Document Fragment View
Matching Fragments
In reference to your legal Notice dated 11.06.2012, the reply on behalf of Railway Administration is as under:-
(1) That the employee has not submitted his RELHS Card (Medical Card) and other relevant documents required to examine the claim of reimbursement.
(2) That in absence of the required documents medical card etc. the claim of medical reimbursement cannot be entertained appropriately as it is a condition precedent that Medical reimbursement claim can be granted to those retired Railway employees, who are the member of RELH Scheme. It is made clear that the Retired Railway employee who is not a member of RELH Scheme under the provisions of Railway Board Circular No.97/H/28/1 dated 23.10.1997 (PS No.11489/97) is not entitled to obtain Medical reimbursement for their treatment.
(3) That the said Railway Boards Circular provides the membership of RELH Scheme to obtain medical reimbursement of the treatment. In this case, the employee is not a member of this Scheme, hence the claim of medical reimbursement in question cannot be granted to him. It is further mentioned here that the citation of Courts judgment mentioned in Legal Notice is not applicable in the circumstances of the present case. Hence, the applicant filed the present O.A., seeking the following reliefs:
3. Opposing the O.A., the respondents have filed a counter reply. It is, inter alia, stated by the respondents that the applicant has opted to draw Rs.100/- per month as medical allowance, instead of obtaining medical card under RELHS-97. The applicant has been getting fixed monthly medical allowance and, therefore, he is not entitled for medical reimbursement. The employees, who are medical card holders under RELHS-97, can avail of all the medical facilities, like medicine, reimbursement of medical expenditure, etc. As the applicant has not been issued medical card under RELHS-1997, he is not entitled for reimbursement of expenditure incurred by him for medical treatment.
8. The members of RELHS-97, their spouse and family members/dependant beneficiaries are provided with full medical facilities as admissible to serving employees in respect of medical treatment, investigations, diet, and reimbursement of claims for treatment in Government or recognized non-railway hospitals. Those who join the RELHS-97 hold identity cards with photographs of all the beneficiaries. It is the plea of the applicant that as there was no Railway medical facility available to him at his place of residence, he was compelled to opt for fixed medical allowance. This plea is untenable inasmuch as the RELHS-97 does not stipulate that the beneficiaries under the RELHS-97 are entitled to Railway medical facility only. Had the applicant become a member of the RELHS-97, he would have been entitled to full medical facilities as admissible to serving Railway employees in respect of medical treatment, investigations, diet, and reimbursement of claims for treatment not only in Railway hospitals but also in Government or recognized non-railway hospitals. Having willingly opted for being paid monthly medical allowance and further not having become a member of the RELHS after his retirement from Railway service, he cannot be allowed to seek reimbursement of expenditure incurred by him for obtaining medical treatment. The applicant has also not produced before this Tribunal any rule, or instruction issued by the Railways showing that retired Railway employees, like him, who are not members of RELHS-97, are entitled for reimbursement of expenditure incurred by them for obtaining medical treatment from any Government hospital, or private hospital, or hospital approved and recognized by the Railways. The Railway Boards letters dated 18.9.1996 and 8.8.2008, filed by him on 19.5.2014, regarding recognition of private hospitals, and delegation of power to General Manager for reimbursement of medical expenses are of no help to his case. Therefore, I do not find any infirmity in the decision taken by the respondent-Railways in rejecting his claim for reimbursement of expenditure on medical treatment obtained by him.