Central Administrative Tribunal - Chandigarh
Balwan Singh vs M/O Defence on 28 January, 2021
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CENTRAL ADMINISTRATIVE TRIBUNAL
CHANDIGARH BENCH
O.A.N0.060/01027/2019 Order pronounced on: 28.01.2021
(Order reserved on: 18.01.2021)
HON'BLE MS. AJANTA DAYALAN, MEMBER (A)
Balwan Singh, Aged about 36 years, S/o Sh. Hari Singh, Resident of
Quarter No.26/5, Old Power House Colony, MES Hisar Military
Station, Hisar Cantt, Hisar Pin-125006, Group C.
.... Applicant
(BY ADVOCATE: MR. YASHDEEP NAIN)
VERSUS
1. Union of India through Defence Secretary, Ministry of Defence,
Raksha Bhawan, New Delhi, Pin-110001.
2. The Principal Controller of Defence Accounts, South Western
Command (PDCA) (SWC), Khatipura Road, Jaipur, Rajasthan.
Pin-302012.
3. Sr. Accounts Officer, Office of Principal Controller of Defence
Accounts, South Western Command (PCDA), (SWC), Khatipura
Road, Jaipur, Rajasthan, Pin-302012.
4. Garrison Engineer (West) Hisar Military Station, District Hisar,
Haryana, Pin-125006.
Respondents
(BY ADVOCATE: MR. B.B.SHARMA)
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ORDER
HON'BLE MS. AJANTA DAYALAN, MEMBER (A)
1. The applicant has prayed for issuance of direction to the respondents to reimburse the full amount of expenditure incurred by him on emergency treatment of his father instead of only Rs.1,52,100/- already paid to him as per CGHS package rate, with interest @ 18%, litigation costs and compensation.
2. The applicant has stated that his father Hari Singh who is dependent on him, felt severe retrosternal pain along with vomiting and mild sweating. As such, he was rushed to Ravindra Hospital and Heart Centre, Hisar on 19.3.2018, in emergency condition due to non-availability of Government/Civil hospital near his residence. On 21.3.2018, the patient was referred for aortic valve replacement and coronary artery bypass Grafting (AVR+CABG) to Sri Balaji Action Medical Institute where he was admitted in emergency ward and remained under treatment till 3.4.2018.
3. The applicant's claim of Rs.32,209/- for treatment in Ravindra Hospital and Heart Centre and of Rs.4,02,363 for treatment in Sri Balaji Action Medical Institute, Delhi, alongwith requisite documents was forwarded by Respondent No.4 to Respondent No.2 on 23.5.2018 (Annexures A-3 and A-
4).
4. The applicant further submits that out of first bill of Rs.32,209/-, the applicant was paid only a sum of Rs.14,939/- vide order dated 3.10.2018 (Annexure A-1). Similarly, out of 3 second bill of Rs.4,02,363/-, the applicant was paid a sum of Rs.1,52,100/- vide order dated 11.12.2018 (Annexure A-2).
5. The applicant filed RTI application in response to which he was informed vide letter dated 1.3.2019 (Annexure A-11) that claim of Rs.4,02,363/- has been considered as per C.G.H.S. package rates for CABG+Valve replacement. Besides, entitlement of the patient being of general ward 10% deduction on package has also been done. The applicant submitted a representation dated 14.6.2019 (Annexure A-12) for reimbursement of full amount spent by him on treatment of his father in emergency which has not yet been considered by the respondents.
6. The respondents have contested the claim of the applicant. They have stated that as per Government of India, Ministry of Health & Family Welfare O.M. dated 11 th June, 2013 (Annexure R-1), reimbursement of medical expenses incurred by a Central Government employee covered under CS (MA) Rules, 1944, on availing medical treatment for himself and his dependent family members in emergency conditions, is to be allowed as per the prevailing non-NABH CGHS rates as applicable to a CGHS covered city and non-NABH rates applicable to the nearest CGHS covered city in case of non- CGHS city as the case may be or the actual expenditure whichever is less. Hence, Respondent No.2 has passed the bill with slab of Rs.1,52,100/- as per the list (Item at Sr. No. 531 for treatment of CABG + Value Replacement) and Rs.14,939/- for life saving treatment under non-NABH.
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7. The respondents have further submitted that in case an official wishes to avail the full reimbursement, the concurrence / approval of AS & DG (CGHS) is required. For this, one has to apply to the CGHS through proper channel in terms of GOI, MoH&F.W. OM dated 22nd May, 2018 (Annexure R-2). It is further submitted that the applicant was charged rate higher than the CGHS prescribed rate. Being empanelled, the Hospital should have charged the rate as prescribed by CGHS. Therefore, the extra charges need to be reimbursed by the concerned Hospital.
8. The respondents have also stated that though the applicant is aggrieved by the orders but he has not challenged those orders and as such, he cannot be granted any benefit.
9. The department has also stated that the applicant has not exhausted departmental remedies and has made no representation. As such, O.A. is not maintainable under Section 20 of the Administrative Tribunals Act, 1985.
10. On 8.1.2021, the learned counsel for the applicant made a statement at the Bar that he does not wish to file rejoinder and as such, the case was listed for arguments on 18.1.2021.
