Chandigarh, Aug 28 (KNN) The regional director of Employee’s State Insurance Corporation (ESIC) Chandigarh and in charge ESI Dispensary has been directed by the District Consumer Disputes Redressal Forum to release the medical claim of a woman of Dhanas of Rs 2.16 Lakhs.

Sonia, a resident of Dhanas complained that in July 2015, she submitted bills of treatment of her father who suffered injuries in a road accident occurred on February 4, 2015. Her father was treated at the Government Medical College and Hospital, Chandigarh and Mayo Healthcare Super Specialty hospital, Mohali. The total cost of treatment was nearby 3.5 Lakh.

She was a member of the ESI scheme and had deposited 1.75 percent from her salary. Also, with the employer's contribution at 4.75 percent. Regarding the reimbursement of the amount, she produced bills before the regional director of ESIC but it was not accepted by directing to submit it with the related dispensary. Following the delay, she submitted the bills to the senior medical officer (SMO) who was the in-charge of ESI Dispensary. Even after submitting it was not taken under process.

Following a delay, she took the matter to the consumer forum with regard to the reimbursement of the bill with 18 percent interest on Rs 50,000 as her mental suffering. Cost of litigation that costs a sum of Rs 25,000.  

Regional Director of ESIC came with the response that the corporation was nowhere related with regard to the complaint made and it was the ESI dispensary to act upon the claim. But, the claim was not submitted before the dispensary on time.

While SMO responded that the verified claim was Rs 2.16 Lakh that had to be made. It became time-restricted and the matter was then observed by the director (medical), Headquarters Office, ESIC, New Delhi. Official delayed which stretched the process and claim was not processed.

Looking into the case, the Consumer forum directed to the SMO to release a sum of Rs 2.16 Lakh with annual interest of 9 percent with effect from October 26, 2016. In addition to this amount of Rs 20,000 and Rs 10,000 was directed to release combining the cost of mental suffering and litigation.