Central Administrative Tribunal - Ernakulam
Ravunny N.B vs Union Of India Represented By The ... on 13 December, 2011
CENTRAL ADMINISTRATIVE TRIBUNAL
ERNAKULAM BENCH
O.A. NO.455 OF 2011
Tuesday, this the 13th day of December, 2011
CORAM:
HON'BLE Mr.JUSTICE P.R.RAMAN, JUDICIAL MEMBER
Ravunny N.B
Retired Office Superintendent / II
Office of the Deputy Chief Engineer / Construction / Ernakulam South
Residing at Njattum Parambil (Karthika) House
Cheerakada Temple Road, Aluva - 683 101
Ernakulam District ... Applicant
(By Advocate Mr.TCG Swamy )
versus
1. Union of India represented by the General Manager
Southern Railway Headquarters Office, Park Town PO
Chennai - 600 003
2. The Chief Medical Director
Southern Railway
IV Floor, Moore market Complex
Park Town PO, Chennai - 600 003
3. The Chief Medical Superintendent
Divisional Office, Medical Branch
Southern Railway, Trivandrum Division
Trivandrum - 695 014
4. The Senior Divisional Personnel Officer
Southern Railway, Trivandrum Division
Trivandrum - 695 014 ... Respondents
(By Advocate Mr. Thomas Mathew Nellimoottil )
The application having been heard on 13.12.2011, the Tribunal
on the same day delivered the following:
O R D E R
HON'BLE Mr.JUSTICE P.R.RAMAN, JUDICIAL MEMBER The applicant is a retired Railway employee. He is covered under Retired Employees Liberalised Health Scheme, 1997, hereafter referred to RELHS - 1997. According to the applicant, the retired employees and their dependents, who were members of the Scheme are entitled to the same medical treatment and facilities as are applicable to serving Railway employees. The applicant on 29.10.2007 when he had been at Bangalore for attending a marriage developed severe chest pain which necessitated immediate hospitalization and the applicant was admitted to Sagar Apollo Hospital, the nearest hospital from where he could receive emergent medical treatment. He was admitted in the Cardiac Intensive Care Unit and immediate treatment was started. The Coronary Angiography report revealed IHD, DV CAD, Unstable Angina and he was advised Coronary Arterial Bypass Graft (CABG) and he underwent the bypass on 03.11.2007 and was discharged on 09.11.2007 after his condition became stable. The discharge summery is produced as Annexure A-2 dated 09.11.2007 issued by the Sagar Apollo Hospital, Bangalore. An amount of ` 3,39,474.50 was incurred by him towards medical treatment underwent by him in the Sagar Apollo Hospital. In terms of para 648 of the Indian Railway Medical Manual Vol. I, according to him, he is entitled to the refund of medical expenses incurred on an emergency. He made a representation dated 11.12.2008 to the 3rd respondent claiming reimbursement of medical expenses incurred by him. All the necessary bills and other records were also enclosed along with the representation, Annexure A-3 is the covering letter dated 11.12.2008. The Senior Divisional Medical Officer, Southern Railway, Ernaklulam forwarded the same to the 3rd respondent by a letter bearing No.49/ERS/08 dated 16.12.2008, a copy of which is produced as Annexure A-4. The Senior Medical Officer, Southern Railway, Ernakulam who forwarded the reimbursement claim certified that the medical records related to the admission and treatment was enclosed therewith for perusal. After going through the file, it is certified that the admission and treatment was made under acute emergency and the case is found to be genuine and recommended for considering reimbursement. It was further certified that the employee is availing regular follow up treatment from the Railway Hospital. Annexure A-4 is dated 16.12.2008. Despite forwarding of the medical reimbursement claim as certified by the Senior Medical Officer, no action was taken on the part of respondents to reimburse the amount incurred by him towards medical expenses. The applicant thereafter made several representations and even met the 3rd respondent and handed over a representation in person. Annexures A-5 and A-6 are such representations made by the applicant. The applicant submits that in similarly situated cases, this Tribunal had allowed the claim and produced the order in OA 564/06 as Annexure A-7. According to him, he is entitled for the entire amount of ` 3,39474.50 as indicated in Annexure A-3. The non feasance on the part of respondents causes substantial prejudice and irreparable injury and loss to the applicant.
2. It is contended that the Railway employees retired and who is covered by the Scheme is entitled for entire reimbursement of the medical expenses incurred by him, when he had undergone an emergency treatment in the nearest hospital.
3. In the reply statement filed by the Chief Medical Superintendent, Southern Railway, Trivandrum, it is stated that the applicant has made his reimbursement claim only on 05.01.2011 and he has been registered in the Office of the Chief Medical Superintendent, Trivandrum as per letter No.P/09/11. The claims upto 2008 has been processed and forwarded for sanction. As per instructions received from Hqrs, cases of medical reimbursement can be processed only after allotment of funds for the current financial year. Therefore, the applicant's claim will be processed as per his registration seniority. It is also stated that the applicant was informed as per reimbursement rules, he should have gone to the private hospital through references of Railway Medical Authority and in case of dire emergency, information has to be given to the Railway Medical Authority within 48 hours. It is also stated that the application will be processed in turn.
4. The statement that the application for reimbursement claim was made only on 05.01.2011 is belied , as per Annexure A-4 forwarding letter to the Railway Medical Authority before whom the applicant had made the claim. Annexure A-4 itself is dated 16.12.2008. While filing the reply statement, the concerned officer has not verified the statement produced along with the OA and the statement that the applicant's claim was made on 05.01.2011 as already pointed out is wrong. Though it is contended that the applicant has to inform the Railway within a period of two days after admission to the hospital as per rules, no rules as such is produced or shown. At any rate, the fact that the applicant has undergone surgery on emergent situation is admitted by the Medical Superintendent in Annexure A-4 and the claim is genuine. If so, the authority should have processed the application without loss of time. The very fact that the applicant's claim was made on 0-5.01.2011 is based on misconception and the same is made as early as in the year 2008. Therefore, the respondents is directed to consider the claim of the applicant as having registered in 2008 and process the same immediately and allow the reimbursement to the extent, as allowable by law. This shall be done within a period of two months from today.
5. Since the respondents has not gone to verify the annexures produced along with the application before stating that the applicant has made the claim only in May, 2011 and unnecessarily the applicant has been dragged to this Tribunal for the medical reimbursement when the case is genuine. The respondents shall pay an amount of ` 2000/- to the applicant by way of cost.
6. OA is disposed of as above.
Dated, the 13th December, 2011.
JUSTICE P.R.RAMAN JUDICIAL MEMBER vs