Central Administrative Tribunal - Madras
Amit Shukla vs M/O Home Affairs on 13 September, 2024
1 of 10 CENTRAL ADMINISTRATIVE TRIBUNAL CHENNAI BENCH OA No. 310/00339 of 2022 DATED FRIDAY, THE 13th DAY OF SEPTEMBER, TWO THOUSAND AND TWENTY FOUR CORAM :
HON'BLE MS. VEENA KOTHAVALE, MEMBER (J) Amit Shukla, aged 37 Years, S/o. Shri Shantilal Shukla, Assistant Director (T/S), HTS, Coimbatore R/o: 7/7, Ramani Shardakrupa Apartment, Shivananda Colony, Tatabad Area, Coimbatore-641012(TN) .....Applicant (Advocate: M/s. K.S. Govinda Prasad ) Versus
1. The Director, Central Hindi Training Institute, Department of Official Language, MHA, 7th Floor, Pt. Deendayal Antyoday Bhavan, CGO Complex, Lodi Road, New Delhi-110003;
2. Dr. Barun Kumar, Ex-Director, Central Hindi Training Institute, Rail Bhavan, 256-A, Raisina Road, Rajpath Area, Central Secretariat, New Delhi-110001;
3. Joint Director (Language), Central Hindi Training Institute, Department of Official Language, MHA, 7th Floor, Pt. Deendayal Antyoday Bhavan, CGO, Complex, Lodi Road, New Delhi-11000;
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4. Mrs. Chitra Krishnan, Dy. Director (South), Hindi Teaching Scheme, Department of Official Language, MHA, E-Wing, C-Block, Besent Nagar, Chennai-600090;
5. Mr. Ram Niwas, Administrative officer, Central Hindi Training Institute, Department of Official Language, MHA, 7th Floor, Pt. Deendayal Antyoday Bhavan, CGO, Complex, Lodi Road, New Delhi-110 00 . ....Respondents (Advocate: Mr. K. Rajendran, Sr. CGSC) 3 of 10 ORAL OR DER (Hon'ble Ms. Veena Kothavale, Member(J) By this Original Application, the applicant is seeking the following relief:-
"a) The leaned Tribunal may kindly summon all records pertaining to applicant's various representations mentioned herein this OA pertaining to his long pending medical reimbursement claim etc. leading to harassment victimization of the applicant and how his medical reimbursement claim has not yet been settled despite being in order, in nutshell entire record held by respondent Nos. 1, 2, 4 & 5;
(b) Direct the respondents to settle the applicant's claim as per existing guidelines regarding settlement of full reimbursement claim by putting it before the appropriate Technical Standing Committee without any delay with a specific deadline to the respondents.
(c) Set aside and quash the impugned order particulars of which are given in para 1 of the OA [ANNEXURE A.1, A.2 and A.3] which have been passed by the respondents without taking into consideration the guidelines of Hon'ble Apex Court, OMs of MoHFW and applicant's request for grant of full reimbursement relaxing the rules.
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(d) Exemplary damages to the applicant for his harassment humiliation and victimization for having requested the respondents repeatedly for settling the claim by quoting the non-compliance of MoHFW OMs, rules and provisions of DoPT, MHA, MOHFW, RTI Act and violations of decision of the Hon'ble Court/Tribunal as enumerated above.
(e) Direct appropriate action against respondents for violating and ignoring the existing guidelines, decisions of the Hon'ble Apex Court and High Courts.
(f) Direct the respondents to pay interest @18% per annum on the final sanctioned amount after the decision of Technical Standing Committee on applicant full reimbursement request.
(f) Cost of litigation may be granted to the applicant appropriately including mental agony and harassment.
(g) Any other direction which the Hon'ble Tribunal may consider just and reasonable to secure the ends of justice. "
2. Briefly stated, relevant facts are as under:-
The applicant claims that he is in Central Govt. Services since 2011. When the applicant was serving as Stenographer Gr. II in RRCAT, Dept. of Atomic Energy, Indore, he was being governed under CHSS (Contributory
5 of 10 Health Services Scheme) and not by CGHS (Central Govt. Health Scheme). Thereafter, on his selection as Assistant Director (T/S) in level 10 in Central Hindi Training Institute, Coimbatore, he joined his duty there on 23.11.2020 (F/N). In Coimbatore, there is no CGHS facility or Wellness Centre and thus the applicant was governed under the CSMA Rules.
