Central Administrative Tribunal - Chandigarh
Jaswant Rai Malik vs Union Of India Through Chief Health ... on 16 September, 2011
CENTRAL ADMINISTRATIVE TRIBUNAL CHANDIGARH BENCH OA No. 294/HR/2011.
Chandigarh: this 16th day of September, 2011.
HONBLE MRS. SHYAMA DOGRA, MEMBER (J).
HONBLE MRS. PROMILLA ISSAR, MEMBER (A).
Jaswant Rai Malik, Driver A (Retd.) Loco Foreman, NR Loco Shed, Delhi Now r/o Mohalla Dawarkapuri, Gali no. 2 Sarawa, Saharanpur.
..Applicant.
(By: Shri H.S. Saini, Advocate) Versus
1. Union of India through Chief Health Director Ministry of Railway, N.R. Railway, Baroda House, New Delhi.
2. Chief Medical Supdt. Divisional Hospital Ambala Cantt.
3. Medical Supdt. N.R. Railway Saharanpur.
.Respondents.
(By: Shri Yogesh Putney, Advocate) O R D E R (By: Honble Mrs. Promilla Issar, Member (A) The applicant has filed this OA praying for the following reliefs:-
i)The impugned order dated 15.12.2010 (A-1) be quashed being illegal, arbitrary and violative of the order dated 25.11.2010 passed by this Tribunal.
ii)A direction be issued to the respondents to reimburse the medical claim of the applicant for balance amount of Rs. 1,28,032/- as certified/approved by Respondent no. 3 with interest @ Rs. 12% from the date of submission of medical bills till actual payment.
2. The facts of the case as projected by the applicant are that while working as Driver A in Loco Foreman , Loco Shed, Northern Railway, Delhi, he was allowed premature retirement w.e.f. 24.6.1998. He has stated that he gave his consent for deduction of requisite subscription from his DCRG to become a member of the Scheme for availing of medical facilities, called, Retired Employees Liberalized Scheme 1997 (for short RELHS-1997) which was in force at that time. He has further stated that suddenly on 29.2.2004, he suffered a severe heart attack and was first got admitted in Mukat Hospital, Sector 34, Chandigarh from where he was shifted to Batra Hospital and Medical Research Centre, New Delhi where he underwent the treatment of CTVS-CABG as emergency case. He remained admitted in the said Hospital from 3.3.2004 to 21.3.2004 and he spent an amount of Rs. 2, 90, 631/- for the said treatment. After his discharge from the hospital, the applicant submitted the medical bill of Rs. 2,90, 631/- along with his representation dated 12.5.2004. However, the claim of the applicant was rejected by Respondent no. 1 vide order dated May, 2006 by declaring the medical care of the applicant as invalid. Feeling aggrieved, he filed OA no. 16/HR/2008 before this Tribunal which was allowed vide order dated 5.11.2008 and the respondents were directed to process the medical bill of the applicant for reimbursement as per the medical rules and pay the amount to him as found to be due. Pursuant to the said order dated 5.11.2008, the respondent paid the amount of Rs. 1,52,000/- out of the total amount of Rs. 2, 80,031/- vide order dated 13.2.2009. Thereafter, the applicant got served a legal notice dated 27.8.2009 on the respondents to pay the balance amount of Rs. 1,28, 031/- to which he received no reply. Feeling aggrieved, he filed OA No. 1058/HR/2009 before this Tribunal which was disposed of vide order dated 25.11.2010 with a direction to the respondents to reconsider the claim of the applicant in the light of law laid down by a DB of Punjab and Haryana High Court in 2009 (1) SCT 372 and also consider the point of quantification of reimbursement as agreed upon in the contract with the approved Hospital and also the point of discrimination and decide the claim afresh. According to the applicant, Respondent no. 1 has rejected his claim in an illegal manner without complying with the specific directions given by the Court. Hence this OA.
3. The respondents have stated in their reply that this OA has been filed by the applicant challenging the order dated 15.12.2010 passed in pursuance to the directions of this Tribunal in OA no. 1058/HR/2009 decided on 25.11.2010 (A-6) vide which the prayer of the applicant for payment of full reimbursement of medical expenditure has been rejected since an amount of Rs. 1,52,000/-, as admissible package rate in accordance with the policy, has already been paid to him. They have further stated that as per observations of this Tribunal in the said case, the rates agreed between the Railways and the Private Hospitals i.e. package rate, was to be reimbursed to the applicant. Thus, the claim of the applicant has been rejected in view of the quantification of reimbursement agreed upon in the contract with the approved hospitals. They have referred to the judgment of Honble Supreme Court on the issue relating to medical reimbursement on package basis in the case of State of Karnataka Vs. Sri R. Vivekananda Swamy, 2008 (2) SCT 756, in which the Apex Court has held as follows:-
In view of the aforementioned settled principles of law there cannot be any doubt that the Rules regarding reimbursement of medical claim of an employee when he obtains treatment from a hospital of his choice can be made limited. Such a rule furthermore having been framed under proviso to Article 309 of the Constitution of India constitutes conditions of service in terms whereof on the one hand the employee would be granted the facility of medical aid free of cost from the recognized Government hospitals and on the other he, at his option, may get himself treated from other recognized hospitals/institutions subject of course to the conditions that the reimbursement by the State therefore would be limited.
