Delhi High Court - Orders
Laj Madan & Anr vs Secretary, Esw & Ors on 7 December, 2022
Author: Prathiba M. Singh
Bench: Prathiba M. Singh
$~17
* IN THE HIGH COURT OF DELHI AT NEW DELHI
+ W.P.(C) 8650/2022
LAJ MADAN & ANR. ..... Petitioner
Through: Ms. Nandini Sharma, Advocate along
with Mr. Vijay Kumar Madan, present
in person.
versus
SECRETARY, ESW & ORS. .....Respondents
Through: Mr. Virender Pratap Singh Charak,
Mr. Pushpender Singh Charak, Ms.
Shubha Prashar, Mr. Dipesh & Mr.
Deepak Mahajan, Advocates for UOI
(M-9891695077)
CORAM:
JUSTICE PRATHIBA M. SINGH
ORDER
% 07.12.2022
1. This hearing has been done through hybrid mode.
2. The Petitioner has been constrained to approach this Court for reimbursement of bills, that were incurred in case of emergency, and are beyond the approved DCHS/CGHS rates.
3. Lt. Sh. Harbans Lal Madan/Petitioner No.2 was working as a Havaldar with the Army and retired in 1965. He was 91 years of age when he passed away in 2021. His wife - Smt. Laj Madan is Petitioner No.1 before this Court and is currently 88 years of age. She was a patient of Arthritis & COPD, and was admitted on 25th May, 2020, in an ECHS empanelled hospital - Fortis Hospital, Faridabad. She was diagnosed with right sided cervicotrochanteric hip fracture. After admission, she unfortunately tested COVID-19 positive and had to be discharged from the hospital and the surgery could not be performed. Since the ECHS empanelled hospitals in Faridabad were not duly Signature Not Verified Digitally Signed By:DEVANSHU JOSHI W.P.(C) 8650/2022 Page 1 of 6 Signing Date:10.12.2022 14:40:46 equipped to provide medical care and surgery to a COVID-19 positive patient with comorbidities, she was admitted to a nearby non-ECHS hospital being Indraprasth Apollo Hospital, Delhi which is stated to be equipped to treat COVID-19 positive patients with comorbidities. She underwent partial hip replacement surgery on 22nd June, 2020 and the total bill generated was to the tune of Rs. 9,57,022/-.
4. Around the same time, Sh. Harbans Lal Madan, who was 90 years of age also tested positive for COVID-19 and was admitted under emergency in the same non-empanelled hospital. He was shifted to ICU soon and was remained in the said hospital till 18th June, 2020. The total bill generated by the hospital was to the tune Rs. 5,30,529/.
5. Mr. Harbans Lal Madan has since passed away and the present writ has been maintained through his son Sh. Vijay Kumar Madan who was also a Lt. Colonel in the Army. Claims were filed with the Respondents for clearing the bills of the hospital for a total sum of Rs. 14,87,551/- (i.e., Rs 5,30,529 + 9,57,022). The said claims were accepted and Claim IDs generated for these two claims. However, as against the said amount, only a sum of Rs. 3,81,724/- was released. Petitioner No.2 i.e., Sh. Harbans Lal Madan, expired on 17th April, 2021 before the reimbursement could be given. Repeated e-mails have also been written by the Petitioners on various dates including 28th January, 2021, 16th April, 2021, 25th May, 2021, etc. However, the Respondents took the position that only the sum already reimbursed is justified and the remaining amount cannot be reimbursed. Hence the present petition has been filed.
6. In this petition, notice was issued and counter affidavit has been filed by the Respondents through Group Captain KS Ganesh working as Station Signature Not Verified Digitally Signed By:DEVANSHU JOSHI W.P.(C) 8650/2022 Page 2 of 6 Signing Date:10.12.2022 14:40:46 Commander at 56 Air Stores Park (ASP), Air Force Station Faridabad. The counter affidavit does not dispute most of the facts stated in the writ petition nor does it challenge the genuineness or authenticity of the documents which have been submitted. The hospital's bills were lodged with the ECHS Poly Clinic, Faridabad through two claims IDs bearing numbers 15556618 and 15523323, dated 21st July, 2020 and 14th July, 2020 respectively.
7. As per the counter affidavit itself, the Bill Processing Agency has confirmed payment of only Rs.3,81,724/- and the MD, ECHS has requested the Petitioners to submit a supplementary claim for projection before the High Powered Committee, which may approve such a claim, considering the unique fact situation involved. This was also demanded of the Petitioners by way of replies to the Petitioners' legal notices, however the Respondents submit that the supplementary bills have not been submitted by the Petitioners. Ld. Counsel for Respondent No.3 has reiterated these submissions today and submitted that the High Powered Committee can still consider the Petitioners' case once the supplementary bills are supplied, as per Letter No. B/49770/AG/ECHS//Policy/2019 dated 8th April, 2019, issued by the Central Organization, MD ECHS.
8. On the other hand, ld. Counsel for the Petitioner submits that all bills have already been provided to the Respondents and copies of the same are also on record, yet the amount has not been reimbursed. She submits that repeated filing of supplementary claims for consideration by the High Powered Committee would not be possible inasmuch as all the documents are now lying with the Respondents.
