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As far as redressal of grievance is concerned, it is subject to expert opinion from MAIDS to be communicated to Directorate of Health Services: GNCT of Delhi which further would communicate to this office in order to reimburse medical claim of Sh.S.C. Gupta. Same had been submitted Court No. IV before Hon'ble Member during earlier hearings. In view of above submission, kindly dispose of the case."

2.3 Dr. Girish Prabhat from DGHS submitted that the case of the complainant has been sent to MAIDS for their expert opinion and the MAIDS nas stated that the procedure of tooth implantation is neither listed under the DGEHS scheme nor it is essential in nature. Further, the complainant did not explore other alternatives before opting for the said procedure Therefore, the case is not proper as per DGEHS rules and could not be approved.

"Perusal of X-rays reveal that alternative essential procedures i.e. removable partial denture or bridge were SHILPI GUPTA also available for rehabilitation after tooth removal OPD SHILPI GUPTA 2026.01.12 papers and other prescription papers produced on 16:26:15 +05'30' 09.02.2021 do not reveal that the treating doctor had explored the alternative essential procedures. These documents were examined and it appears that implant was not the only essential treatment available for the patient and implant cannot be said to be essential in the instant case. As regards reimbursement of dental treatment, the same has to be examined by the Competent Authority as per rules and it is not under the purview of MAIDS In view of the expert opinion of MAIDS, the treatment taken by the patient was not essential therefore, reimbursement of tooth implantation is not admissible"

The Commission observes that the complainant's grievance regarding reimbursement for the procedure of tooth implantation done at empanelled hospital has been examined in detail by the concerned department i.e. Court No. IV Directorate of Education and Directorate of Health Services (DHS), GNCT of Delhi and the DHS further sent the case of the complainant to MAIDS for their expert opinion. wherein, the Director (MAIDS) opined that OPD papers and other prescription papers do not reveal that the treating doctor had explored the alternative essential procedures Further, it appears that implant was not the only essential treatment available for the patient and implant cannot be said to be essential in the instant case, Therefore, after perusal of the record and stated positions taken by the Directorate of Health Services (DHS), GNCT of Delhi and MAIDS, it does not seem plausible for the respondent department i.e. Directorate of Education, GNCT of Delhi, to reimburse the complainant by going out of the ambit of DGEHS Rules.