Delhi High Court: In the present petition filed under Article 226 and 227 of the Constitution, challenging the impugned order dated 05-07-2023 by the Principal Bench, Central Administrative Tribunal (‘the Tribunal’), and seeking directions to the respondents to reimburse the balance amount against medical bills, the Division Judge Bench of Suresh Kumar Kait and Girish Kathapalia*, JJ., while setting aside the impugned order dated 05-07-2023, directed that the respondents to reimburse to the petitioner the entire remaining amount of Rs. 4,80,879.15 paise with interest thereon at the rate of 4.5% per annum for the period from the due date till payment of the same within a period of four weeks from the date of this order.
Background
In the instant case, the petitioner’s deceased husband was the Central Government employee and retired on 31-03-1989 as Superintendent from Central Public Works Department (‘CPWD’). Being an employee of the Central Government, the deceased was beneficiary of Central Government Health Scheme (CGHS).
On 06-06-2020, the deceased was admitted in the Indraprastha Apollo Hospital in emergency and was diagnosed with Covid19. On 10-06-2020, he had to be shifted to the Intensive Care Unit (‘ICU’) where his health was managed with supplement of oxygen and nebulisation. On 11-06-2020, he was shifted back to the ward, but on 18-06-2020 he had to be again shifted to ICU as his condition deteriorated. On 05-07-2020, his condition further deteriorated so he was electively intubated and was shifted to ventilator. On the morning of 07-07-2020, he passed away in the hospital itself.
The hospital raised bills dated 07-07-2020 for a sum of Rs.10,06,730.15 paise, which was entirely paid by the petitioner from her and other family members’ savings. Later, the petitioner submitted those medical bills for reimbursement, but by way of Sanction Order dated 27-01-2021, the respondent 2 directed only part reimbursement to the tune of Rs.5,25,854/-.
After unsuccessful communication with the respondents, the petitioner preferred the Original Application before the Tribunal.
Before the Tribunal, the respondents filed a counter-affidavit, pleading that claim of the petitioner had to be rejected on the basis of Circular dated 10-07-2020, issued by the Director, CGHS to the hospitals in general qua capping of the expenses to certain fixed rates. The Tribunal by way of the impugned order, dismissed the Original Application of the petitioner, mainly on the ground that if the law laid down in the judicial precedents flowing from this court was applied pertaining to the medical treatment taken from non-empanelled private hospitals, it would create a burden on the exchequer.
Decision and Analysis
The Court after perusal of facts and contentions was of the view that, the directions dated 20-06-2020 was directed towards the hospitals; and there was nothing on record to show that the petitioner was aware of the same. If the respondents suspected that the subject medical bills raised by the Indraprastha Apollo Hospital were inflated ones, nothing prevented them from initiating appropriate legal proceedings against the hospital, instead of depriving the petitioner a full reimbursement. Especially, it not being their case that the petitioner colluded with the hospital to obtain an inflated bill.
The Court then relied to Shiva Kant Jha v. Union of India, (2018) 16 SCC 187 wherein it was held that, “The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by doctors/hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds. Clearly, in the present case, by taking a very inhuman approach, the officials of CGHS have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court.”
The Court then set aside the impugned order and consequently allowed the present petition, thereby directing the respondents to reimburse to the petitioner the entire remaining amount of Rs.4,80,879.15 paise with interest thereon at the rate of 4.5% per annum for the period from the due date till payment of the same within a period of four weeks from date of this order.
[Jagir Kaur v. Union of India, 2024 SCC OnLine Del 4698, decided on 08-07-2024]
*Judgement Authored by: Justice Girish Kathapalia
Advocates who appeared in this case :
For Petitioner: Sanjeev Goyal, Rajesh Gupta, Ritu Gupta, Komal Sharma, Rekha Goswami and Raghni Srivastava, Advocates.
For Respondent: Ritu Reniwal, Senior Panel Counsel; Mahendra Kumawat and Deepa Malik, GP.
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