4. They have further stated that the applicant after his pre-mature retirement from New Delhi settled at Saharanpur and he suffered an acute pain on 29.2.2004 and instead of going to Railway Hospital at Saharanpur, he approached Mukut Hospital at Chandigarh on 3.3.2004 on his own whereas there is the PGI at Chandigarh which is equipped with all medical facilities. Moreover, instead of taking treatment at Mukut Hospital, Chandigarh, he went to Batra Hospital, New Delhi which is at a distance of 250 Kms from Chandigarh against the medical advice of the doctors as is evident from the discharge slip dated 3.3.2004. They have further stated that the applicant took treatment without taking advice of the Authorized Medical Attendant nor was he referred to the private hospital by an Authorised Medical Attendant which is a condition precedent. They have also stated that the Govt. of India has prescribed the package rates for treatment at the approved private hospitals, which were upheld by the Honble Punjab and Haryana High court in the case of RCP Karn Vs. Union of India and others, 2003(3) SCT 520, wherein it was held that the petitioner therein is not entitled to reimbursement of the full medical claim and is entitled to reimbursement as per the policy framed by Govt. of India and in vogue at the relevant time as per approved rates. Thus, he is not entitled to the relief claimed by him.
5. The applicant has filed a rejoinder generally reiterating the averments made in the OA.
6. We have heard the learned counsel for the parties and perused the records of the case.
7. It would be relevant to refer to the following judgments on the issue of medical reimbursement in which it was held as follows:-
i)Roshni Devi Vs. State of Haryana and others.
2002(3) RSJ 490.
Medical Reimbursement Request declined mainly on the ground that the deceased got treatment from a hospital which is not recognized by the Government of Haryana Treatment is a matter of confidence between the patient and the doctor - If a patient opts to go to a particular Hospital in order to get the genuine treatment, expenditure on getting such treatment should not be scuttled down on the technical ground that he had got the treatment from a hospital which is not recognized - Held that the Govt. did not act in a rational manner while rejecting the case of the petitioner for medical re-imbursement To reject the genuine claim of medical reimbursement of an ex-employee which is his legal right, will be an act of arbitrariness The impugned order of rejection liable to be set aside - Respondents directed to sanction the medical reimbursement claim of the deceased and to pay the same at the rates of AIIMS New Delhi or PGI Chandigarh, whichever is lower.
ii)Chander Bhan Vs. State of Haryana and others.
2004(4) RSJ 66.
Medical reimbursement Denial of claim Ground that petitioner got himself treated from the institution which is not approved hospital/institute for treatment. Petitioner got heart attack and in emergency, to save his life, admitted in institute which was not recognized - Held that reimbursement wrongly denied Re-imbursement shall be in accordance with the rates charged by AMIIMS/PGIMER.
8. It is also relevant to quote para 2 of instructions dated 4.2.1993 published in Swamys Compilation on Medical Attendance Rules in Emergent Cases which reads as under:-
(2) Settlement of claims.- The medical claims for specialized treatment for heart diseases, kidney transplantation etc., may be settled as per the schedule of rates approved for the treatment of CGHS beneficiaries from time to time at private recognized hospitals under that Scheme or the actual charges, whichever is less, and all other cases may be settled as per the itemwise ceilings prescribed in the Annexure. No reference should be made to this Ministry/Directorate General of Health Services in the matter for further relaxation of the Rules and may be settled by the concerned Ministry/Department.(underline emphasized)
9. From the pleadings, it is evident that after his pre-mature retirement from New Delhi, the applicant settled at Saharanpur. Suddenly on 29.2.2004, he suffered a severe heart attack and was first got admitted in Mukat Hospital, Sector 34, Chandigarh from where he was shifted to Batra Hospital and Medical Research Centre, New Delhi, and there he underwent treatment for CTVS-CABG as an emergency case. He remained admitted in the said Hospital from 3.3.2004 to 21.3.2004 and he spent an amount of Rs. 2, 90, 631/- for the said treatment. The respondents have paid the admissible amount to him as per the provisions of the agreement arrived at between them and the Batra hospital, according to which CGHS rates are to be paid. Therefore, we find that since the respondents have already paid the admissible amount as per CGHS rates, the applicant does not have a valid claim for any higher amount and the action of the respondents in this respect is perfectly legal and valid.
10. Consequently, in the totality of the facts and circumstances of this case, this OA has been found to be devoid of merit and is accordingly dismissed with no order as to costs.
(PROMILLA ISSAR) (SHYAMA DOGRA)
MEMBER (A) MEMBER (J)
Dated: 16.9.2011.
ms
AT/J/12
1
OA No. 294/HR/2011.