Central Administrative Tribunal - Madras
Mrs Geetha Kumar vs Posts on 21 June, 2023
i OA No. 3/2023 CENTRAL ADMINISTRATIVE TRIBUNAL CHENNAI BENCH O.A No.3/2023 Dated Nedneedatne 2 day of June Two Thousand Twenty Three CORAM & HON'BLE MS. LATA BASWARAJ PATNE, Member (J) Mrs. Geetha Kumar, W/o. (Late Kirthy Kumar, 3B-4, Gokulam PH-II, DABC Apartments, Nolarmbur, Mogappair (W), Chenn-ai - 600 095. we Applicant By Advocate: M/s. R. Malaichamy Ys.
1. Union of India, rep. by the Additional Deputy Directory General (HQ) Directorate General, Central Govt.Health Scheme (CGHS-IID, Nirman Bhavan, New Delhi - 110 108.
2. The Additional Director, Central Govt.Health Scheme (CGHS), No.9, Bikanur House Hutments, Shahjahan Road, New Delhi -- 110 011.
3. The Additional Director, Central Govt.Health Scheme (CGHS), South Zone, Sector - VIII, R.K.Puram, New Delhi = 110 022, 4, The Additional Director, Central Govt.Health Scheme (CGHS}, Rajaji Bhavan, Chennai * 600 090.
By Advecate: Mr. Su. Srinivasan SCGSC OANo. 3/2023 Respondents 3 OA No. 3/2023 (Pronounced by Hon'ble Ms, Lata Baswaraj Patne, Member (J) The Applicant has filed this Original Application under Section 19 of the Administrative Tribunals Act, 1985 seeking for the following reliefs:
i. To call for the records of the 4" Respondent pertaining ta his order made In SIIT/CGHS/C/CP No.7/2019/2022-23/746 dated 22.06.2022 in so far as denying to pay interest on the medical reimbursement claim amount paid to the Applicant and set aside the same; consequent to ii, direct the Respondents te pay interest for the sanctioned amount of Rs.9,60,561/- to the Applicant at the rate applicable to GPF amount, and.
2. The brief facts of the case in nut shell are as under:-
2.1 The Applicant states that her husband Shri. Kirthy Kumar, was working in the Department of Telecommunications, Sanchar Bhavan, New Delhi-110 001 and retired from service on superannuation on 31.08.2010 as Deputy Director General, 2.2 The Applicant's husband was a CGHS beneficiary. While in service, issued CGHS card bearing No. 3437774 to him and Applicant also having the same CGHS Card bearing No.3437789 in the year 2010 valid upto life time.
Thereafter, her husband fell ill and was diagnosed with 'CVA-Lacunar Infarct in Left Carpus Calfosum' at Billroth Hospitals and suffered repeated strokes which Impacted his right side limp and was diagnosed with 'CNS Vasculitis Subcortical Demntia Upon'.
2.3 The Applicant spent multiple expenses relating to aforementioned iliness and in spite of best treatment given to her husband by the Medical Officers, he died on 18.04.2012, 2.4 The Applicant incurred an expenditure of Rs.19,04,020.67 at various stages at various hospitals. Thereafter, with great difficulties, she has obtained all the necessary documents, i.e., bills, reports, emergency 4 OANo., 3/2023 certificates, discharge summary etc., and submitted the same to the 4% Respondent vide her representation dated 24.05.2012.. On receipt of claim application and medical bills, the 4" Respondent recommended the case of applicant for medical reimbursement to the 1* Respondent vide his letter dated 25.05.2012.
2.5 Thereafter, the 1* Respondent directed the 4 Respondent to furnish some documents to process the case of the Applicant vide letter dated 11.06.2012. The 1* Respondent also informed the 4" Respondent that the treatment taken prior to 29.02.2012 would be reimbursed at New Delhi and the treatment taken from 13.09.2012 would be reimbursed at Chennal vide letter dated 19.09.2012. Thereafter, the 4" Respondent reimbursed an amount of Rs.45,852/- out of a claim amount of Rs.84,366.76 for the period from 29.02.2012, 2.6 She has received a letter dated 18.06.2013 of the 1% Respondent addressed to the 4" Respondent In which It has been mentioned that the Applicant's "claims are to be forwarded to the concerned zone where the patient was attached so that they could be appropriately processed" for the rest of the amount.
2.7 She was of the hope that she would get the medical réimbursement at the earliest, but the issue has been dragged for many years without any justification. Therefore, lastly she made a representation dated 06.06.2018 and requested the Respondents to reimburse the medical claim of Rs.18,19,653.91 (Rs.19,04,020.67 - 84,366.76) with Interest.
