Central Administrative Tribunal - Ernakulam
A.V.Avaracchan vs Union Of India Represented By The ... on 21 June, 2012
CENTRAL ADMINISTRATIVE TRIBUNAL
ERNAKULAM BENCH
O.A.No.1007/2011
Dated this the 21st day of June 2012
C O R A M :
HON'BLE Mrs.K.NOORJEHAN, ADMINISTRATIVE MEMBER
A.V.Avaracchan, S/o Varghese, Sr.Trackman
(Supernumerary), O/o Sr.Section Engineer,
Southern Railway. Aluva, Trivandrum Division
R/o Areekal House, Peechanikadu, Puliyanam P.O, Angamali.
...Applicant
(By Advocate Mr.Martin G.Thottan)
Vs
1 Union of India represented by the General Manager,
Southern Railway, Park Town, Chennai - 3.
2 The Chief Medical Director, Southern Railway, Chennai - 3.
3 The Chief Medical Superintendent Southern Railway.
Trivandrum Division, Trivandrum-695014
...Respondents
(By Advocate Mr.V.V.Joshi)
This application having been heard on 14th June 2012, the Tribunal
delivered the following :-
O R D E R
HON'BLE Mrs.K.NOORJEHAN, ADMINISTRATIVE MEMBER The applicant is aggrieved by the arbitrary rejection of his medical reimbursement claim on the ground of late submission. 2 Brief facts of the case as stated by the applicant are that he while working as Sr.Trackman under the Sr.Section Engineer, Aluva, felt pain all over his body including chest with sweating. He was immediately admitted by his family members and neighbours to the nearby Little Flower Hospital, at Angamali on 21.4.2010. This fact was intimated to the District Medical Officer on 22.4.2010 by Annx.A1. He underwent several tests and he was diagnosed to be suffering from extensive Aortic Dissection. He was advised for an immediate surgery because of the risky nature of the disease. The nearest hospital where facilities and expertise to conduct such surgery available is Amirtha Institute of Medical Science. On enquiry, the cost of surgery at Amirtha Institute of Medical Science was informed to be around 10 lakhs to 12 lakhs. Therefore the applicant's relatives consulted the Sr.Railway Medical Officer at Ernakulam who advised them to take him to Railway Hospital, Perambur air lifted to Chennai accompanied by a doctor to administer him oxygen as he had breathing difficulty. He was admitted in Perambur Hospital on 28.4.2010. He underwent the surgery there and was discharged on 5.6.2010. It is submitted that he incurred an amount of Rs.63,650/- at Little Flower Hospital for initial treatment, Flight charges for him and the doctor who accompanied him to Chennai Railway Hospital came to Rs..47435/-. Further he averred that he was admitted in an emergency condition at Lakshmi and Little Flower Hospitals on different periods for post surgical treatment and incurred an amount of Rs.10217/-. In May 2011 he reported for duty. It is submitted that immediately after joining duty he submitted medical claim in the prescribed proforma on 6/7.5.2011 which was forwarded vide letters dated 6th and 7th May 2011 to the Sr.Divisional Medical Officer, Ernakulam. To the utter shock and surprise to the applicant his medical claim was rejected by Annx.A7 on the ground of late submission by letter dated 20.7.2011. It is submitted that the rejection of his due claim by the authorities concerned is arbitrary and unconstitutional.
3 The respondents contested the O.A by filing reply. It is admitted that both the claims of the applicant were received by the Sr.Divisional Medical Officer, Ernakulam for reimbursement of medical expenses for treatment availed in two spells. The first spell of treatment was from 21.4.2010 to 28.4.2010. On discharge he was taken to Railway Head Quarters Hospital, Perambur, Chennai by flight on the same day for admission and treatment. He was admitted there on 28.4.2010 and discharged on 5.6.2010, After his discharge a claim for Rs.63650/- incurred at Little Flower Hospital Angamaly was submitted only on 7.5.2011 i.e beyond more than one year after discharge. The second claim for Rs.10270/- was submitted on 6.5.2011 for treatment of the period 12.11.2010 to 13.11.2010 at Little Flower Hospital, Angamaly is within 6 months. It is submitted that regarding the first claim, as per Indian Railway Medical Manual Rule, 652, it should have been preferred within 6 months from the date of discharge. Regarding the second claim, it is submitted as per circular of the Chief Personnel Officer, Southern Railway, Chennai, such claim cannot be entertained because of non-reporting of private hospital admission to the concerned Railway Doctor within 48 hours. These conditions have not been fulfilled by the applicant. They have annexed Annx.R1 and R2 in this regard. According to them, the applicant or his relatives ought to have informed within the prescribed period to the concerned authority regarding the delay in preferring the medical claim, which has not done in this case. They denied the contention of the applicant that his treatment was conducted under the supervision of Sr.Railway Medical Officer. They further submitted that his alleged admission in Little Flower Hospital from 12.11.2010 to 13.11.2010 was not reported to the Railway Doctor. Therefore, such claim cannot be entertained and rejected as per rules.