3. After joining the services, applicant applied for Paternity and Earned Leave w.e.f. 25.11.2020 to 22.12.2020 and went to Wardha in Maharashtra where applicant's wife was getting treatment for pregnancy. At that time, as global pandemic COVID19 was spreading rapidly, several restrictions were imposed by the Central and State Govt. including night curfew. In the midnight of 19.12.2020, as applicant's wife complained of unbearable pain, the applicant, in such emergency circumstances, somehow managed to take his wife to the nearest private hospital "RR Clinic and Maternity Home, Wardha" at around 03.30 am and after primary investigations and formalities, on the instructions of the doctor, applicant's wife was hospitalized for treatment. The applicant further submits that after completing all the formalities as per Central Services (Medical Attendance) Rules, 1944, applicant submitted his medical reimbursement claim form on 24.12.20 with all supporting documents and self- explanatory note to respondent No.4 with a request that in the light of MoHFW OM No. H.11022/01/2014-MS dated 15.07.2014 (Annexure-A/5), full 6 of 10 reimbursement may be given to him by relaxing the rule in accordance with the said OM, in which the reimbursement procedure under CSMA had been simplified and all the formalities of verification of bills, issuance of essentiality certificate by the treating doctor, etc., had been done away with. The applicant also submitted the essentiality/emergency certificate of the treating doctor with the claim form. However, the respondents did not take any action which prompted him to send several letters and E-Mails requesting the respondents to settle his claims. However, vide impugned order dated 23.08.2021 (Annexure- A3), the respondents sanctioned Rs. 14,187/- without adhering to the request of the applicant for full reimbursement and without putting the matter before the Technical Standing Committee for consideration in compliance with OMs of MoHFW. Further, despite sanction, no amount has been paid to the applicant. Therefore, he has filed the OA seeking the aforesaid relief.
4. After notice, the respondents have entered appearance through their counsel by filing reply stating that the applicant submitted medical bills of his Wife's delivery for Rs.20,381/- and it was received in the 4 th Respondent's office on 29.12.2020. Since the Applicant's Wife was an emergency case and the bill amount exceeded the limit of sanctioning power of Head of Office the 4 th Respondent, it was sent to CHTI, New Delhi, for getting approval of the 1 st Respondent. The amount calculated as Rs.14,187/- including medicine was sent 7 of 10 to the 1st Respondent's office. The said sanctioned amount was wrongly calculated as Rs.14,187/-, but the Central Government Health Scheme rate is Rs.9200/- only and for Covid Test Rs.10/- added. It is further submitted that the bill was prepared as per the admissible rates of CGHS following the instruction given in OM No. F. No. S- 14025/14/2012-M.S dated 11.06.2013 of Ministry of Health and Family Welfare, Government of India, which clearly states that for medical treatment in emergency cases where package rates are prescribed under CGHS, the non-NABH rates of the CGHS covered rates of the nearest CGHS cities, i.e. in case of non-CGHS covered cities, or the actual whichever is less will be applicable. It is further submitted that since the claim was processed within the CGHS Rules and sent to the 1st respondents office. The 4th Respondent has not referred this issue to any technical committee. No such advice was also received from the 1st Respondent's office. Incidentally, in the opinion of the Department, the applicant's case for admitting full claim by relaxation does not satisfy the requirements for such emergency and treatment in private hospitals mentioned in the O.M. No. H11022/01/2014-MS dated 15.07.2014 regarding request for relaxation of procedures through a Technical Standing Committee and, therefore, the applicant is not entitled to the relief claimed by him and prayed for dismissal of the O.A.
5. Heard Learned counsel for the applicant and learned counsel for the 8 of 10 respondents and gone through the pleadings.
6. Learned counsel for the applicant submits that the Respondents have not acted in accordance with the established procedure for settling the medical reimbursement by following the CSMA Rules, MoHFW OMs, guidelines framed by Hon'ble Apex Court in OM Prakash Gargi case, therefore, the respondents have acted arbitrarily with malafid intention to harass the applicant and unnecessarily withholding applicant's medical reimbursement claim without any justification.
7. Learned counsel for the applicant has relied upon the following decisions in support of his contentions:-
i) Decision of the Hon'ble High Court of Delhi in the case of Smt. Jagir Kaur Vs. Union of India & Anr in W.P. (C ) No. 15460/2023 dated 08.07.2024
ii) Decision of the Hon'ble Supreme Court of India in the case of Shiva Kant Jha Vs. UOI dated 13.04.2018.
It is relevant to extract the obsevation of the Hon'ble Supreme Court in the said judgment dated 13.04.2018 as under:-
"13. It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed 9 of 10 and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds. Clearly, in the present case, by taking a very inhuman approach, the officials of the CGHS have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court."
8. In view of the submissions made, it is clear that the respondents have not conisdered the decision of the Hon'ble Apex Court while reimbursing the full medical claim of the applicant. Further, the claim of the applicant has not been referred to the Technical Standing Committee as per the applicable CSMA Rules.
9. It is not in dispute that the applicant got the treatment for his wife in 10 of 10 private hospital under emergency situation due to prevalence of Covid 19 pandamic and he was not in a positon to take her to an empanelled hospital due to severe restrictions in that place. Though he has submitted his claim for medical reimbursement along with all necessary documents and claimed for reimbursement of bill, however, only Rs. 9200/- has been sanctioned on the basis of Central Government Health Scheme Rules. He further claims that despite sanction, no amount has been paid to him.
10. In the light of the facts and circumstances of the case and the judicial pronoucements, communication dated 16.07.2021, 27.07.2021 and 23.08.2021 are hereby quahsed and set aside. The respondents are directed to reimburse the full amount after deducting the amount, if any, already reimbursed, within a period of four months from the date of receipt of a copy of the order.
11. With the above observation, the OA is, accordingly, allowed. No order as to costs.
(Veena Kothavale) Member(J) 13.09.2024 asvs