Punjab State Commission Holds Food Corporation Of India Liable For Delaying The Disbursement Of Medical Scheme Amount To Its Retired Employee

Brief Facts:

Mr Kuldip Kumar (“Complainant”), a retired government employee of the Food Corporation of India (“FCI”), was entitled to avail medical facilities for himself and his spouse under the Medical Health Scheme of the FCI. This scheme underwent several modifications over the years, with changes in reimbursement limits and conditions. The Complainant obtained a medical identity card, and following the scheme, he submitted medical certificates from specialized doctors for himself and his wife. The FCI, through circulars and approvals from the Ministry of Consumer Affairs, modified the scheme to simplify reimbursement procedures. In May 2020, the Complainant submitted the required certificates to the FCI, Jalandhar. The FCI, however, issued a circular in December 2016 superseding the existing Medical Scheme for Retired employees, creating confusion regarding the applicable scheme for departmental workers.

The Complainant submitted claims for medical expenses in June 2021, and while one claim was processed and credited, another claim remained uncertain and unprocessed. The FCI allegedly failed to comply with the issued instructions and court directives, leading to a deficiency in service. Feeling aggrieved, the Complainant filed a consumer complaint in the District Consumer Disputes Redressal Commission, Jalandhar, Punjab (“District Commission”). The District Commission dismissed the appeal after perusing the evidence placed by both parties. As a result, the Complainant filed an appeal in the State Consumer Disputes Redressal Commission, Punjab (“State Commission”).

The FCI contended that every claim of the Complainant had already been settled and thus, the complaint lacks merit and must be dismissed.

Observations by the Commission:

The key consideration for the State Commission was whether the FCI delayed the payment of the medical bills/claims. The Complainant asserted that, as per circular instructions, the claim should have been processed within 4 days. Whereas, the FCI argued that the claim was processed within 30 days, as stipulated in the circular dated 30.12.2016. The State Commission examined the relevant clauses of the circulars and noted that the Complainant’s claim was for outpatient treatment (OPD), not requiring scrutiny by a Medical Officer. The Complainant provided certificates validating the need for OPD treatment for chronic diseases, and the State Commission found no requirement to refer the claim to a Medical Officer.

The State Commission further referred to a circular dated 02.06.2017, setting time limits for clearing bills. It concluded that the FCI admitted to delaying the reimbursement by 26 days. Therefore, the State Commission held that there was a deficiency in service, and the Complainant was entitled to reasonable compensation and litigation charges.

As a result, the appeal was partly allowed, and the District Commission's order was set aside. The Complainant was awarded a composite amount of compensation and litigation expenses, totalling Rs.10,000/-. The FCI was directed to comply with the order within 45 days.

Case Title: Kuldip Kumar vs Food Corporation of India through the Divisional Manager and Anr.

Case No.: First Appeal No. 48 of 2023

Advocate for the Complainant/Appellant: Complainant-in-person

Advocate for the Respondent: Ms Ruchi Sekhri

Click Here To Read/Download The Order