Claimants are required to establish emergency treatment necessity to qualify for full medical reimbursement beyond prescribed rates as per established policies.

ORDER :

1. Petitioners assail order, dated 23.02.2024, passed by the Central Administrative Tribunal, Hyderabad Bench (for short “the Tribunal”), in O.A.No.020/0884/2021, by which, they were directed to reimburse balance medical claim to a tune of Rs.1,69,300/- to the respondent herein, incurred for his medical treatment.

2. Petitioners herein are respondents and respondent is claimant before the Tribunal. For the sake of convenience, they are referred to as “respondents” and “claimant” as arrayed before the Tribunal.

3. Claimant retired from service from the post of Senior Commercial Clerk/NLR, South Central Railway, Vijayawada Division, on attaining age of superannuation on 30.09.2011. On 06.02.2020, he fell down and sustained injury. Therefore, he was admitted to Apollo Specialty Hospital at Nellore. His condition was evaluated and diagnosed as “D-10-D11 0YL WITH LISTHESIS L2-L5 SPONYLOLISHESIS LUMBAR CANAL STENOSIS ANKULOSED SPAINE IN KYPHO SCOLIOSIS.” Later, he had undergone surgical procedure on 11.02.2020 and was discharged from the hospital on 15.02.2020. Claimant has incurred an amount of Rs.1,90,000/- towards the medical treatment, which he claimed for reimbursement by application, dated 30.09.2020. As against the same, he was allowed reimbursement only for an amount of Rs.20,700/- by proceedings, dated 18.11.2021. Aggrieved by the same, he preferred O.A. No.020/0884/2021 before the Tribunal.

4. Respondents filed counter-affidavit inter alia stating that the treatment availed by the claimant is due to injury caused on account of fall which is not an emergency treatment, rather routine treatment, for which claimant in terms of Railway Board letter No.2005/H/6-4/Policy-II, dated 31.01.2007, is entitled to undergo in any Government Hospitals/Railway Hospitals/affiliated and recognized or empanelled private hospitals, which he did not choose and rather got treatment done at non-empanelled private hospital, for which, he is entitled to be reimbursed as per the CGHS package rates provided therein. The respondents have processed the claim made by him in terms of aforesaid Railway Board circular letter, as per which, for the treatment undergone i.e., “Lumbar Laminectomy” surgical procedure, the prescribed rate of Rs.20,700/- has been allowed as per his entitlement and, therefore, prayed to dismiss the O.A.

5. The Tribunal, having considered aforesaid submissions, by placing reliance on the judgment of the Hon’ble Apex Court in Shiva Kant Jha v. Union of India , (2018) 16 SCC 187 , later followed by Delhi High Court in Union of India v. Joginder Singh , 2023 SCC OnLine Del 2707 : (2023) 3 LLJ 404allowed the claim for balance medical reimbursement at Rs.1,69,000/- and directed the respondents to pay the same to the claimant within a period of six weeks from the date of receipt of the order. Assailing the same, present writ petition is filed.

6. Heard Sri C.V.R. Rudra Prasad, learned Central Government Counsel, appearing for the writ petitioners and Sri Edukondalu Chandu, learned counsel for the respondent/claimant.

7. Learned counsel for the writ petitioners submits that the claim of the claimant for medical reimbursement is regulated by policy, in particular, the joint procedure order for medical reimbursement cases and instructions, dated 31.01.2007, issuedby Railway Board, which inter alia provided for specific procedure and also stipulated the package rates, hence, any claim made contrary to the same cannot be entertained. Ela