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2019 Supreme(Del) 1587

MANMOHAN
Baby Devananda D (Minor) Thr her Mother Deepa S – Appellant
Versus
Employees State Insurance Corporation – Respondent


Advocates Appeared:
For the Petitioner:Ashok Agarwal, Kumar Utkarsh, Advocates.
For the Respondent:Shyel Trehan, Amicus Curiae, Sonali Malik, Yakesh Anand, Nimit Mathur, Dr. Naresh Kumar Arora, Addl. Director (Insp.), Dhruv Prasad, Amrita Prakash, CGSC, Hari Shankar Sharma, Advocates, Rajshekhar Rao, Kotla Harshavardhan, Mansi Sood, Gaurav Sansanwal, Advocates.

JUDGMENT :

1. In the present two writ petitions, the petitioners have challenged the validity and legality of Clauses 5.1 and 5.3 of the Guidelines of the ESI Corporation titled “ESIC Decisions on Medical Services-July, 2014”. The impugned clauses read as under:-

“5.1 Upper limit on the expenditure for procedures not covered under CGHS package rates would be Rs. 10 lacs per beneficiaries per year.

5.3 In respect of children of IP, congenital diseases requiring referral to SST and genetic disorders would be eligible for coverage up to the ceiling mentioned earlier only in case the child is born after the IP had become eligible for SST.”

2. The present writ petitions were initially tagged with a batch of matters filed by the employees who were insured under the Employees’ State Insurance Act, 1948 (for short “ESI Act”) but whose minor children had been denied Super Speciality Treatment on the grounds that the minors had been born prior to the employees having become eligible for Super Speciality Treatment and/or the expenditure to be incurred on their treatment was beyond the ceiling

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