Central Administrative Tribunal - Bangalore
Sunder Shettigar vs D/O Post on 20 December, 2022
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OA.No.170/192/2021/CAT/Bangalore Bench
CENTRAL ADMINISTRATIVE TRIBUNAL
BANGALORE BENCH, BENGALURU
ORIGINAL APPLICATION NO.170/00192/2021
DATED THIS THE 20TH DAY OF DECEMBER, 2022
CORAM:
HON'BLE MS. JUSTICE S. SUJATHA, MEMBER (J)
HON'BLE SHRI RAKESH KUMAR GUPTA, MEMBER (A)
Sundar Shettigar,
Aged 75 years,
S/o Late Loku Shettigar,
(Postmaster (HSG-1), Chikkamagalur HO).
Residing at No.153, 1st Block,
Katipalla-575030,
Mangalore (DK District). ..Applicant.
(By Advocate Shri B. Venkateshan)
Vs.
1.The Union of India,
Represented by the Secretary,
Department of Posts,
Dak Bhavan,
New Delhi-110001.
2.The Postmaster General,
South Karnataka Region,
Bangalore -560 001.
3.The Superintendent of Post Offices,
Chikkamagalur Division,
Chikkamagalur -577102. ....Respondents
(By Shri S. Prakash Shetty, Sr. Panel Counsel)
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OA.No.170/192/2021/CAT/Bangalore Bench
O R D E R (ORAL)
PER: RAKESH KUMAR GUPTA, MEMBER (A)
1. The applicant has filed the present Original Application under Section 19 of the Administrative Tribunals Act, 1985 seeking the following relief:
a) To set aside the impugned orders No.E2-4/ROMC/Dlgs., dated 01.12.2020 and 21.1.2021 (Annexure A-7 & A-8), issued by the Supdt.
Of Post Offices, Chikkamagalur, vide which the applicant's claims for reimbursement of Medical expenses have been rejected.
b) To direct the respondents to reimburse the admissible Medical expenses claim.
c) To pass such orders as this Tribunal deems fit and expedient in the facts and circumstances of the case.
2. The facts of the case as pleaded by the applicant in his pleadings, are as follows:
a) The applicant joined service as Postal Assistant w.e.f. 17.9.1965. He retired from service on attaining the age of superannuation on 31.5.2005. After his retirement he settled down with his family at his native place Katipalla, Mangalore, in DK district.
b) The applicant was suffering from "Jaundice. He was admitted to the KMC hospital at Mangalore , as an emergency case on 20-11-2020. On the same day he was tested for Covid-19 as positive. Since there was no Covid ward at KMC hospital, he was shifted to Yenepoya hospital, 3 OA.No.170/192/2021/CAT/Bangalore Bench Kodialbail, Mangalore and was admitted on 21-11-2020. There, on diagnosis, it was found that he was suffering from "Covid-19 Positive with Obstructive Jaundice and Severe Hyponatremia". The estimated Medical Expenses as assessed by the doctors was more than some lakhs. He being a pensioner was unable to meet such huge expenditure. He requested the SPOs Chikkamagaluru, on 24-11-2020 to sanction the medical expenses that are going to be incurred towards his Medical treatment.
c) The details of expenses amounting to Rs 2,62,345.56 incurred by the applicant for treatment in both hospitals were as follows:
i. KMC Hospital Mangalore - Rs. 1,03,875.00
ii. Yenepoya Hospital, Mangalore - Rs.1,58,470.56
Total - Rs. 2,62,345.56
d) The claim of the applicant was rejected by the Supdt. of Post Offices Chikkamagaluru vide letters No F2-4/ROMC/Dlgs, dated 1.12.2020 & 21.1.2021 on the ground that the retired officials are not eligible for reimbursement of Medical expenses as he is paid Rs.1000/- per month as fixed medical allowance.
e) In terms of OMs dated 5.6.1998 & 24.8.1998, at annexures A-2 & A-
3, the Central government has extended the benefits of reimbursement of Medical claims to retired Pensioners and their family members as per CCS (MA) Rules-1944.
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f) This Tribunal in another identical case of Shri M Kamalakshi Nayaka in OA No. 964/2016, decided on 11.10.2018 has held that the applicant is entitled for the reimbursement of Medical claims under CGHS or CSMA rules whichever is higher in respect of inpatient treatment only and settle the case within a period of two months. The respondents in that case, have since implemented the said order.
3. The respondents have filed their written statement wherein they have averred as follows:
a) The applicant retired in the cadre of HSG-I Postmaster at Chikkamagalur HPO on superannuation w.e.f 31.05.2005. After retirement, the CS (MA) Rules are not applicable. The avenues available for availing medical facility for pensioners is enumerated in Ministry of Health and Family welfare OM No. 5.14025/23/2013-
MS.EHSS dt:29.09.2016. The applicant is residing at Katipalla (Mangalore) which is a non-CGHS area.
b) As per OM dated 29.9.2016, pensioners residing in non-CGHS areas, have the following options:
i. They can avail Fixed Medical Allowances (FMA) @ Rs.500/-
per month (Now Rs.1000/- a month).
ii. They can also avail benefits of CGHS (OPD and IPD) by registering themselves in the nearest CGHS city after making the required subscriptions as per CGHS guidelines. 5
OA.No.170/192/2021/CAT/Bangalore Bench iii. They also have the option to avail FMA, for OPD treatment and CGHS for IPD treatments after making the required subscriptions as per CGHS guidelines. (The applicant falls in this category)
c) The OM dated 05.06.1998 quoted in the earlier Tribunal/court orders is not a final order of the nodal ministry which is produced as Annexure A-2 of OA. The V CPC recommended that CS (MA) (Not CGHS) Rules 1944 be extended to pensioners residing in non-CGHS areas.