2.8 Since, no reply to her claim, she has filed OA No.863 of 2018 before this Hon'ble Tribunal and it was disposed of by an Order dated 06.07.2018 with certaln directions. Further, the Respondents did not comply with the 5 OANo. 3/2023 Order of this Hon'ble Tribunal made in 0.A.No.863 of 2018, the Applicant has constrained to file C.P.No.7 of 2019, 2.9 After Covid-19 period, the 4" Respondent has _ sanctioned Rs.8,44,653/- dated 10.06.2022 and Rs.1,16,908/- dated 31:05,2022 and credited to the account of the Applicant.
2.10 Though the Applicant submitted all relevant documents in the year 2012 itself claiming relmbursement claim for Rs.18,73,679.60 but the Respondents again and again asked the Applicant to submit some documents and delayed the matter.
4.11 Thereafter, as directed by this Hon'ble THbunal, the authority has sanctioned Rs.1,16,908/- dated 31.05.2022 and Rs.8,44,653/- dated 10.06.2022 against her claims for Rs.18,73,679.60. The said CP was also closed by an Order dated 20.06.2022 with liberty to act In accordance with law, if so advised.
2.42 The Applicant requested the Respondents to pay interest on the amount paid because of delay in settlement of the claim amount though it was Rs.9,00,561/- out of Rs.18,73,679.60 vide her representation dated 16.06.2022, 2.13 The Applicant has submitted a representation dated 16.06.2022 after receipt of the letter dated 15.06.2022 of the 4" Respondent and requested the 4" Respondent to provide a detailed break up explanation as to how the said amount was computed for consideration of sanctioning and also requested to pay the interest amount for the relmbursement amount to her.
2.14 On receipt of the said letter dated and email of the Applicant, the 4"
Respondent has replied that as per the existing CGHS Rules and Guidelines, there is no provision to pay interest on medical reimbursement claims.6 OA No. 3/2023
Being aggrieved, the Applicant has constrained to file this Original Application before this Hon'ble Tribunal for seeking certain directions.
3. After notice, the Respondents have appeared through their Counsel and filed the detailed reply and opposed the relief claim by the Applicant on the grounds that the claim papers of the applicant was forwarded to Delhi HQ for reimbursement by 4 respondent and the same was misplaced /lost while shifting the CGHS HQ from Bikaner House, Delhi to RK Puram as informed by the first respondent office. Hence the 4" respondent, the Additional Director CGHS Chennal-vide letter dated 14/03/2019, letter dated 07.08.2019, letter dated 21.08.2019 requested the applicant to submit all the documents in duplicate for processing the claim. In response the applicant submitted few documents which were not sufficient for processing the claim. Hence the applicant was informed the same vide letter dated 28.02.2020.
3.1, In the meantime, the 4" respondent requested Apollo Hospital Chennai for duplicate copies of the documents related to applicant's husband. After receiving duplicate copies of the claim at additional director office Chennai, the same is processed and admissible amount Is arrived at Rs.844653/- which is more than sanctioning power of the Additional Director. Hence it was forwarded to Directorate of CGHS vide letter dated 17.02.2020. It Is submitted that the counsel for the applicant submitted that no other documents. are available and the applicant will be satisfied if an order regarding medical reimbursement is passed on the basis of the available documents.
2.2 As the documents submitted by the Advocate of the applicant was incomplete, Directorate letter dated nil informed 4" respondent to request duplicate medical bills from the hospitals where the applicant's husband had got his treatment done, and then examine the case accordingly. As per the 7 OANo. 3/2023 Directorate instructions, 4 respondent requested Billroth Hospital, NIMHANS, Velammal Hospital, for duplicate copies of the documents related to applicant's husband. The NIMHANS hospital responded telephonically and expressed their inability to provide the duplicate bills. The Velammal Hospital Informed 4th respondent that they are unable to reproduce the duplicate bills.
3.3 In view of the above 4° respondent sought necessary special permission of the competent authority so as to clear the pending bills. The incomplete bills of Blilroth hospital, NIMHANS hospital, Velammal Hospital.
a) The bills of Apollo hospital amounting Rs.8.44,653/-as the admissible amount is more than the sanctioning power of the 4" respondent.
3.4 The matter has been examined in the Directorate and with the approval of the competent authority, Directorate informed 4th respondent vide letter dated 20.04.2022 to take further action as under:
i. Admisstble amount as calculated in case of Apollo hospital's bills may be paid.
ii. Admissible amount in respect of other hospitals may be calculated as per CGHS rates and paid.
