Central Administrative Tribunal - Jodhpur
Ramesh Prakash Mathur vs M/O Railways on 31 July, 2018
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CENTRAL ADMINISTRATIVE TRIBUNAL
JODHPUR BENCH
...
Original Application No.290/00517/2016
Reserved on : 26.07.2018
Pronounced on : 31.07.2018
CORAM:
HON'BLE MRS. HINA P.SHAH, MEMBER (J)
Ramesh Prakash Mathur s/o Late Sh. Gopal Prasad, aged
about 68 years, R/o Killi Khana, Killa Ki Ghati, Jodhpur.
Retired from the post of HSK-I under Assistant Material
Manager (Store), North Western Railway, Jodhpur
...Applicant
(By Advocate: Shri S.K.Malik)
Versus
1. Union of India through the General Manager, North
Western Railway, Jaipur.
2. Chief Medical Superintendent, North Western Railway,
Jodhpur
...Respondents
(By Advocate: Shri Vinay Jain)
ORDER
The applicant, in the present OA, is seeking quashing and setting aside of impugned order dated 30.7.2016 as well as dated 5.9.2016 on the ground that the same are illegal. He has also prayed that the respondents be directed 2 to reimburse the medical claim amounting to Rs. 1,93,158/- along with interest @ 12% per annum.
2. Brief facts of the case are as under:-
The applicant retired on superannuation on 30th June, 2009 and he has deposited one month's salary with the respondents for availing medical facilities for self and dependent family members. The applicant was having chest pain and he was admitted to Mathura Das Mathur Hospital, Jodhpur on 16.10.2015. The Doctors advised him to undergo bye-pass surgery. Thereafter, after getting Angiography done on 19.10.2015 at Mathura Das Mathur Hospital, Jodhpur, he went to Ahmedabad for prayer and taking blessing of Sai Dham Temple during Dashera Festival (Navratra). On 21.10.2015, he suddenly got heart pain and was taken to the SAL Hospital, Ahmedabad in emergency when he was admitted in ICU ward and on 23.10.2015 Coronary Artery Bye-Pass Surgery was carried out and he was discharged on 31.10.2015.
Thereafter, the applicant submitted medical claim dated 21.12.2015 amounting to Rs. 1,93,158/- for the expenses incurred on treatment at SAL Hospital, Ahmedabad.3
It is his submission that the respondents vide impugned order dated 30.7.2016 rejected his claim on the ground that emergency has not been established as the applicant got operated in SAL Hospital, Ahmedabad on 23.10.2015. Thereafter, the applicant filed representation dated 31.08.2016 explaining to the respondents that he had gone to visit Sai Dham Temple, Ahmedabad for religious purposes and due to his having serious medical problems, he was taken to nearby hospital, therefore, he could not inform the authorities in such acute condition.
With regard to the emergency, he explained that the physical condition of himself and symptoms indicated his condition to be treated on emergency basis and which can also be clearly seen from the hospital discharge summary. He submitted that there was no question of any fictitious case or pre-planned case, therefore, it is prayed that the respondents be directed to reimburse the medical claim and make payment as per rules.
The said representation of the applicant was rejected by the respondents vide impugned order dated 5.9.2016 on the ground that no emergency was established and, therefore, he is not entitled for any reimbursement of medical claim as per Railway Board letters. 4
3. The respondents rebutted the claim of the applicant on the ground that the applicant was admitted in Mathura Das Mathur Hospital, Jodhpur on 16.10.2015 due to chest pain. He was advised by the Doctors that his blockage has to be cleared and bye pass surgery has to be undergone. It is shocking to note that the applicant undergone Coronary Angiography on 19.10.2015 at the hospital at Jodhpur and immediately thereafter despite advice given by the Doctor for the Bye Pass Surgery, he went to Ahmedabad to enjoy Dashera festival. It is submitted that when the applicant was advised Coronary Bye Pass Surgery, he was not supposed to travel to another city, rather he should have reported to the Divisional Railway Hospital, Jodhpur for Coronary Artery Bye Pass Surgery so that he might have been referred to the recognized referral hospital. Perusal of the factual position reveals that the applicant with malafide intention went to SAL Hospital, Ahmedabad in a planned manner for Coronary Artery Bye Pass Surgery. As no emergent situation emerged, the claim of the applicant for medical reimbursement was rightly dismissed in consonance with the Railway Board Circular dated 31.1.2007. Therefore, the order passed by the respondent 5 department is just and proper and the same is not in violation of Article 14 and 16 of the Constitution of India.
