Denied claim over ‘missing bill’ for life-saving injection, Kerala man wins Rs 53,900

Life-saving injection, no bill and lapsed reimbursement

The man approached Samaritan Heart Institute, Ernakulam, after suffering a fall at his workplace on January 25, 2017. He was referred to a cardiologist and was diagnosed with a serious heart condition. Since he had ESI benefits, he asked to be moved to the ESI facility for reimbursement of medical expenses. He was later transferred to ESI Hospital, Pathalama and then admitted to Aster Medcity, Ernakulam.

He paid Rs 60,500 towards treatment expenses and requested Samaritan Heart Institute to provide complete bills and documents to claim reimbursement from ESI. He alleged that the hospital failed to issue a separate bill for Elaxim 40 mg injection costing Rs 43,900. The hospital told him that the bill could not be issued because it was purchased in bulk. Due to the absence of a bill, ESI did not process his reimbursement claim.

He alleged deficiency in service and unfair trade practice on the part of the hospital and sought Rs 43,900 towards the loss suffered along with Rs 1 lakh compensation.

Hospital’s contentions

The hospital denied the allegations and stated that the complainant was admitted with severe chest pain and was diagnosed with CAD, ACS-STEMI (inferior wall) and right ventricular myocardial infarction. It claimed that he was advised emergency angioplasty, but he, along with his relatives, opted for some other treatment instead, and the hospital administered the injection to save his life.

The hospital contended that the complainant had later chosen to leave and was shifted to an ESI facility; it argued that it was not an ESI panel hospital at that time and had already provided the required treatment bills and documents.

The hospital stated that the bill issued to the complainant was in accordance with the billing formalities of the hospital, and also the hospital provided all the emergency life-saving treatments without receiving payment in advance from the complainant. The complainant or the bystanders neither objected nor challenged the bill issued by them.

The hospital said that there was no deficiency as there was no need for the injection bill to be issued separately and that the complainant was provided with an invoice and bill breakup.

‘Award granted’

The commission directed Samaritan Heart Institute to pay Rs 43,900 to the complainant, being the amount lapsed for him due to the non-issuance of the bill by them, and also ordered them to pay Rs 5,000 as compensation for the mental trauma, agony and hardship suffered by him.

The commission also directed the institute to pay Rs 5,000 as litigation cost, and it is liable to comply with the directions within 45 days from the date of the order, failing which the amount shall carry 9 per cent per annum from the date of the order until the date of full realisation.

Takeaway

The ruling highlights that the institute’s statement that individual bills cannot be given since the purchase of the medicine is bulk in nature cannot be accepted, and is liable for deficiency in service.

For consumer-related grievances, individuals may contact the consumer helpline in their respective states and Union territories (Kerala: 1800-425-1550) or call the National Consumer Helpline at 1915 for assistance. 

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