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Rajinder Mani, Dig (Retd.) vs Union Of India & Ors on 7 October, 2020

Author: Rajiv Sahai Endlaw

Bench: Rajiv Sahai Endlaw, Asha Menon

$~7
*       IN THE HIGH COURT OF DELHI AT NEW DELHI
+       W.P.(C) 7596/2020
        RAJINDER MANI, DIG (RETD.)                   ..... Petitioner
                         Through: Dr. Surender Singh Hooda & Mr.
                                    Aditya Hooda, Advs.
                                 Versus
        UNION OF INDIA & ORS.                        ..... Respondents
                         Through: Ms. Amrita Prakash, Adv.
        CORAM:
        HON'BLE MR. JUSTICE RAJIV SAHAI ENDLAW
        HON'BLE MS. JUSTICE ASHA MENON
                   ORDER

% 07.10.2020

1. The petitioner, a retired Deputy Inspector General (DIG) of Border Security Force (BSF) and a beneficiary of the respondents Central Government Health Scheme (CGHS), has filed this petition (a) impugning the decision taken by the Technical Standing Committee of the respondents CGHS on 18th December, 2019 to, against the bill submitted by the petitioner of Rs.7,81,698/-, reimburse Rs.2,00,090/- only, leaving a deficit of 5,81,608/-; and, (b) seeking mandamus to the respondents CGHS to pay the said amount of Rs. 5,81,608/- to the petitioner.

2. It is the case of the petitioner, that (i) the petitioner, a resident of Gurugram and a cardiac patient undergoing treatment from Paras Hospital at Gurugram, was advised by the said Paras Hospital, Gurugram on 3rd June, 2019 to undergo a Minimal Invasive Cardiovascular Surgery; (ii) the petitioner approached the CGHS dispensary Gurugram, on 27th June, 2019, which referred the petitioner to Cardiothoracic and Vascular Surgeon (CTVS) at any CGHS approved centre; (iii) the petitioner decided to take the opinion from Apollo Hospital, Bangalore, considered best for Minimal W.P.(C) No.7596/2020 Page 1 of 3 Invasive Cardiovascular Surgery; (iv) the petitioner proceeded to Bangalore and on 6th July, 2019, as advised by the Apollo Hospital, Bangalore, got admitted for the surgery and the surgery was conducted on 10th July, 2019 and the petitioner discharged on 16th July, 2019; (v) however the petitioner was again admitted to Apollo Hospital, Bangalore on 17 th July, 2019 but discharged on the same day; and, (vi) owing to paucity of time, the petitioner could not obtain the prior permission of the CGHS authorities and paid the entire bill of Rs.7,81,698/- of the Apollo Hospital, Bangalore and submitted the bill aforesaid, on return to Delhi, to the respondents CGHS.

3. From a reading of the aforesaid, it is evident that it is not as if the petitioner visited the Apollo Hospital, Bangalore in any emergency while otherwise being at Bangalore. The petitioner purposely, on being advised surgery, though a resident of Gurugram, opted to have the same conducted, not at Gurugram or Delhi but at Apollo Hospital, Bangalore.

4. We have enquired from the counsel for the respondents CGHS the basis for computing the amount released to the petitioner of Rs.2,00,090/-.

5. The counsel for the respondents CGHS appearing on advance notice states that she has no instructions in this respect but has received instructions that the petitioner was not found eligible for full reimbursement but found eligible only for partial reimbursement. She is however unable to tell, why.

6. From a reading of the petition, it appears that the Apollo Hospital, Bangalore is not a CGHS empanelled hospital. However, the counsel for the petitioner, on enquiry refers us to the synopsis where it is claimed to be pleaded so and to ground 'D' in the grounds enumerated in the petition.

7. The counsel for the respondents CGHS states that her instructions are that Apollo Hospital, Bangalore is not a CGHS empanelled hospital.

8. Issue notice.

9. Notice is accepted by the counsel for the respondents CGHS.

10. The counter affidavit be filed within six weeks.

11. Rejoinder, if any be filed within further two weeks thereafter.

12. List on 12th January, 2021.

RAJIV SAHAI ENDLAW, J ASHA MENON, J OCTOBER 7, 2020 'gsr'..