Stating that it is wrong to deny medical treatment to a person in need, the District Consumer Disputes Redressal Commission directed an insurance corporation to release money so that a five-year-old girl may get hearing implants.
The patient’s father, Bisheshwar Yadav of Sector 4, filed a case against Employees’ State Insurance Corporation (ESIC, Chandigarh) through its regional director. Yadav, who has been a member of the ESIC Scheme since 2015 said his daughter had a congenital hearing defect in both ears. While ESI Model Hospital, Chandigarh, paid for the surgery to implant the hearing aid in her right ear, it refused to sanction ₹6 lakh for implanting the device in her left ear stating that there is no provision for second advance for implantation of hearing aid, said Jasbir Singh, the complainant’s counsel. The surgery had been recommended by doctors at the Postgraduate Institute of Medical Education and Research (PGIMER).
Yadav served a legal notice, to which the corporation said that the case had been forwarded to the medical superintendent ESIC Model Hospital, Chandigarh, for process, but he had not received any response till date. Alleging that the act amounts to deficiency in service and unfair trade practice, Yadav moved the consumer commission.
The corporation stated that the office of the medical superintendent ESIC Model Hospital, Chandigarh, had said that as per their circular, the advance for cochlear implant for the second ear is not admissible, but the complainant intentionally withheld vital facts with regard to receipt of reply (from the commission) and filed the present complaint without impleading the ESIC Model Hospital, Chandigarh, as necessary party.
{{/usCountry}}The corporation stated that the office of the medical superintendent ESIC Model Hospital, Chandigarh, had said that as per their circular, the advance for cochlear implant for the second ear is not admissible, but the complainant intentionally withheld vital facts with regard to receipt of reply (from the commission) and filed the present complaint without impleading the ESIC Model Hospital, Chandigarh, as necessary party.
{{/usCountry}}The commission observed: “In the spirit of law, it is wrong to deny the medical treatment to a medically needy person simply on the ground that unilateral implantation is allowed by taking the shelter of the aforesaid instructions, especially when it was recommended by the PGIMER and is required for the normal functioning of the ears of the complainant’s daughter.”
It added: “The main principle/objective to set up the corporation is to provide certain benefits to its employees in case of sickness, maternity and employment injury etc and not to deny the same. Thus, the opposition party has committed deficiency in service by not allowing the advance payment for the hearing aid of the left ear of the complainant’s daughter.”
The commission directed the ESIC to sanction the advance of ₹6,18,050 as recommended by PGIMER, Chandigarh, for implantation of the hearing aid in the left ear of his daughter. It was directed to comply with the order within 45 days.