding that limiting the claim without informed consent amounted to deficiency in service.
The complaint was filed by Ajaib Singh, a resident of Sangrur, who underwent treatment for prostate cancer at Fortis Hospital in Mohali between October to December 2018. Singh had spent ₹4,01,951 on the treatment but was reimbursed only ₹1,11,750 by the authorities in January 2021.
Challenging the partial reimbursement, Singh argued that he had submitted all necessary bills and documents and was entitled to the full amount under applicable rules. He termed the reduced payment illegal and sought the balance along with compensation for harassment for having served the department throughout his career.
The opposite parties in their statement said that the amount reimbursed to the complainant is as per rules and regulations framed by the state government. They said that the complainant himself in his affidavit stated that he is ready to claim the medical expenses as per the rates prescribed by the government and now the complainant is backing out from the terms of the affidavit furnished by him.
However, the commission found that the authorities failed to prove that the complainant’s acknowledgement to the applicable package rates or policy restrictions at the time of treatment.
“…there is nothing on record to establish that the detailed terms and conditions of the said policy, particularly the prescribed package rates, were ever supplied, explained or made known to the complainant at the relevant time.” the commission observed.
“Mere submission of a standard form or affidavit, without demonstrating that the contents and implications thereof were duly explained and accepted, cannot bind the complainant to such limiting conditions,” it further observed.
The commission also took into account,that the treatment was for a life-threatening illness and that the authenticity of the medical expenses had not been disputed by the authorities.
The commission observed that there had been a deficiency in services and directed the authorities to pay the balance amount of treatment of ₹2,90,201 along with interest. Additionally, ₹20,000 was awarded as compensation for harassment and litigation costs.
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