9. Heard and perused the record. Paragraph 5 of the counter affidavit admits that free medical facilities are available for all veterans and their Signature Not Verified Digitally Signed By:DEVANSHU JOSHI W.P.(C) 8650/2022 Page 3 of 6 Signing Date:10.12.2022 14:40:46 dependents as per ECHS policy. It is also confirmed that the bills in ECHS are processed at CGHS rates and are governed by the rules of the Ministry of Defence and Ministry of Health and Family Welfare. This Court also considers the stand of the Respondent, and the submission of ld. Counsel for the Petitioner that all claims have been duly filed before the Respondent. Notably, the e-mail response by the Respondents to the Petitioner which has been placed on record dated 28th May, 2021, clearly records as under:
"1. At the outset please accept our heartfelt condolences on the sad demise of your father Hav HL Madan. We share the grief on the loss of one of our own among the fraternity and pray for eternal peace to the departed soul.
2. I offer my sincere apologies for the unexplainable delay in responding to your request to review the amounts passed against the claim ids 15523323 & 15556618. As head of the organisation. I take the entire blame for this unexplainable lapse on our part. I shall not attempt to, offer any excuses or alibi as it is our internal systemic fault that missed our attention. My mail dated 17 May was only a sincere effort in all humility at earnestly acknowledging the overdue action at our end and was in no way meant to be hurtful or insensitive towards the request made by you. Please accept my apology if it has conveyed being indifferent.
3. As regards the claims are concerned, following is submitted
(a) Claim Id 15523323. The claimed amount is Rs 5,30,529/- The amount deducted is Rs 3,50,092 and the amount paid is Rs 1,80,437/- The claim is regarding the treatment of a COVID patient in a non empanelled hosp. As per provisions the reimbursement of treatment for COVID is carried out on the basis of our letter B/49773/AG/ECHS/Rates/Policy dt 29 Jul 2020 wherein the COVID package rates as promulgated by Signature Not Verified Digitally Signed By:DEVANSHU JOSHI W.P.(C) 8650/2022 Page 4 of 6 Signing Date:10.12.2022 14:40:46 the respective State Govts are applicable and where the State Govts have not promulgated the rates of Delhi Govt are applicable. These provisions came into effect on 29 Jul 20 whereas the hospital admission was from 04 Jun to 18 Jun 20 and hence the Non NABH/CGHS rates have been applied.
Therefore it has resulted in large deductions. The provisions of the letter dt 29 Jul 20 are being applied for all COVID hosp admissions post the issue of the policy letter. Hence the same has not been made applicable for this claim.
(b) Claim Id 15556618. The claim has been preferred for Hip Fracture with COVID +Ve. The claimed amount is Rs 9,57,022/-, The amount deducted is Rs 7,55,735/ and the amount passed is Rs 2,01,287/-.
The hosp admission was from 28 May to 26 Jun 20.
In this case the CGHS package rates for hip fracture have been applied causing large deductions. The COVID package rates have not been applied as the policy did not exist at that point of time.
4. As per the policy in vogue, the claims have been correctly processed. However, having discussed the case with the validators in Central Org, ECHS, I am of the view that applicability of letter dt 29 Jul 20 may be considered for projecting the case to High Powered Committee under the clause of seeking treatment under specific conditions for isolation of patients to avoid contacting infection as given out vide letter No B/49770/AG/ECHS//Policy/2019 dt 08 Apr 2019. This may result in additional reimbursement to some extent.
5. May I therefore request you to submit a supplementary claim as per Para 4 of letter No B/49770/AG/ECHS//Policy/2019 dt 08 Apr 2019. You may contact us for any guidance or assistance for submission of the supplementary claim.
6. Once again, I apologise for the delay in response"
Signature Not Verified Digitally Signed By:DEVANSHU JOSHI W.P.(C) 8650/2022 Page 5 of 6 Signing Date:10.12.2022 14:40:4610. A perusal of the said e-mail shows that the Respondents are willing to get the case placed before the High Powered Committee under the clause for seeking treatment under special considerations, such as for isolation of patients to avoid infection. Moreover, it has previously been held by both the Supreme Court in Shiva Kant Jha v. Union of India, (2018) 16 SCC 187, and by the ld. Division Bench of this Court in Tanveer Mir Ahmed v. State of NCT Delhi & Ors. [W.P. (C) 5253/2021, decision dated 27th May, 2021], that treatment in a non-empanelled hospital in emergency situations, may be reimbursed to Government employees.
11. Considering this and especially the fact that the Respondents are willing to get the case placed before the High Powered Committee, and as the complete medical bills have been placed on record even in this petition, it is directed that the claims already filed shall be placed as they are before the High Powered Committee without taking a technical objection that a further claim form/supplementary bill has not been filled by the Petitioners. The High Powered Committee shall take a decision within eight weeks on the claims of the Petitioners and a status report shall be placed on record by the next date of hearing, as to the decision of the Committee and its reasons.
12. List on 29th March, 2023.
PRATHIBA M. SINGH, J DECEMBER 7, 2022 Rahul/MS Signature Not Verified Digitally Signed By:DEVANSHU JOSHI W.P.(C) 8650/2022 Page 6 of 6 Signing Date:10.12.2022 14:40:46