4 Heard the learned counsel for the parties and perused the record. 5 The undisputed fact is that the applicant underwent an emergency surgery in the Railway Hospital, Chennai. It goes without saying that before a conclusion is arrived to have a surgery in the Railway Hospital, Chennai, diagnosis of the disease is necessary. Only for this purpose as well as the fact that the applicant was taken ill suddenly that he was admitted in Little Flower Hospital, Angamaly, since he is a resident of Angamaly and this hospital was the closest to his residence. Various tests and investigations were done in the hospital from 22nd 28th April, 2010. In the discharge summary at Annex. A-2, it is noted that 64 Slice CT showed extensive aortic dissection, which warrants high risk surgical repair of aortic dissection + AVR. Poor prognosis was explained by the relatives. The recommendation of the Little Flower Hospital was to take treatment in Amrita Institute of Medical Sciences. Since the Institute gave an estimate of Rs. 10 to 12 lakhs for the surgery, the applicant and his family members on the advice of Sr. DMO, Ernakulam decided to avail the treatment in Railway Hospital, Chennai. The applicant was discharged at his request on 28.04.2010 for undergoing treatment at Railway Hospital, Chennai and was air lifted to Chennai on the day of discharge. Therefore, the applicant has a right for reimbursement of his medical claim for the treatment in Little Flower Hospital from 22nd to 28th April, 2010 as it was for treatment in an emergency. Since, Ernakulam has only a Railway dispensary and not a hospital, he could not get admitted for investigation and diagnosis. The claim was rejected as time barred. For post operative review, the applicant had to be admitted once in Lakshmi Hospital and twice in Little Flower Hospital at Angamaly on an emergency basis. The applicant was not moving and talking properly and hence not in a condition to travel to Chennai every time for review. He preferred a bill for Rs. 10,217/- and this was forwarded by the Senior Divisional Medical Officer/ERS on 06.05.2011. The latter has noted that the applicant has availed this emergency treatment under life threatening condition. This bill was preferred within six months of completion of treatment. The applicant has averred that his bill for treatment in Little Flower Hospital, Angamaly for the period from 22nd to 28th April, 2010 was preferred only in May, 2011. This is because he was totally bed ridden during the period and he regained his ability to speak and move only many months after the surgery. In view of his health condition, the respondents have put him in the sick list and he is adjusted against a supernumerary post till date. Since medical claim has to be accompanied by essentiality certificate, other documents, bills, etc., the applicant needed the assistance of his colleagues. Therefore, he is attributing the delay to his helplessness in getting the claim ready by himself. The respondents have pointed out that as per Rule 652 of Indian Railway Medical Manual (Annx. R-1) all claims for reimbursement of medical charges should be preferred within six months from the date of completion of the treatment. However, it is mentioned therein that claims which are not preferred within six months should be subjected to investigation and special sanction can be accorded in relaxation of rules.
6 In my view, such relaxation needs to be extended to the applicant in view of the seriousness of his illness and the long convalescence period he required for recovery. The Railway Hospital, Chennai in their discharge summary has noted that the patient had a prolonged post operative recovery with acute renal valve problem, then the development of pericardial tamponade managed by emergency subxiphoid pericardiastomy, bedsore and high grade fever. Rule 647 of Indian Railway Medical Manual (IRMM for short) permits reimbursement, if medical treatment was availed at the instance of Medical Officer. Annex. A-1 shows that the Sr. DMO/ERS was informed about of the applicant being admitted in Little Flower Hospital in an emergency condition by the Office of the Section Engineer, Railway. According to the applicant, his advice was taken at every juncture. Rule 648 of Indian Railway Medical Manual allows certain relaxation when a treatment is taken in an emergency, fixing certain upper monetary limits for the competent authority for reimbursement for treatment taken in respect of recognized and non-recognized hospitals. Rule 649 of Indian Railway Medical Manual provides for an escort from family to accompany the Railway employee. Rule 4(1) (b) of Central Services, Medical Attendance Rules says that if the patient is too ill to travel the authorised medical attendant shall be entitled for travelling allowance for the journey. In this case, as per the advice of Little Flower Hospital, Angamaly, the applicant was accompanied by his doctor. Hence, applicant is eligible for the bill preferred for the travelling expenses for self and medical attendant in accordance with the Rules.
7 In view of the forgoing, the respondents are directed to admit both the medical and travel claims of the applicant and consider these bills favourably in the light of Rule 648 and 649 of IRMM. A time line of three months is granted for taking necessary action for scruitiny of the medical and travel claims and taking an appropriate decision and issuing an intimation to the applicant. O.A is disposed of with the above direction. No costs.
(Dated 21st June 2012)
(K.NOORJEHAN)
ADMINISTRATIVE MEMBER
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