3.5 Then 4" respondent informed the applicant to submit the required documents for the payment of the claims. As there is no response from the applicant, 4th respondent requested the same from the advocate of the applicant vide letter dated 11.05.2022. After receiving required documents from the advocate of the applicant payment was done and this was informed to the advocate of the applicant vide letter dated 15.06.2022.
3.6. The claim papers of the applicant were forwarded to Delhi: HQ for reimbursement by 4" respondent. Unfortunately, the claim papers of the applicant was misplaced/lost while shifting the CGHS HQ from Bikaner House, Delhi to RK Puram. The 4th respondent is. unaware of this and not 8 OA No.-3/2023 received any correspondence from the applicant in between from 19.06.2013 to 05.06.2018. Later the applicant approached the Hon'ble Tribunal at Chennai. The Hon'ble Tribunal, in. its order dated 06.07.2018, directed the respondents to consider the applicant's representation and pass a detailed reasoned and speaking order in accordance with law within a period of two months from the date of receipt of the order. The respondents requested the applicant to submit all the documents in duplicate for processing the claim. In response the applicant submitted few documents which were not sufficient for processing the claim. Then 4" respondent tried to get the same from the hospitals where the applicant's husband taken treatment, but the hospitals expressed their inability to provide them. Then the respondents sought special permission from the competent authority to process the incomplete bilis.
3.7 The Respondents sincerely tried everything in their hands to settle the claims of the applicant as per the existing rules and guidelines. The delay in settling the applicant's claims is due to unforeseen circumstances and the applicant's inability to submit duplicate copies of the complete bills. As per the existing rules and guidelines of CGHS, there is no provision to pay Interest on medical reimbursement claims. Hence, prayed for dismissal of OA.
4, The Learned Counsel for the Applicant relied upon the following judgments:-
i Order dated 08.08.2012 in R.S.A No.3524 of 2012 passed by the Hon'ble High Court of Punjab-Haryana High Court at Chandigarh in the matter of State of Hryana and Ors vs. Ranbir Singh i, Order dated 13.02.2020 in CWP No.27498 of 2018 passed by the Hon'ble High Court of Punjab-Haryana High Court at Chandigarh in the matter of Bishamber Lal Gaba vs. State of Haryana and Ors, 9 OA No. 3/2023 5 The Learned Counsel for the Respondent relied upon the following judgments rendered:-
i Order dated 07.10.1996 in passed by the Hon'ble Supreme Court of India in the matter of OM Prakash Gargi vs. State of Punjab & Ors.
ii, Order dated 03.09.2013 in WMP No.i19390 of 2013 passed by the Hon'ble Supreme Court of India in the matter of Jagdish Kumar vs. Pepsu Road Transport Corporation iit. Order dated 19.08.2014 in LPA No.i124 of 2014 passed by the Hon'ble High Court of Punjab and Haryana at Chandigarh in the matter of Om Parkash vs. State of Haryana and Ors.
6. Heard learned counsel MrR.Malaichamy for the applicant and Mr.Su.Srinivasan, SCGSC for the respondents the sides and perused the relevant records.
7. It is to be noted that admittedly there is an undue delay in processing the file of medical relmbursement on the part of the Respondents and the Respondents have not reimbursed the full amount.
8. tis to be noted that in the judgments of the Hon'ble High Court of Panjab and Haryana at Chandigarh in No. R.S.A No.3524 of 2012 (O&M) dated 08.08.2012 in the matter of State of Haryana and Ors vs. Ranbir Singh, while dealing with the similar issues observed thus:-
"as regards the judgment delivered by the Apex Court in Om Parkash Gargi vs. State of Punjab and others, (1996) 14 SCC 399 their Lordships did not lay down the abstract and absolute rule that no payment could be made for the delayed payment, but it only observed that some time could be spent on verification of amounts spent by the petitioner, as such the petitioner was not entitled to receive payment on interest for the said period. That period at the most, could be treated as three months. It is extremely a hardship for a person to wait for months and years to receive amount of expenses incurred by him for his treatment and he is forced to enter into long correspondence, making representations, time and again making rounds of the office for seeking his right, therefore, certainly after a reasonable period of three months which the office could spend for completion of formalities, it would be just and expedient to direct payment of interest on the amount. In the similar circumstances, the Division Bench of this Court in case Waryam Singh vs. State of Punjab 10 OA No. 3/2023 1996 (2) S.C.T. 495 awarded interest @ 15% per annum from the date of expiry of three * months.
