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2004 Supreme(Del) 492

High Court Of Delhi
MILAP SINGH - Appellant
Versus
UNION OF INDIA - Respondent
CIV.WRIT PETITION 4415 of 2002
Decided On : 07/13/2004

Advocates Appeared:
Amrit Kaur, R.K.SAINI, Saroj Bidawat,

Headnote:Medical Claim - Refusal to reimburse medical expenses — Denial on the ground that higher rates were charged by the hospital — It was for the respondents to settler the matter inter se regarding rates charged — Prior decisions of the Court covering dispute in question — Writ petition allowed with cost of Rs. 20,000/- for not following the judgment of the Court-Constitution of India 1950, Article 14.

( 2 ) WITH the consent of learned counsel for the parties, the petition is taken up for final disposal at this stage.

( 3 ) THIS is one more case of a retired Government servant who has been refused reimbursement of the full medical expenses incurred by him despite numerous judgments on this issue. The respondents chose to act in complete violation of the principles of law laid down by various judgments negating the Central Government Health Scheme (hereinafter to be referred to as, `the CGHS ), which was propounded as a health facility scheme for the Central Government employees so that they are not left without medical care after retirement. It was in furtherance of the object of a welfare State, which must provide for such medical care that the scheme was brought in force, but the repeated cases which have come to the Court show every effort of the respondents to dilute the effect of the said Scheme. The respondents continue in their conduct, which is contemptuous in character, by continuing to deny such claims despite clear law enunciated on this point.

( 4 ) NOW coming to the facts of the present case. The petitioner retired as a Government servant on 31. 12. 1980 as an Assistant Controller Stationery from the Ministry of Works and Housing and was getting a monthly pension of Rs. 7,018/ -. The petitioner is a member of the CGHS and is 79 years old. On 02. 02. 2001 while going for his morning walk, the petitioner felt pain in his chest and started perspiring. The petitioner was rushed back to home and members of the family of the petitioner requested for immediate help from the Escorts Heard Institute and Research Centre (hereinafter to be referred to as, `the said Hospital ) where the petitioner was shifted and it took five days to stabilize the condition of the petitioner. The petitioner was finally operated upon on 07. 02. 2001 for Coronary Artery By-pass Grafting (heart by-pass surgery ). The petitioner was discharged from the said Hospital on 17. 02. 2001 and the total medical bill paid by the petitioner was for Rs. 2,45,000/ -.

( 5 ) THE petitioner on 10. 04. 2001 requested the CGHS authorities, respondent No. 1, for reimbursement of the amount spent on the surgery, but was reimbursed only a sum of Rs. 1,40,000/- on 12. 06. 2001. Despite follow up of the matter, the balance amount has not been paid to the petitioner.

( 6 ) THE only defence taken in the counter affidavit is that though the said Hospital, respondent No. 2 is recognized under CGHS vide Office Memorandum dated 18. 09. 1996. The hospitals recognised under CGHS are liable to charge only rates prescribed under the said Office Memorandum. The amount can be reimbursed only to the extent of the package deal as per the Office Memorandum dated 11. 06. 1997.

( 7 ) IT is this very issue, which formed part of adjudication in the case of Prithvi Nath Chopra v. UOI and Anr. , 2004 III AD (DELHI) 569 where pronouncements of the Supreme Court and this Court have been considered. The only difference is that in the said case, it was Indraprastha Apollo Hospital where the medical treatment had been availed of. The effect of the Office Memorandum dated 18. 09. 1996 was considered in the said judgment. It was observed in paras 14 and 15 as under :-

14. LEARNED counsel for the respondent has referred to the Office Memorandum of 18. 9. 1996 recognising private hospitals/diagnostic centres under CGHS, Delhi. The Indraprastha Apollo Hospital is one of the approved hospitals under the said Office Memorandum and the amount which can be charged is set out in terms of para 2 which is as under :

2. It has further been decided that the CGHS beneficiaries taking treatment in the above mentioned hospitals with the prior permission of the CGHS/offices appointed by the Government will be entitled for reimbursement as per the package deal rates given in the Annexures-I and II. The rates for indoor treatment mentioned in Annexures I and II are for Semi Private Category. For Private Ward ther












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