This recommendation was because CS (MA) rules as such do not apply to pensioners. Taking the recommendation forward, the department of Pension and Pensioners Welfare forwarded a reference to the Department of Health. The OM dt: 05.06.1998 of the health Ministry is only a response to the reference from the MOP&PW. The DOH only opined that it was amenable to the idea of extending the CS (MA) rules to pensioners not residing in non-CGHS areas provided that the responsibility of its administration is owned up by the concerned Ministries/ Departments. The Department of Expenditure had concluded that it was not feasible to extend CS (MA) Rules 1944 to pensioners which is clearly stipulated in Annexure A-2 and Annexure A-3 of OA.
d) As per OM No.14025/23/2013-MS.EHSS dated 29.9.2016, the applicant was eligible to avail FMA for OPD treatment and CGHS for IPD treatments after making the required subscription as per CGHS guidelines. Hence, the claim of the applicant was not considered. 6
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4. Heard learned counsels for the parties and perused the pleadings made by them.
5. The applicant, in this case, is a retired Central Government employee, who after retirement was staying in a non-CGHS area. He did not register himself for CGHS benefits for IPD treatment from CGHS as prescribed in OM No.14025/23/2013-MS.EHSS dated 29.9.2016 of the Ministry of Health. A close perusal of the CS(MA) Rules 1944, clearly indicate that these do not apply for retired Government officials, as given under Note-2 below Rule 2 of these rules.
6. The issue regarding extension of CS (MA) rules to retired Government servants was considered by the Government of India. The V CPC had recommended that CS (MA) rules be extended to pensioners residing in non- CGHS areas. However, after due consideration, this recommendation was not accepted by the Government of India.
7. Keeping the above points in view, the medical claim of the applicant is not covered under the CS (MA) rules and the relief claimed by him for grant of medical reimbursement under these rules is inadmissible.
8. The issue of medical coverage to pensioners has been duly examined by the Government and OM dated 29.9.2016 had been issued, which is as follows:
OFFICE MEMORANDUM Sub-Reimbursement of medical claims to pensioners under CS (MA) Rules, 1944 as directed by various CATs/Courts- Regarding.7
OA.No.170/192/2021/CAT/Bangalore Bench The undersigned is directed to state that various references are being received in Ministry of Health and Family Welfare on the above mentioned subject. It is hereby clarified that CS (MA) Rules, 1944 are not applicable to pensioners till date.
2. It is further informed that the following options to avail medical facilities are available to Central Government pensioners:
a) Pensioners residing in CGHS covered areas:
1. They can get themselves registered in CGHS dispensary after making requisite contribution and can avail both OPD and IPD facilities.
2. Pensioners residing in CGHS areas cannot opt out of CGHS and avail any other medical facility (i.e. Fixed Medical Allowance). Such pensioners, if they do not choose to avail CGHS facility by depositing the required contributions, cannot be granted Fixed Medical allowance in lieu of CGHS.
b) Pensioners residing in non-CGHS areas:
1. They can avail Fixed Medical Allowance (FMA) @ Rs.500/- per month.
2. They can also avail benefits of CGHS (OPD and IPD) by registering themselves in the nearest CGHS city after making the required subscription.
3. They also have the option to avail FMA, for OPD treatment and CGHS for 1PD treatments after making the required subscriptions as per CGHS guidelines.
3. In view of the above, reimbursement of medical claims to pensioners under CS (MA) Rules, 1944 as directed by various CATS/Courts, need not be referred to the Ministry of Health and Family Welfare. The respective Administrative Department/Ministry may take their own decision in this regard.
4. Further, all Departments/Ministries are requested to intimate their employees proceeding for retirement regarding the above options for medical facilities available to the Central Government pensioners.
9. As is apparent from the above OM, the pensioners residing in non-CGHS area, had the option to avail for Fixed Medical Allowance of Rs. 1,000/-, (as in the case of the applicant), and also avail benefits under CGHS for IPD by 8 OA.No.170/192/2021/CAT/Bangalore Bench registering himself in the nearest CGHS city after making the required subscription as per these CGHS guidelines.
10. It is apparent that the option was available to the applicant from September, 2016. He has not chosen to avail the CGHS benefits by registering himself in the nearest CGHS city after making the required subscription. It is possible that being a retired employee since 31.5.2005, he may have been ignorant of this rule position which came into effect from September 2016.
11. However, taking into account the fact that this was a welfare measure for the benefit of retired Government servants, the applicant may be allowed to avail the option of joining CGHS even at this belated stage also w.e.f the date of obtaining the treatment as an IPD, and then submit his medical claim for consideration with the CGHS authority for reimbursement under CGHS guidelines, treating his case to be a case of medical emergency.
12. Annexures A-7 and A-8 dated 01.12.2020 and 21.01.2021 respectively, issued by the Superintendent of Post Offices, Chikkamagaluru are set aside and the matter is restored to the file of the Superintendent of Post Offices, Chikkamagaluru for reconsideration.
13. Respondent No.3 shall examine the possibility of the applicant joining the CGHS by paying the subscription for the past periods during which the claim has been made, subject to re-payment of the amount received under CSMA Rules.
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OA.No.170/192/2021/CAT/Bangalore Bench
14. The OA is disposed of with the above observations. However, there shall be no orders so as to costs.
(RAKESH KUMAR GUPTA) (JUSTICE S. SUJATHA)
MEMBER (A) MEMBER (J)
/vmr/