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ESIC regional director, 3 officials penalised for delay in reimbursement
ESIC officials have been directed to pay ₹50,000 fine to a Mohali woman, and clear her medical bills to the tune of 2.8 lakh with interest
The district consumer disputes redressal commission, Mohali, on Monday imposed a fine of ₹50,000 on four senior officials of Employees’ State Insurance Corporation (ESIC), Punjab, for delaying the payment of medical reimbursement claim of a woman insured under the ESI Scheme.
The officers include ESIC regional director and director health services besides social security officer and medical officer at the ESI Hospital in Phase 7, Mohali. The ESI scheme is a social security scheme to provide medical healthcare facilities to insured workers and their families.
Commission president Sanjiv Dutt Sharma, in his order, directed the officials to also pay interest at the rate of 9% per annum on the total payment of each medical bill — to the tune of ₹8,126, ₹11,383 and ₹2,59,637 — from the date of filing of the complaint.
Complainant Gurpreet Kaur, who works at May Steels Private Limited in Mohali, is a member of the ESI scheme and was regularly making contributions to the rate of 1.75% along with employer contribution at the rate of 4.75% of her salary since May 1, 2008, said her advocate Jasbir Singh. In lieu of payment of the ESI contribution, the insured person and her family members are eligible for cashless medical treatment, he said.
The complaint
Kaur was diagnosed with an ailment at the ESI Hospital in 2013 and further referred to the PGIMER, Chandigarh, and Cosmo Hospital, Mohali. She underwent treatment from February 21 to May 16, 2013, and cleared ₹2,79,146 medical bills from her own pocket. These bills were submitted for medical reimbursement through a legal notice, dated June 19, 2015, with the ESIC in Sector 19, Chandigarh.
The counsel further said that the complainant had visited the ESIC office a number of times, and even contacted the social security officer and ESI Hospital in Mohali for reimbursement of her medical bills, but in vain. Finally, she filed a consumer complaint on December 29, 2016.
While ruling in her favour, the commission ordered that all penalised officials are responsible to compensate the complainant jointly and severally. The payment is to be made within 30 days from the date of receipt of a certified copy of the order, it was stated.
Not a first case
Even last October, in a case of sheer negligence and red-tapism on the part of ESIC, Punjab, a 13-year-old boy died as the corporation delayed advance payment of ₹2 lakh to the PGIMER for his heart surgery by more than one month.
The matter came to light after the deceased boy’s father submitted a complaint with the director, health services, ESI. In his complaint, Ram Kumar, who works at a private firm in Mohali, stated that on September 23, his son Sachin was diagnosed with a health problem at the PGIMER, for which an urgent surgery was recommended.
The very next day, the father reportedly submitted an estimate of ₹2 lakh given by the PGIMER to ESI Hospital, Mohali. His application was forwarded to the director, health services, ESI, on September 28 for approval. However, due to the delay in disbursal, surgery could not take place and the child passed away on October 16. The father finally got a call to collect the letter sanctioning the advance payment on November 11.