In the instant case, the appellate court has not awarded interest @ 15% per annum, but in all its reasonability, it only awarded interest @ 12% per annum on the delayed payment, after deducting the period of three months, which appears to be quite reasonable".
9, It is to be noted that, while dealing into the same Issue, the judgment of the Hon'ble High Court of Panjab and Haryana in the matter of Bishamber Lal Gaba vs. State of Haryana and Ors held thus:
"(6) Reliance is placed on the judgment rendered by this Court in the case of State of Haryana and others v. Ranbir Singh, MANU/PH/2379/2012 : 2013 (3) SLR 200, to contend that in such a case, the Court should consider it appropriate to pay the interest on the sanctioned amount of medical reimbursement at the rate of 12% per annum on The delayed payment.
(7) In view of the above, the present writ petition is disposed of with a direction to respondent Nos. 1 and 2 to pay interest 6% per annum on the delayed payment from the date it fell due till it was finally pad, The said interest be calculated and paid to the petitioner within two months from the date of receipt of certified copy of this order. In case, the same is not paid within two months, the same shall be paid thereafter along-with interest @ 12% from the expiry of said two months".
10. On the other hand, the Learned Counsel for Respondent has relied upon the Order dated 07.10.1996 in passed by the Hon'ble Supreme Court of India in the matter of OM Prakash Gargi vs. State of Punjab & Ors.
"admittedly, the petitioner had claimed reimbursement of medical expenses spent in private hospital for heart disease, Ultimately, the amount came to be disbursed on August 28, 1991 but there was delay in Payment thereof. The petitioner filed the writ petition. The High Court in LPA directed payment of the amount but disallowed interest at 12% as claimed by the petitioner. He filed a review petition and the same came to be dismissed. Thus, this special leave petition".
It is contended by the learned counsel for the petitioner that in several cases, the Division Bench had directed payment of interest, but in this case, they have departed from the above principle. When a special leave petition was filed by the State, this Court had dismissed the same in limine. Therefore, the petitioner is entitled to the payment of interest.
We. do not find any force in the contention. It is true that but for the benefit of reimbursement of the amount granted by the li OANo. 3/2023 Government, the petitioner has no right to claim reimbursement. The question is: Whether on account of delay in reimbursing the amount incurred towards medical expenses, the State should be liable to pay also Interest on the delayed payment? We are of the view that it ts inexpedient and not proper to direct the State to pay interest for delay in payment of the reimbursement amount. it requires verlfication of the amounts spent by the petitioner and similar person. His right only is to get reimbursement and it does not follow that for the delay in the payment of medical reimbursement, he should also be entitled to interest thereon. The order passed by this Court on an earlier occasion was to the effect of dismissing the special leave. petition In limine. Therefore it does not furnish any for following the same. Under these circumstances, we do not think that it would be proper to direct payment of interest on the delayed reimbursement of the medical expenses Incurred by a Government servant"
The Learned Counsel for Respondent placed rellance upon Order dated 03.09.2013 in WMP No.19390 of 2013 passed by the Hon'ble Supreme Court of India in the matter of Jagdish Kumar vs, Pepsu Road Transport Corporation "However, interest will not carry on medical bills if found payable in view of the decision of the Supreme Court In OM Parkash Gargi vs. State of Punjab, (1996) 11 SCC 399", The Learned Counsel for Respondent also placed reliance upon Order dated 19.08,2014 in LPA No.1124 of 2014 passed by the Hon'ble High Court of Punjab and Haryana at Chandigarh in the matter of Om Parkash vs. State of Haryana and Ors, "In the present appeal, the appellant is insisting on payment of interest on some delayed payment of medical re-imbursement as well as awarding of cost upon the respondents. The learned Single Judge has declined both these prayers, while relying upon a decision of the Hon'ble Supreme Court in the case of Gm Parkash Garg! vs. State of Punjab, (1996) 11 SCC 399, We are of the considered opinion that in the facts and circumstances of the case, the learned Single Judge has rightly declined the payment of interest on the delayed payment of medical reimbursement as well as awarding of costs upon the respondents. In our opinion, the learned Single Judge has passed appropriate directions, granting relief to the appellant, to consider his claim in accordance with Jaw. Thus, we do not find any illegality in the order passed by the Learned Single Judge".
The Learned Counsel for Respondent also placed rellance upon Order dated 30.08.2019 in OA No.365 of 2019 passed by the Hon'ble Central Administrative Tribunal, New Delhi in the matter of S.P. Singh vs. UOI & Ors.
