Central Administrative Tribunal - Delhi
Smt. Pushpa Rani vs Union Of India Through on 8 December, 2008
Central Administrative Tribunal, Principal Bench O.A. No. 662/2008 New Delhi this the 4th day of December, 2008 HONBLE MRS. MEERA CHHIBBER, MEMBER (J) Smt. Pushpa Rani, age 38, W/o Late Jagbir Singh Group C Ex-Electrician of GE (Utility), Electric Supply Delhi Cantt. C/o Rajesh Tehalan, House No.276, Pocket-2, Sector-24, Rohini, Delhi. Applicant By Advocate: Shri E.J. Verghese. Versus 1. Union of India through the Secretary, Ministry of Defence, New Delhi-110001. 2. The DCDA, Area Accounts Office (WC), Tigris Road, Delhi Cantt.-110010. 3. The PCDA (WC), Sector-IX-C, Chandigarh. 4. The GE (Utility), Electric Supply, Delhi Cantt.-110 010. 5. Ms. Simranjit Kaur, DCDA, Area Accounts Office (WC), Tigris Road, Delhi Cantt.-110 010. Respondents By Advocate: ORDER (ORAL)
This OA has been filed by the widow of deceased employee, Late Shri Jagbir Singh, who was working as Electrician with GE (Utility). It is submitted by the applicant that her husband was admitted in Chhabra Nursing Home at Sonepat on 29.3.2006 as he was in coma which is evident from the discharge slip dated 30.3.2006. The same day her husband was admitted in Apollo Hospital. He was treated and was finally discharged on 10.4.2006 (page 22). Apollo Hospital had raised bill amounting to Rs.3,83,093.85 but after giving discount, the bill was reduced to Rs.3,48,487.15 which is evident from page 55 and 20. The employee had submitted the bill for reimbursement. However, only an amount of Rs.1,91,403.00 was sanctioned by the authorities which is evident from page 9. The employee died on 15.3.2007. Thereafter representation was given by the applicant to the authorities claiming the balance amount (page 48) wherein it is stated by her that she was informed by the officers that Apollo Hospital had overcharged. Therefore, she gave a representation to the Apollo Hospital on 7.11.2007 (page 49) whereupon Apollo Hospital issued a certificate stating therein that two surgeries were carried out on the deceased employee (page 50), therefore, applicant once again gave a representation along with the said certificate to the authorities for reimbursement of the full amount (page 51). But since no reply was given by the authorities, she had no other option but to file the present OA.
2. Counsel for the applicant has relied on the judgments of Honble High Court of Delhi in Milap Singh Vs. U.O.I. reported in 2004 (4) SCT 698, B.R. Mehta Vs. U.O.I. and Others reported in 79 (1999) DLT 388 and u reported in 111 (2004) DLT 190.
3. Respondents on the other hand have submitted that the applicant should have produced the CGHS card to the hospital for credit facilities for his treatment and the hospital was supposed to prefer the bill for reimbursement to his department subject to the ceiling of approved rates as per para 11 of Government of India, Ministry of Health and Family Welfare OM dated 7.9.2001. They have further stated that the hospital has not charged as per CGHS rates and the case has been referred to Director, CGHS, Director General of Health Services, New Delhi for their decision regarding the amount admissible. As far as delay in processing the case is concerned, they have explained it is attributable to the applicant for non-compliance of the paras of the OM. They have thus prayed that OA may be dismissed.
4. I have heard both the counsel and perused the pleadings as well. It is not disputed by the respondents that applicants husband was CGHS beneficiary and Apollo Hospital is recognized by the respondents for taking treatment. It is also not disputed that applicant was taken to the hospital in emergency as is evident from the discharge slip of the Chhabra Nursing Home. Applicant was suffering from introcerebral haemorhage and was in coma when he was referred for further treatment to Neurological Specialist as is also mentioned in the discharge slip that the C.T. Scan of Brain shows multiple haemorhagic areas. It is thus clear that applicant had to be admitted in the Apollo Hospital in emergency. However, perusal of Annexure A-1 shows that out of Rs.3,56,022/-, only an amount of Rs.1,91,403/- was sanctioned and reimbursed but no reason is given why the balance money was not given to the applicant. It is also relevant to note that in the counter-affidavit respondents have themselves stated that the Apollo Hospital has not charged as per CGHS rates and the case has been referred to Director, CGHS Director General of Health Services, New Delhi for their decision regarding the amount admissible which means the matter has not yet been finally decided by the respondents.
5. At this juncture it would be relevant to quote from the judgment of the High Court of Delhi in the case of Milap Singh Vs. U.O.I. & Others wherein it was observed as follows:-
14. The undisputed position that emerges is that a patient is entitled to reimbursement of the full amount of medical expenses and not only at the rates specified in the circular of 1996 and in case respondent No.2 has charged a higher rate, than could have been charged, it is for respondent No.1 to settle the matter with respondent No.2. The petitioner cannot be deprived of the reimbursement. The observations in para 26 of Prithvi Nath Chopras case (Supra) are useful in this behalf, which are as under:-
26. It can also not be disputed that the Indraprastha Apollo Hospital has been made available land at token amount and it was for the respondents to have settled the amounts of reimbursement at the hospital. If the respondents have any grievance about the quantification of the amounts charged, it is for the respondents to take up the matter in issue with the Apollo Hospital. But that cannot deprive the petitioner of full reimbursement of the amount as charged by the recognized Indraprastha Apollo Hospital. In fact the petitioner has been compelled to pay the charges first and thereafter reimbursement is taking place while the present policy is stated to be one where the respondents are directly billed by the approved hospitals which policy is salutary since the patient may not at a time have the funds available at first pay the amount and then claim reimbursement.
6. In view of above, if Apollo Hospital is stated to have overcharged the applicants husband, it is for the respondents to take up the matter with the Apollo Hospital. However, since they themselves have stated that the matter is being taken up with the Director, CGHS Director General of Health Services, New Delhi, this matter is disposed off by directing the respondents to consider all the facts and the certificate issued by the Apollo Hospital and then to pass a reasoned and detailed order within a period of three months from the date of receipt of a copy of this order under intimation to the applicant.
7. As far as relief for interest is concerned, it has already been held by the Honble Supreme Court in the case of Om Prakash Gargi Vs. State of Punjab reported in 1996 (11) SCC 399 that the question is whether on account of delay in reimbursing the amount incurred towards medical expenses, the State should be liable to pay also interest on the delayed payment? We are of the view that it is inexpedient and not proper to direct the State to pay interest for delay in payment of the reimbursement amount. It requires verification of the amounts spent by the petitioner and similar person. His right only is to get reimbursement and it does not follow that for the delay in the payment of medical reimbursement, he should also be entitled to interest thereon. After all payment of reimbursement is to be verified, therefore, applicant would not be entitled to any interest.
8. With the above directions, OA is disposed off. No costs.
(Mrs. Meera Chhibber) Member (J) Rakesh