Decided on October 20,2008

SUDHEER Appellant
Esi Corporation Ltd. Respondents


- (1.) THE unsuccessful complainant is the appellant.
(2.) THE case of the complainants in brief is that himself and his family members were covered by ESI Scheme vide Ex. A1 ESI card. While so, his mother Smt. CH. Radha suddenly fell ill. She had severe vomiting and pain in stomach. She was admitted in ESI Hospital at Sanathnagar on 1.5.2006. She was given treatment for four days by administering glucose, etc. They diagnosed that she was suffering from 'Uretei Collie (L) Renal Caluli' and referred her to Urology Department of Osmania Hospital, Hyderabad by discharging her on 4.5.2006 vide Ex. A2.
(3.) WHEN he took her to Osmania General Hospital they refused to admit her. As he has no other alternative, he admitted her in a private hospital by name Pramila Hospital at Basheerbagh, Hyderabad. The doctors at the hospital opined that it was an emergency case, and had to perform an operation. They conducted the operation on 5.5.2006 and discharged her on 8.5.2006. Altogether he paid Rs. 50,000 evidenced under Exs. A3. When he claimed the said amount from the ESI under Ex. A4 they informed under Ex. A5 that the disease was not covered under G.O. Ms. No. 117 for reimbursement (vide letter Ex. A5). Since the Osmania General Hospital did not admit his mother, he was forced to spend the amount in a private hospital for which he was entitled to be reimbursed. Therefore, he claimed Rs. 50,000 with interest @ 24% p.a., together with compensation of Rs. 30,000 and costs of Rs. 3,000. The respondent ESI Corporation Ltd. resisted the case. While admitting that complainant's mother Smt. CH. Radha was admitted in their hospital. as she was suffering from 'Uretei Collie (L) Renal Caluli' referred her to Osmania Hospital as they were not having the department of Urology. It was in conformity with the instructions contained in G.O. Ms. No. 117 dated 27.3.2000. Only in case of refusal or denial of treatment for any reason by a Government hospital, the patient can be referred to any of the hospitals recognized by the Government as per tie -up arrangement. Prameela Hospital where the complainant's mother was admitted, is not one of the hospitals recognized by the Government as a referral hospital. There is no proof that Osmania General Hospital refused to admit the patient or render medical assistance. On the application filed by the complainant, a special scrutiny committee was constituted and it has rejected the claim. He did not suffer any mental agony nor any loss, and therefore prayed for dismissal of the complaint.;

Click here to view full judgement.
Copyright © Regent Computronics Pvt.Ltd.