Railways to Compensate Employee for Rejecting Medical Claim

Railways to Compensate Employee for Rejecting Medical Claim

The Railways has been asked by the apex consumer commission to compensate an employee for rejecting his medical claim on the grounds that it was not an emergency situation when he took his wife to a private hospital.

The National Consumer Disputes Redressal Commission (NCDRC) upheld Punjab state consumer commission’s order which had directed the Railways to pay a compensation of Rs 15,000 besides reimbursing medical claim of Rs 56,477 to Ludhiana resident Swaran Singh whose wife was admitted in a hospital.

“The State Commission has taken a view that continuous fever and vomiting for six days would have been detrimental to the life of the patient who remained in hospital for almost 10 days.

“Therefore, it was a case of emergency and as such, the rejection of reimbursement claim by the opposite party (Railways) was not justified,” the NCDRC bench headed by its presiding member Justice Ajit Bharihoke said.

According to the complaint, Singh, a retired railway employee, was a beneficiary of Liberalized Health Scheme of the Railway under which his wife was also entitled to the benefit.

The complaint said that Singh’s wife was rushed to a private hospital in an emergency medical condition on March 22, 2009 and was admitted there till April 1, 2009.

The Railways had rejected Singh’s claim saying the insured has to avail treatment in a private/recognized hospital and civil hospital only under such emergency that there was no scope for coming to a Railway hospital.

The district forum had dismissed the complaint saying the emergency for taking treatment at a private hospital without previous approval from the concerned authority was not established.

The state commission allowed Singh’s appeal and asked the Railways to reimburse the amount with compensation.

The Railway’s appeal against the state commission’s order was rejected by the NCDRC.