It is further submission of the respondents that the applicant should have placed on record the CAG report and discharge tickets along with indoor papers so that there would be clear picture for the treatment to be undergone at SAL Hospital, Ahmedabad. It was their submission that the distance from Jodhpur to Ahmedabad is about 460 kms and in such pecurious condition of the applicant, it would not have been advisable for the applicant to travel to such a far distance. Therefore, his claim for medical reimbursement is rightly rejected due to malafide intention of the applicant in taking medical treatment at SAL Hospital, Ahmedabad.
4. Heard learned counsel for the parties and perused the material available on record of the respective parties and documents annexed therewith.
5. It is undisputed that the applicant has taken treatment of Bye Pass Surgery at SAL Hospital Ahmedabad. The only issue to be decided pertains to the ground of emergency. The applicant has explained that in such a situation he was required to take immediate treatment at SAL Hospital, Ahmedabad. On going through the sequence of the dates, it 6 is clear that the submission of the applicant pertaining to emergency cannot be accepted. The chronology of treatment taken by the applicant is that on 16.10.2015, he developed a chest pain and was admitted to Mathura Das Mathur Hospital, Jodhpur and on 19.10.2015, he undergone angiography at the said hospital at Jodhpur. The Doctors clearly advised on his discharge that since there is blockage, bye pass surgery is required to be undertaken. It is to be noted here that in spite of such severe condition of his health and the Doctor's advice for Bye Pass Surgery, the applicant travelled to Ahmedabad on 21.10.2015 for prayer and taking blessings at Sai Dham Temple which is completely shocking to note. It is further to be noted that he suddenly got heart pain on 21.10.2015 and was admitted to ICU ward in SAL Hospital in emergency. From the sequence of events, it is clear that it was not a case of emergency as in such situation nobody can imagine to go and enjoy Dashera festival at Ahmedabad, when the applicant was advised for Coronary Artery Bye Pass Surgery and he was not supposed to travel to another city, rather he would have reported to the Divisional Railway Hospital, Jodhpur so that he might have been referred to a recognised hospital for the treatment. As no emergency 7 has emerged in the case of the applicant, therefore, the claim of the applicant for reimbursement of medical expenses has rightly been rejected by the respondents in consonance with the Railway Board Circular dated 31.1.2007.
6. So far as the judgment of Surjit Singh vs. State of Punjab and Others (1996) 2 SCC 336 is concerned, the facts of the said case are different as in that case, the employee was claiming reimbursement of medical expenses incurred by him at the rates prevalent in Escorts Heart Institute whereas the Government was paying him medical reimbursement on the basis of the rates prevalent in the All India Institute of Medical Sciences (AIIMS), New Delhi, being a Government Hospital which is not the case in hand, and therefore, the same cannot be compared.
As far as the case of K.P. Singh Vs. Govt. of NCT of Delhi in OA No.821/2007, decided by C.A.T., Principal Bench, New Delhi on 28.09.2007 is concerned, the facts in the said case was that the reimbursement of the claim has to be done in full, if it falls within the package rates prescribed by the Government and the charges, if any, of more than the package rates, the same was to be borne by 8 the Government servant and the said situation is not in the present case.
In case of Kapileshwar Sahai Vs. UOI & Ors. in OA No.290/00398/2016, decided by our Bench on 04.05.2017, here too, the facts of the case is completely different as the Railway Hospital, Jodhpur did not have the replacement of Knee surgery for which a reference to JRH Hospital, Mumbai was necessary and the knee replacement was indeed required, to alleviate further deterioration of the condition of the patient. Also, the Railway Board letter dated 31.01.2007 recommended treatment in Govt. Hospitals at full admissible amount for reimbursement and which is not the case in hand, and therefore, the said case will not help the applicant.
Also, the case of Sohan Lal Jain Vs. State of Rajasthan & Anr. in S.B. Civil Writ Petition No.8662/2005, decided by Hon'ble Rajasthan High Court, Jaipur, decided on 11.04.2007 is concerned, the said case was a fit case of emergency, and therefore, the Court had rightly directed the respondents to reimburse the entire amount of medical claim to the petitioner.
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7. After going through the history of the present case, it cannot be said that the present case pertains to emergency. An employee cannot have an absolute right to claim reimbursement of any amount which is not covered under the provisions of law, as in the present case the treatment taken in SAL Hospital, Ahmedabad was a pre-planned one and also the same is not in consonance with Railway Board Circular dated 31.01.2017.
8. Therefore, I find no reason to interfere with the decision taken by the respondents vide impugned orders dated 30.7.2016 and 5.9.2016 which are just and proper. Accordingly, the OA being without merit is dismissed with no order as to costs.
(HINA P.SHAH) Judicial Member R/