Forum directs BSNL to foot ex-employee’s medical bill

Manmeet Singh Gill

Tribune News Service

Amritsar, January 6

The district consumer disputes redressal forum has directed the BSNL to pay Rs 54,238 for medical insurance claim to its former employee, along with Rs 3,000 as litigation expenses.

Karam Chand, a resident of Batala road, had filed a complaint against Bharat Sanchar Nigam (BSNL) stating he retired from the office of the opposite party and was entitled for all medical and health benefits as per the policy.

He stated that he fell ill and remained admitted to a private hospital where he spent Rs 69,138 on his treatment. He stated that the opposite party was immediately informed about the hospitalisation and the treatment to be taken thereof as the complainant was entitled for cashless treatment. The hospital is on the BSNL list of the empanelled medical institutes. Karam Chand alleged that the opposite party failed to settle his claim, thus forcing him to file the complaint.

The opposite party, in its reply, stated that it had to follow the Central Government Health Scheme (CGHS) rules framed by the government. It stated that it had assessed the medical claim under the CGHS rules to a total of Rs 6,900.

The forum observed that no detail of the deduction of the amount from the total amount spent by the complainant on his treatment had been placed on record. It stated that the only plea of the opposite party was that the complainant was entitled only to the amount of Rs 6,900 under the CGHS rules, but as the complainant had got treatment from a hospital empanelled by it, the opposite party was liable to pay the expenses incurred by him.

The forum, however, observed that the complainant, being a group C employee, was entitled to semi-private ward, but in the medical bill the room rent was charged at Rs 4,000 for four days which amounted to Rs 16,000. It stated that as per the entitlement, the complainant was eligible for semi-private ward room rent of Rs 8,000.

The forum directed the opposite party to pay Rs 69,138 after deducting Rs 8,000 for private room rent and Rs 6,900 which had already been paid to the complainant.