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4. Learned Counsel Ms.Kumari M., representing the applicant reiterating the grounds urged in the application submitted that the benefit claimed for carrying out the Cochlear Implant Surgery to the applicant's daughter by Dr.Milind V. Kirtane, a Specialist ENT Surgeon at Cumballa Hill Hospital, Mumbai, was during the course of his employment which comes within the purview of the service benefits. The respondents having sanctioned an advance amount of Rs.2,00,000/- to enable the applicant to meet the expenses towards Cochlear Implant Surgery to his daughter, Ms.K.Suma Bhat, now cannot turn around and deny 5 OA 593/2023/CAT/BANGALORE BENCH the same on flimsy grounds. The age limit of 16 years provided in the OM dated 12.06.2009 (Annexure R1)- Guidelines for Cochlear Implant Surgery, is relaxable in cases of children using hearing aids and getting auditory training from age one years of less, may be considered at higher age also on a cases to case basis. Placing reliance on the medical certificate issued by the Ministry of Health and Family Welfare, Government of India to Ms.K.Suma Bhat, daughter of the applicant, learned counsel submitted that she had the hearing loss in both ears by birth and as such notwithstanding she has completed 16 years of age on the date of Cochlear Implant Surgery i.e., 24.09.2014, the applicant is entitled to claim reimbursement of medical expenses incurred towards said Cochlear Implant Surgery. The Cochlear Implant Surgery was done with the approval of the Income Tax Commissioner, Mysuru. Consultation was done with the specialist Surgeon in July, 2014 and details of the same were communicated to the Commissioner of Income Tax and approval was secured. The Standing Committee has failed to consider the request of the applicant in a right perspective. It is only a misconceived information that no relaxation is permissible 6 OA 593/2023/CAT/BANGALORE BENCH since the patient has completed 16 years of age at the time of Cochlear Implant Surgery. The Committee has come to the conclusion that no recommendation for ex-post facto approval of implant could be made. The laudable object of Assistance to Persons with Disabilities for Purchase/Fitting of Aids and Appliances (ADIP) Scheme has to be achieved. The same cannot be rejected on technicalities. The applicant being retired Government servant is solely dependent on his pension and is entitled for reimbursement of medical expenses actually incurred for the surgery of his daughter. Hence seeks for interference of this Tribunal.

6. Heard the learned Counsel for the parties and perused the material on record.

9 OA 593/2023/CAT/BANGALORE BENCH

7. The claim of the applicant relates to the medical expenses incurred with respect to Cochlear Implant Surgery done to his daughter, Ms.K.Suma Bhat on 24.09.2014 at Cumballa Hill Hospital, Mumbai - a non-Government hospital. It is not in dispute that the date of birth of Ms.K.Suma Bhat, applicant's daughter is 31.03.1998. As on the date of surgery, the age of the applicant's daughter was around 16 years 6 months. Placing reliance on the OM dated 12.06.2009 (Annexure R1), the respondents contend that the age group for reimbursement of medical expenses for Cochlear Implant Surgery was between 1 to 16 years, since the applicant's daughter had crossed the age of 16 years on the date of the Cochlear Implant Surgery, his claim for reimbursement is not valid. Clause-(1)(i)(a) of the guidelines for Cochlear Implant Surgery - Selection criteria for Cochlear Implant, as prescribed in OM dated 12.06.2009 (Annexure R1) reads thus:

"5. Ceiling Rate:
The ceiling rate for cochlear implant shall be Rs.5,35,000/- (Rupees Five Lakh thirty five thousand only) for reimbursement of cost of cochlear implant with 12 11 OA 593/2023/CAT/BANGALORE BENCH channels/24 electrodes with behind the ear speech processor.

The best results are achieved if cochlear implants take place between the age of 1-5 years. Hence, it is, therefore, proposed to permit reimbursement in a graded manner. In the pre-lingual deafness, total reimbursement of the ceiling rate or actual, whichever is less, for cochlear implant will be allowed in respect of implants carried out on children aged between 1 and 5 years. For children between the age of 5 and 10 years, 80% of the ceiling rate for implant will be reimbursed. For children above the age of 10 years, but below 16 years of age, only 50% of the ceiling rate for the implant will be reimbursed."

8. In terms of the said ceiling rate specified for children above the age of 10 years but below 16 years of age, only 50% of the ceiling rate for Cochlear Implant will be reimbursed. The ceiling rate for Cochlear Implant is fixed at Rs.5,35,000/- only.

9. It is not in dispute that an advance of Rs.2,00,000/- has been sanctioned by the respondents to enable the applicant to meet the expenses towards the Cochlear Implant Surgery to his daughter, Ms.K.Suma Bhat. Even assuming that the guidelines prescribed 12 OA 593/2023/CAT/BANGALORE BENCH that Cochlear Implant Surgery should be allowed only in Government Hospitals having proper post-operative rehabilitation and reimbursement to Cochlear Implant Surgery will be permitted only after the request has been approved and recommended by the Standing Committee, could be relaxed as per Clause-1(i)(a) of the guidelines prescribed in OM dated 12.06.2009 and Cochlear Implant Surgery was not available during the relevant period in any Government Hospital with post operative rehabilitation, the ceiling rate prescribed therein comes in the way of the applicant to claim the actual medical expenses incurred towards his daughter's Cochlear Implant Surgery. The same has to be considered in terms of OM dated 12.06.2009. If giving beneficial interpretation to Clause-1(i)(a) in favour of the applicant, considering the amount of advance of Rs.2,00,000/- already granted, the applicant would be entitled to 50% of Rs.5,35,000/- ceiling rate prescribed i.e., Rs.2,67,500/-. After deducting the amount of advance Rs.2,00,000/- sanctioned as per Annexure A3, the applicant is entitled to Rs.67,500/- as against Rs.12,80,750/- claimed.