Calcutta High Court (Appellete Side)
Apar Nath Singh vs Union Of India & Others on 14 May, 2012
Author: Aniruddha Bose
Bench: Aniruddha Bose
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32 14.05.12 W.P. 20395 (W)_of 2011
ab
Apar Nath Singh
Vs
Union of India & Others.
Mr. Nandadulal Banerjee
... For the Petitioner.
Mr. Subrata Talukdar
... For the D.V.C.
The writ petitioner is an erstwhile employee of the Damodar
Valley Corporation. He superannuated from his service on 31st May,
2011. In this proceeding, his main prayer is for reimbursement of
medical expenditure incurred for treatment of his daughter. She had
undergone Cochlear Implant Surgery which is a surgical treatment for
deafness. This surgery was done in Ramkrishna Mission Seva
Pratishthan, Kolkata on 15th October, 2009, on the basis of reference
made by the hospital of the corporation only.
It appears that the corporation has withheld the
reimbursement relying on a Central Government Guideline, which
restricts reimbursement of cost of such surgery. A copy of this
circular, in the form of office Memorandum No. 6-469/2003-
CGHS/R&H dated 12th June, 2009 has been produced before me by
the learned Counsel for the corporation. The memorandum deals with
the subject entitled "Reimbursement of the cost of Cochlear implant
to beneficiaries under CGHS/Central Services (Medical Attendance)
Rules, 1944". The circular contains certain conditions on satisfaction
of which reimbursement would be permissible. There is restriction on
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age, and surgery performed beyond such age would disqualify or
reduce reimbursement of cost as per the said Guideline. It has also
been provided in the said circular that such implant should have
approval of an expert committee and otherwise should be undertaken
in Government Hospitals/Centres.
Though admittedly, the corporation is not bound by such
guideline as a statutory corporation, submission of Mr. Talukdar,
learned Counsel for the corporation is that his clients follow this
guideline so far as reimbursement of medical expenditure is
concerned.
Since there is no statutory application of the aforesaid
guideline on the employees of the corporation, I am opinion that the
corporation ought to reexamine the claim of the petitioner. Even
though the daughter of the petitioner was not treated in a government
hospital, I find from records that she was treated in Ramkrishna
Mission Seva Pratishthan. This hospital enjoys substantial degree of
credibility and reliability in West Bengal. The corporation's own
hospital had referred the petitioner to this hospital. Since the said
memorandum does not have binding effect on the corporation, I direct
the respondents not to withhold the reimbursement solely on the
ground that the daughter of the petitioner was not treated in a government hospital. So far as the Central Government Guideline is concerned, it appears to me that the main reason for imposing so many restrictions is to prevent wasteful expenditure. The surgery seems to be a complicated one, and its success also seems to depend on the age of the patient and supporting therapies.
In this case, reimbursement can be denied only if the surgery 3 performed on the daughter of the petitioner is found to be wholly irrational. It is not in dispute that this surgery is an accepted mode of treatment for deafness, but its success depends on certain factors.
Considering the circumstances in this case, I direct the respondent corporation to exercise their own discretion in this matter and not be fully bound by the guideline specified for CGHS patients. Decision in this regard may be taken by the corporation upon giving to the petitioner opportunity of hearing within a period of ten weeks from the date of communication of this order. It shall be open for the corporation to constitute a medical board consisting of experts of their own choice. Such Board may assess the condition of the daughter of the petitioner and if it is found that the surgery was not superfluous and there was a reasonable chances of success, then reimbursement should not be withheld.
The writ petition stands disposed of in the above terms. Since this writ petition is being disposed of without calling for any affidavit, the allegations made in the writ petition shall be deemed to have not been admitted.
There shall, however be, no order as to costs.
Urgent photostat certified copy of this order, if applied for, shall be supplied to the learned Counsel for the parties, as expeditiously as possible.
(Aniruddha Bose, J.) 4