Parties: Dilip Kumar vs ESIC & Hospital
Court: DCF, Ranchi
Date of Decision: 27.12.2022
Specialization: Hospital
Facts in Nutshell:
The wife of complainant suffering from illness was treated at ESIC hospital OP 1as she was insured under Employee’s state insurance scheme where she was referred to OP 2 hospital on 25.11.2011.
Surgery was performed on 26.11.2011 and advance deposited was asked stating that complainant can seek reimbursement later under ESIS. Complainant paid Rs. 45000/- to OP 2 and later filed the claim but the same was repudiated, to which OP2 stated that complainant suo motto choose the treating doctor who is not in the list of ESI panel. The complainant alleged that the statement of OP 2 is false and fabricated, OP 2 provided the name of treating doctor to which complainant agreed. OP 2 neither disclosed that treating doctor was not in list of panel nor intimated that using a cabin with western toilet would debar the complainant from benefits under ESIS. Complainant filed consumer complaint for compensation of Rs. 50000/- in toto.
Version of OP’s:
The OP 1 on the outset denied the allegation that complainant need to approach ESI court for appropriate relief as special Act.
OP 2 stated that patient was already under the treatment of treating doctor (who was not on panel of ESI) which is evident from the prescription dated 23.11.2011, hence patient party insisted for treatment with the said doctor. No assurance was given by OP 2 for reimbursement, OP 2 is only liable for giving treatment and its patient party to decide about which room facilities. As per agreement with ESIC the beneficiary are entitled to get general ward and if they want to upgrade the room facilities they need to pay out of pocket.
Held:
The learned court applied the principle of CAVEAT EMBTOR i.e. the buyer purchase at his own risk in absence of an express warranty with the contract. However, the principle is applied in the sale of good Act but in this case it is an outburst of implementation of contract between the parties and as per the terms of contract the hospital was bound to provide treatment within the package fixed by the ESIC, for any complaint in this case ESIC is the suitable authority to taken punitive action. Hence complaint was dismissed and no relief can be given to the complainant in this case.