"4, On the other hand, learned counsel for the respondents submitted that in the earlier two OAs filed by the applicant, he has not sought the rellef of Interest on the amount of medical reimbursement claim and as such, the Instant OA Is barred by principal or walver and acquiescence. Counsel further submitted that after the decision of this Tribunal dated 5.4.2018 passed in OX 1931/2015, the respondents after taking appropriate steps in 12 OA No, 3/2023 the matter have made the payment to the applicant vide cheque dated 27.7.2018, which fact has. not been disputed by the applicant. As such there is no delay in processing the payment. The claim of the applicant was forwarded to CGHS and CDA (Army) Meerut promptly and payment was made by them as per policy/guidelines.
4.1 Counsel for the respondents further submitted that applicant request for payment of interest on reimbursement amount of medical expenses cannot be acceded to as there is no provision in the relevant rules for such payment. Moreover, he placed rellance on the decision of the Apex Court in the case of Om Prakash Gari vs. State of Punjab & others, reported in (1996) 11 SCC 399, wherein in para 4 the Apex Court held that it is inexpedient and not proper to direct the State to pay interest for delay in payment of the reimbursement amount.
5. Thereafter in rebuttal, counsel for the applicant submitted that the Hon'ble High Court of Punjabi and Haryana in Ranbir Singh (supra) also considered the aforesaid judgment of the Apex Court in the case of Om Prakash Gari (supra) and observed as under:~ "As regards the judgment delivered by the Apex Court in Om Parkash Gargi vs. State of Punjab and others, (1996) 11 SCC 399 their Lordships did not lay down the abstract and absolute rule that no payment could be made for the delayed payment, but it only observed that some time could be spent on verification of amounts spent by the petitioner, as such the petitioner was not entitled to receive payment on interest for the said period. That period at the most, could be treated as three months, It is extremely a hardship for a person to wait for months and years to receive amount of expenses incurred by him for his treatment and he is forced to enter into long correspondence, making representations, time and again making rounds of the office for seeking his right, therefore, certainly after a reasonable period of three months which the office could spend for completion of formalities, it would be just and expedient to direct payment of interest on the amount. In the similar circumstances, the Division Bench of this Court in case Waryam Singh vs. State of Punjab 1996 (2) S.C.T. 495 awarded interest @ 15% per annum from the date of expiry of three months.
In the instant case, the appellate court has not awarded interest @ 15% per annum, but in all its reasonability, It only awarded interest @ 12% per annum on the delayed payment, after deducting the period of three months, which appears to be quite reasonable.
6. Having heard learned counsel for the partles and perusing the pleadings available on record, It is observed that this is not a simple case in which there has been a delay in payment of medical reimbursement claim due to inaction of the respondents. The applicant has already stated as noted in para 2 above that In compliance of Order of this Tribunal dated 11.7.2014, the respondents on the basis of Technical Standing Committee report restricted the payment to the tune of Rs.1,74,538/- vide orders dated 20.11.2014 and 6.2.2015. When the applicant felt eo SA
11. 13 OA No. 3/2023 aggrieved by partial reimbursement, he preferred OA 1931/2015 and the said OA was decided by this Tribunal vide Order dated 5,.4.2018 In which the direction was given to the respondents to re-examine the case of the applicant and carry out necessary verifications etc. before making the final payment to the applicant within a period of two months from the date of receipt of certified copy of the sald Order. Hence, subsequent to that Order, the respondents have passed an order placed at Annexure A-2. (Colly) by which full reimbursement of the medical claim of the applicant has been passed. Hence, the claim of the applicant seeking payment of interest from 20.11.2014 ie, the date on which he firstly submitted his medical is without merit, as the respondents have passed final orders In compliance of the aforesaid decision of this Tribunal of 05.04.2018 and issued a cheque dated 27.07.2018. Hence, we do not find any delay at all after the adjudication' of the claim of the applicant and, therefore, there Is no merit to grant any Interest as asked for by the applicant of this OA.
7. Inthe result, and, for the foregoing reasons, the Instant OA is accordingly dismissed being devold of merit. There shal! be no order as to. costs."
On bare reading of above orders, it is seen that the facts and ratlo of these orders are not applicable to the present case.
12, Order dated 22.06.2022, Is hereby quashed and set aside and the Respondents are directed to pay the Interest for the sanctioned amount of Rs.9,60,561/- at the rate of 6% with effect from 06.06.2018 till 31.05.2022 In view of the above, I am of the considered view that the impugned within three months from the date of receipt of a copy of this Order, L3.
Accordingly, OA Is-allowed in terms of the above. No order as to costs.