AI generated image used for representational purposeNEW DELHI: A district consumer commission in Kerala, in an order dated July 30, held a hospital liable after it failed to issue a separate bill for a life-saving injection, preventing a patient from claiming reimbursement under the Employees' State Insurance (ESI) scheme. Holding that the hospital was responsible for the loss, the commission directed it to pay Rs 53,900, including compensation and litigation costs.How a missing bill for a life-saving injection led to the disputeAccording to the commission's order, complainant O Vinod Kumar suffered a fall at his workplace in January 2017 and was taken to the hospital. During admission, he informed the hospital that he was covered under the ESI scheme and requested to be shifted to an ESI-linked hospital so that he could claim reimbursement for his treatment expenses. He was later referred to an ESI hospital and admitted to another hospital where the ESI facility was available.The complainant said he spent Rs 60,500 on his treatment. While the hospital gave him some medical bills and records, it did not issue a separate bill for an Elaxim 40 mg injection costing Rs 43,900. According to him, the ESI authorities refused to reimburse this amount because the required bill was not produced.The hospital denied the allegations. It said the injection was given as an emergency life-saving treatment and that it had already provided all the necessary bills and treatment records. It also argued that it could not issue a separate bill for the medicine because it was purchased in bulk and that the complaint had been filed nearly one year and eight months after the treatment."The complainant approached the opposite party for the bill for 'Elaxim 40 mg' cost of Rs 43,900. The opposite party did not give the bill saying that individual bill cannot be issued due to the bulk purchase of medicine... Since the opposite party had not given the bill for the said medicine worth Rs 43,900, the complainant had not received the ESI benefits," the court order reads.Why the commission held the hospital responsibleThe bench of President D.B. Binu and members V. Ramachandran and Sreevidhia T.N. said the hospital's explanation that it could not issue an individual bill because the medicine was bought in bulk could not be accepted. It noted that the complainant had repeatedly asked for the bill required to claim reimbursement under the ESI scheme."The statement of the opposite party that individual bills cannot be given since the purchase of the medicine is bulk in nature cannot be accepted," the bench said.The commission observed that the hospital failed to provide the treatment records and the individual bill for the medicine despite repeated requests from the complainant. It said the bill was necessary for processing the ESI claim."Opposite party had not given the treatment records including the individual bills for the medicine. As far as ESI is concerned, where the complainant is having insurance coverage, production of the bill is inevitable," it further added.Holding the hospital responsible for the patient's inability to get reimbursement, the commission partly allowed the complaint and directed it to pay Rs 43,900 towards the amount the complainant could not recover under the ESI scheme, Rs 5,000 as compensation for mental agony and hardship, and Rs 5,000 towards litigation costs. It directed the hospital to comply with the order within 45 days, failing which the amounts awarded towards reimbursement and compensation would carry 9 per cent annual interest until payment."The complainant had not received the insured amount due to the non production of the treatment bill for which the opposite party is responsible," the commission concluded.