Central Information Commission
A S Raman vs Southern Railway on 15 January, 2025
के ीय सूचना आयोग
Central Information Commission
बाबा गंगनाथ माग, मुिनरका
Baba Gangnath Marg, Munirka
नई िद ी, New Delhi - 110067
File No: CIC/SORLY/C/2023/141061
A S Raman ....िशकायतकता /Complainant
VERSUS
बनाम
CPIO,
Divisional Office, Medical Branch,
Southern Railway,
Thiruvananthapuram - 24 .... ितवादीगण /Respondent
Date of Hearing : 13.01.2025
Date of Decision : 14.01.2025
INFORMATION COMMISSIONER : Vinod Kumar Tiwari
Relevant facts emerging from complaint:
RTI application filed on : 18.08.2023
CPIO replied on : 04.09.2023
First appeal filed on : Not on record
First Appellate Authority's order : Not on record
2nd Appeal/Complaint dated : 10.10.2023
Information sought:
The Complainant filed an RTI application (offline) dated 18.08.2023 seeking the following information:
"I am a RELHS-96 subscriber availing the medical benefits from HR/TCR. My estt. Unit in CE/CN/HS and acc, unit the FA of CAO/CN/NS under the CAO/CN/NS. My statement made by FAECAO/NAS.Page 1 of 7
I submitted the MRC claim of Rs. 193753/- dt 15/4/16 by my RECHS-96 card no. 782/96 (membership of value in 7th CPC in 78000/- and requested to payment in a month's time as allowed by the Supreme Court of India. Only an amount of 143376/- is after 20 months and the balance amount of Rs. 50376/- is still due. The claim is to be settled as per its rule under Rlys.LAW,612. Sub sec.11. retd. Employees vide RELHS/96.
Please clarify
1) The procedure and the rule is violated by you in settling the claim. You have not adopted RE Ltts. Rule stated above.
2) The authority who executed the RELHS/96 is GM/P no. power in vested upon you to deny the bills and to settle the claim as you are mislead upon putting the letters on my rights by violating the Service Books."
The CPIO furnished a reply to the complainant on 04.09.2023 stating as under:
"Your claim for reimbursement of medical expenses for treatment availed at Amala Institute of Medical Sciences, Thrissur was processed during the year 2017. As per enclosed medical records, your case was diagnosed as Moderately Differentiated Adeno Carcinoma GE junction and availed inpatient treatment from 06.02.2016 to 23.02.2016. The total amount claimed was Rs.1,91,203/-. Payment for the admissible amount of Rs.1,43,377/- for reimbursement as per Rly. Board's guidelines and CGHS Rates for Cancer Surgery has already been settled through pay order No.08528/15 dt.11.12.2017.
1&2: As per Indian Railway Medical Manual - 2000 para 612 A Retired Employees Liberalized Health Scheme-1997 (9RELHS-1997) state that Retired Railway employees covered under RELHS-97 will be provided with full medical facilities as admissible to serving employees in respect of medical treatment, investigations, diet, and reimbursement of claims for treatment in Government or recognized non railway hospitals. They will also be eligible inter-alia, for a) ambulance services b) medical passes c) home visits d) medical attendance for first two pregnancies of married daughters at concessional rates and e) treatment of private servants as applicable to serving railway employees.
Claim for reimbursement submitted by Retired/serving employees are processed under as per Railway Board Letter No. 2005/H/6-4/Policy-ll, Dt.31.01.2007 para II (c), treatment taken in a recognized private hospital but for an ailment for which it is not recognized or treatment Page 2 of 7 taken in a non- recognized private hospital reimbursement "should be made at the CGHS rates" of that city or nearest city. CGHS (Central Govt. Health Scheme) approved rates are to be recommended/processed as an upper limit for sanction.
Your RTI application is disposed accordingly."
Feeling aggrieved and dissatisfied, complainant directly approached the Commission with the instant Complaint.
A written submission dated 06.01.2025 filed by the Complainant is taken on record. Contents of the same are reproduced below:
"...I am the victim the railway pensioner retired as EE/ Constriction S. Rly. HQ. Chennai, Egmore from the control of the CAO/CN/S.Rly Egmore, Chennai-3.
I submitted my Medical reimbursement claim dtd 15.04.2016 for my cancer surgery and treatment in the Amala Institute of Medical research center, Trichur. My eligibility for reimbursement in full as per my RELHS/96 the Agreement. Health certificate executed by the GM/P/S.RLY Madras as No. 782/96.
The relevant guidelines to be followed by the GM/P/S RLY/MAS to arrange the reimbursement in full in a period of one month is also submitted along with the application in the prescribed format with the required documents and certified vouchers from the treated doctor as prescribed by Rly Dept. This claim is still not settled and I am put to suffering to meet the medical expenses. I Request for your kind necessary orders to pass to my legitimate claim as per Rly. Rule No. 612 A sub sec.11.
(For the Retired employees Health scheme the RELHS/96/97) Enclosures
1. Covering letter of the MRC claim dtd 15.04.2016 and my RELHS No. 782/96
2. Railway Rule No. 612 A Sub Sec.11
3. Judgment of the Hon'ble Supreme Court in wp (civil)No. 694 of 2015 dtd 13-04-2018 Page 3 of 7
4. OM No. 17/3/202 I- P&PW(Coord)E 7179 Ministry of P/PG and P dept. of P and PW Gov. India dtd 06-08-2021.
5. My complaint petition to the Hon'ble CIC New Delhi as per RTIA/2005
6.Medical reimbursement claim Grievance petition to the CPO/S. Rly NORTHERN RAILWAY NEW DELHI,HQ. BOOKLET KNOW YOUR REETIREMENT BENEFIT Page No. 17 PARA No.6 Medical facilities:- Under" Retired Employees Liberalised Health Scheme, 1988", retired Railway employees are entitled to avail free medical facilities, both indoor and outdoor, for self, spouse and dependent basic pay at the time of retirement."
