A case related to health services and functioning of ESI has come to light from the capital Delhi. Here a son admitted his ailing father to different hospitals to save his life. After not getting a bed in AIIMS, he turned to other hospitals. Even his father was treated in private hospitals included in the panel of Employees' State Insurance (ESIc) Corporation, but despite all efforts, his life could not be saved. The son spent a total of Rs 1.81 lakh on his father's treatment. After this, when he asked for the treatment amount back from ESI Corporation, the payment was stopped citing not following the referral process. However, now the South-West District Consumer Disputes Redressal Commission of Delhi has considered this action of ESI as deficiency in service.
ESI will have to return Rs 1.77 lakh with interest
The son spent about Rs 1.81 lakh on his father's treatment. After this, when he asked for the treatment amount back from ESI, the payment was stopped citing not following the referral process. Now the South-West District Consumer Disputes Redressal Commission of Delhi has considered this action of ESI as deficiency in service and has ordered to return Rs 1.77 lakh with 6 percent annual interest. The District Consumer Commission has directed the ESIC Directorate (Medical), Tilak Nagar, to return Rs 1.77 lakh to the complainant with 6 percent annual interest. Apart from this, an order has also been given to pay an additional amount of Rs 15,000 to compensate for the mental distress and expenses incurred in the case.
Payment was stopped citing referral process
According to the case, when the father's health became critical, the son tried to get him admitted to AIIMS, but a bed was not available there. After this he turned to other hospitals and also got his father treated in private hospitals included in the panel of ESIC. During this period, a total of Rs 1.81 lakh was spent on treatment. After the death of his father, the son sought reimbursement of medical expenses from ESIC, but the corporation refused to pay citing not following the prescribed procedure of referral. After this the son lodged a complaint in the District Consumer Commission.
'It is important to save the patient's life, not technical formalities'
The bench comprising District Consumer Commission Chairman Suresh Kumar Gupta and member Harshali Kaur made important comments in its order. The Commission said that when immediate treatment is necessary to save the life of a patient, it is not appropriate to deny reimbursement of medical expenses on the basis of technical formalities like referral. The Commission acknowledged that the complainant was trying to provide better treatment to his father. In such an emergency situation, it was not right to give priority to the technical process of referral.
Right to health is linked to the right to life under Article 21.
The Commission said in its decision that the right to health and medical care is linked to the right to life under Article 21 of the Constitution. Denial of reimbursement of medical expenses merely on the basis of paperwork and technical deficiencies is a violation of Articles 14 and 21 of the Constitution. According to the Commission, in emergency medical situations the priority of the patient and his family is to save the life. In such a situation, financial relief cannot be denied merely on the basis of procedural formalities.
Son kept visiting hospitals for treatment
According to the case, the family of complainant Sanjeev Kumar Pandey, resident of Sagarpur, was insured under the ESI scheme. When his father Kapil Dev Pandey's health deteriorated, the family first got him treated in hospitals in Ludhiana. After this he was brought to Delhi in the hope of better treatment. Here Sanjeev Kumar tried to get his father admitted to different hospitals including AIIMS and Batra Hospital. Due to non-availability of beds in AIIMS, the family had to turn to other hospitals.
Elderly father dies in hospital during treatment
After not getting relief even in Batra Hospital, Kapil Dev Pandey was taken to Kalra Hospital. After this he was admitted to ESI Hospital located in Basai Darapur. However, despite all efforts, he died during treatment on 29 October 2016. The family had spent a total of Rs 1.81 lakh on the father's treatment. After this, Sanjeev Kumar sought reimbursement of this amount from ESI, but only Rs 4,615 was given to him by the corporation.
Cited for not following procedure
ESI's reason behind stopping the payment was that the complainant had not followed the prescribed procedure. According to the corporation, treatment was given in private hospitals without taking referral from the concerned hospital or dispensary. On this basis, full reimbursement of medical expenses was refused. After this, Sanjeev Kumar filed a complaint in the District Consumer Commission challenging the decision of ESI.
Commission said- It is important to save life, not technical formalities
Hearing the case, a bench of District Consumer Commission Chairman Suresh Kumar Gupta and Member Harshali Kaur considered the action of ESI as deficiency in service. The Commission said that when immediate treatment is necessary to save the life of a patient, it is not appropriate to deny reimbursement of medical expenses on the basis of technical formalities like referral. The complainant was trying to get better treatment for his father. In such circumstances, the technical process of referral should not have been given priority.
Articles 14 and 21 were also mentioned
The Commission said in its order that the right to health and medical care is linked to the right to life under Article 21 of the Constitution. Denial of reimbursement of medical expenses merely on the basis of paperwork and technical deficiencies is a violation of Articles 14 and 21 of the Constitution. The Commission has ordered the ESIC Directorate (Medical) to return Rs 1.77 lakh to the complainant with 6 percent annual interest. Apart from this, he has been asked to pay an additional Rs 15,000 for mental distress and legal expenses.
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