11. I have heard the learned counsel for both the sides and have perused the material available on record.
12. The learned counsel for the applicant stated that the case of the applicant for full reimbursement of medical expenses spent by him on treatment of his father is liable to be allowed in view of law laid down by Hon'ble Apex Court in 5 the case of SHIV KANT JHA VS. UNION OF INDIA, 2018 (2) SCT 529. In that case, the claim of a retiree for implant of CRT-D Device was allowed at AIIMS rate for treatment taken in a non-empanelled Hospital. The Court found that keeping in view the emergent nature of the case, the competent authority approved reimbursement of implant but at AIIMS rate. It was held that treatment of petitioner therein in non-empanelled hospital was genuine because no option was left with him at the relevant time and as such, respondent State was directed to reimburse the balance amount. On the other hand, the learned counsel for the respondents submitted that the decision of Hon'ble Apex Court is confined to that case only.
13. I find that the facts of the two cases are quite different. Firstly, the device implanted in Shiv Kant Jha's case is CRT-D Device which is not listed in CGHS rates at all. On the other hand, in the present case, the treatment taken of AVR+CABG is prescribed in the list of CGHS and it has a prescribed rate attached to it. Secondly, the treatment taken in Shiv Kant Jha's case was from a non-empanelled Hospital but in the present case the treatment has been taken in an empanelled Hospital. Moreover, in Shiv Kant Jha'a case, there being no CGHS rates prescribed, the bill was settled at AIIMS rates. In the present case, the treatment has a prescribed CGHS rates and the bill has been passed at that rate. Hence, these cases are clearly distinguishable both on facts and on law. Most importantly, the Apex Court itself has clearly held in the case of Shiv Kant Jha's case that "the said decision is confined to this case only". As such, there is no question of 6 drawing parity with the case of Shiv Kant Jha in this or any other case, as per the orders of the Apex Court itself.
14. It is further observed that even though applicant has submitted that he is also aggrieved by impugned orders dated 3.10.2018 (Annexure A-1) and 11.12.2018 (Annexure A-2), but he has not sought quashing thereof in the "Relief Clause"
of the O.A. As such, no relief can be granted to him on this ground alone.
15. Also, I find that the respondents have categorically stated that the applicant has made no representation to the department for the relief sought by him in the O.A. The applicant has not mentioned any representation made by him subsequent to the impugned orders. Further, even though this submission is made by the respondents in their reply, the applicant has not rebutted this and has also not filed any rejoinder. Thus, the plea of not making any representation and thus not exhausting alternative remedies before approaching this Tribunal is not denied by the applicant. Hence, the O.A. is not maintainable on this ground alone.
16. It is also observed that the father of the applicant was rushed to ICU in Ravindra Hospital and Heart Centre, Hisar and an amount of Rs.32,209/- was spent on his treatment there. He was referred for higher treatment to Sri Balaji Action Medical Institute, New Delhi and an amount of Rs.4,02,363/- was spent on his treatment there. But, the claim of the applicant was considered and sanctioned by the authorities at CGHS rates only. I find that as per policy decision dated 11.6.2011 (Annexure R-1), reimbursement of 7 medical expenses incurred by a Central Government employee covered under CS (MA) Rules, 1944 and availing medical treatment for himself and his dependent family members in emergency conditions would be allowed as per the prevailing non-NABH CGHS rates as applicable to a CGHS covered city and non NABH rates applicable to the nearest CGHS covered city, as the case may be, or the actual expenditure whichever is less. This OM supersedes all earlier orders issued from time to time under CS (MA) Rules, 1944. The respondents have also enclosed a list of CGHS Treatment Package rates (Annexure R-1) and at Sr. No. 531, an amount of Rs.1,69,000/- is prescribed for Non-NABH rates and for NABH it is Rs.1,94,350/-. It is clear from this OM of 2011 that for taking treatment in emergent situation, reimbursement at CGHS rates is only permissible. For treatment in CGHS covered cities, it is CGHS rates and for cities not covered by CGHS, it is the CGHS rates of nearest CGHS covered city. In both cases, the reimbursement is to be restricted to the CGHS prescribed rates. These instructions are uniformally applicable to all government servants. No exception can be made for the applicant alone. Such special treatment would itself be against the principle of equity. The respondents have correctly gone by the prescribed rates and passed the claim of the applicant for appropriate amount and no illegality is found in the order.
17. Besides, I also note that major claim is for Sri Balaji Action Medical Institute, New Delhi, which is an empanelled Hospital. As such, it is bound by its agreement with the Government to charge the patients only at CGHS rates. Any 8 extra charge against the agreement, if made by them, needs to be reimbursed by the Hospital itself to the government servant for which the matter has to be taken up by the government servant himself. In fact, the hospital can be considered for black listing for such practice. As such, in the present case also, the applicant has to pursue the matter with the hospital authorities.
18. Further, I find that in case a person wishes to claim full reimbursement, then his case is to be processed in terms of Govt. Of India OM dated 22nd May, 2018 (Annexure R-2) which has admittedly not been done. As the applicant has not fulfilled the basic requisite pre-conditions before making his claim for full medical reimbursement, he cannot be said to be entitled for the same. These orders are policy instructions and are applicable to all universally. Hence, no exception can be made for the applicant alone.
19. The O.A. is dismissed being devoid of merit.
20. No order as to costs.
(AJANTA DAYALAN) MEMBER (A) Place: Chandigarh Dated: 28.01.2021 HC*