A written submission dated 09.01.2025 filed by the Respondent is taken on record. Contents of the same are reproduced below:
"With reference to the RTI appeal of Shri A S Raman, Retd. XEN/CN/CLT the following remarks are being submitted.
A claim for reimbursement of medical expenses for treatment availed at Amala Institute of Medical Sciences, Thrissur was processed during the year 2017. As per enclosed medical records, his case was diagnosed as Moderately Differentiated Adeno Carcinoma GE junction and availed inpatient treatment from 06.02.2016 to 23.02.2016. The total amount claimed was Rs.1,91,203/-. Payment for the admissible amount of Rs.1,43,377/- was made on 13.12.2017 for reimbursement as per Rly. Board's guidelines and CGHS Rates for Cancer Surgery.
As per Board Letter No. 2005/H/6-4/Policy-II, Dt.31.01.2007 para - II (c), treatment taken in a recognized private hospital but for an ailment for which it is not recognized or treatment taken in a non- recognized private hospital reimbursement "should be made at the CGHS rates" of that city or nearest city. CGHS (Central Govt. Health Scheme) approved rates are to be recommended/processed as an upper limit for sanction.
Copy of Railway boards' letter No. 2005/H/6-4/Policy-II, Dt.31.01.2007 and CGHS guidelines vide CGHS Office Order Lr.No.F.No.S.11045/36/2012- CGHS(HEC) dt.07.09.2015 are attached for kind reference.
In his case, Surgery charges Rs.25,000/- Anesthesia charges Rs.10,000/- for Grade IV surgery, investigation at CGHS rates, cost of medicines and surgical disposables vide CGHS Office Order Lr.No.F.No.S.11045/36/2012- CGHS(HEC) dt.07.09.2015 were allowed. OT charges Rs.20,000/- for this Page 4 of 7 surgery was disallowed since the duration of surgery was not reflected anywhere in the general bill or inpatient bill. Outpatient bills and other bills without breakup charges were not allowed. It is informed that as per the existing guidelines for reimbursement of medical expenses, no further payment is pending in this case."
Relevant Facts emerged during Hearing:
The following were present:-
Complainant: Present through video-conference. Respondent: Dr. Shobha Jasmine S, Chief Medical Superintendent/PIO present through video-conference.
The Complainant, while reiterating the contents of his RTI application pleaded that his medical reimbursement claim is yet to be completely settled by the Respondent Public Authority despite a lapse of more than eight years. He prayed the Commission to take action against the Respondent for not settling his claim as per the desired norms.
The Respondent stated that a reply intimating the factual status and also containing some clarification has already been provided to the Complainant within stipulated time. Further, since the complainant took his treatment in a Private non-empaneled hospital, therefore, his claims have been settled as per the prescribed CGHS rates following the guidelines, instructions on the subject.
Decision The Commission after adverting to the facts and circumstances of the case and perusal of the records, noted this is a complaint filed under Section 18 of the RTI Act before the Commission, where no further direction for disclosure of information can be given in the light of the judgement decision of the Hon'ble Supreme Court in the case of Chief Information Commissioner and another Vs. State of Manipur & Another reported in MANU/SC/1484/2011 : AIR 2012 SC
864.
The role of CIC is restricted only to ascertain if the information has been denied with a mala-fide intention or due to an unreasonable cause. Upon Page 5 of 7 perusal of the facts on record and submissions of the Respondent during hearing, the Commission finds that an appropriate reply has been given by the Respondent earlier vide letter dated 04.09.2023 now vide letter dated 09.01.2025 in the form of updated reply which is taken on record, a copy of which may be shared with the Complainant if not already done. No mala-fide is established on part of the CPIO in this case. Here, it is relevant to quote a judgment of the Hon'ble Delhi High Court in the matter of Registrar of Companies & Ors v. Dharmendra Kumar Garg & Anr. [W.P.(C) 11271/2009] dated 01.06.2012 wherein it was held:
" 61. It can happen that the PIO may genuinely and bonafidely entertain the belief and hold the view that the information sought by the querist cannot be provided for one or the other reasons. Merely because the CIC eventually finds that the view taken by the PIO was not correct, it cannot automatically lead to issuance of a show cause notice under Section 20 of the RTI Act and the imposition of penalty. The legislature has cautiously provided that only in cases of malafides or unreasonable conduct, i.e., where the PIO, without reasonable cause refuses to receive the application, or provide the information, or knowingly gives incorrect, incomplete or misleading information or destroys the information, that the personal penalty on the PIO can be imposed...."
In view of the above, intervention of the Commission is not required in the matter.
Further, the Complainant is advised to approach appropriate forum for redressal of his grievance.
The Complaint is dismissed accordingly.
Vinod Kumar Tiwari (िवनोद कुमार ितवारी) Information Commissioner (सूचना आयु ) Authenticated true copy (अिभ मािणत स ािपत ित) (S. Anantharaman) Dy. Registrar 011- 26181927 Date Page 6 of 7 Copy To:
The FAA, Divisional Office, Medical Branch, Southern Railway, Thiruvananthapuram - 24 Page 7 of 7 Recomendation(s) to PA under section 25(5) of the RTI Act, 2005:-
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