National Commission Increases Compensation to ₹50.75 Lakhs for ESIC Delay in Daughter's Treatment

August 16, 2024

Case Summary

Dr. Inder Jit Singh, presiding over the National Consumer Disputes Redressal Commission (NCDRC), stated that the amount of compensation and punitive damages should be determined based on the specific facts and circumstances of each case.

Brief Facts

A nurse from Hyderabad, a member of the Employees’ State Insurance Corporation (ESIC), sought financial assistance from ESIC for her daughter’s blood cancer treatment, which required an expensive Bone Marrow Transplant (BMT) at Tata Memorial Centre. Although the Senior State Medical Commissioner issued a letter of credit, Tata Memorial Centre demanded full payment upfront. Despite numerous requests, the Medical Commissioner of ESIC did not approve the payment in time, causing delays. The complainant, growing desperate as her daughter’s condition deteriorated, approached higher authorities, including the Prime Minister and the National Human Rights Commission. She also filed a petition in the High Court, which ordered ESIC to release the funds. However, ESIC ignored the court’s order, resulting in her daughter undergoing chemotherapy at Apollo Hospital, where she eventually passed away. Subsequently, the complainant filed a contempt case against ESIC for not complying with the court order. The State Commission ruled in her favor, ordering ESIC to pay ₹5,00,000 and ₹10,000 in costs. Dissatisfied with this ruling, the complainant appealed to the National Commission.

Contentions of the Opposite Party

ESIC contended that although the treatment was approved, delays were caused by an investigation into the complainant’s eligibility. Once eligibility was confirmed, the advance payment was sanctioned, but procedural delays and ongoing investigations hindered timely action. Despite their efforts to expedite the process, the complainant’s daughter unfortunately passed away before the funds were disbursed. ESIC also highlighted that substantial amounts had already been spent on her treatment across various hospitals. The organization apologized for the delays, attributing them to the complexities of procedural requirements involving multiple states.

Observations by the National Commission

The National Commission noted that the complainant’s eligibility to receive ₹50.75 lakhs from ESIC, which was ultimately sanctioned and prepared for disbursement, was not contested. The Commission upheld the State Commission’s findings of service deficiency by ESIC and its officials, which warranted compensation for the complainant. However, the ₹5 lakhs awarded by the State Commission was deemed insufficient given the circumstances and the significant mental distress endured by the complainant.

To justify an increase in compensation, the Commission referred to various case laws. In Wg. Cdr. Arifur Rahman Khan and Aleya Sultana vs DLF Southern Homes Pvt. Ltd. & Ors., the Supreme Court defined “compensation” broadly, including actual or expected losses as well as compensation for physical, mental, or emotional suffering. The Consumer Protection Act (CPA) authorizes the Commission to award compensation to address any injustice.

In Charan Singh v. Healing Touch Hospital, the Supreme Court emphasized that Consumer Forums must grant damages that not only compensate the individual but also aim to correct the service provider’s conduct. Additionally, in Suneja Towers (P) Ltd. v. Anita Merchant, the Supreme Court reaffirmed that the quantum of compensation and punitive damages should be based on the specific facts and circumstances of each case. The Court also clarified that awarding compound interest was neither provided for by the statute nor supported by any contractual terms or practices between the parties.

The National Commission granted the appeal and revised the State Commission’s decision. Considering the circumstances and the delay that contributed to the complainant’s daughter’s untimely death, the Commission increased the compensation to ₹50.75 lakhs, which was the original amount sanctioned for the daughter’s treatment.

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