The central legal point established in the judgment is the interpretation and application of the office memorandum dated 28.07.2010, which allowed treatment in a hospital outside Delhi empanelled with CGHS for beneficiaries under DGEHS. The court emphasized the welfare provision and found the rejection of the petitioner's claim as arbitrary and illegal.

JUDGMENT

Rekha Palli, J. - The petitioner, a retired Judicial Officer of the Delhi Judicial Service and a member of the Delhi Government Employees Health Scheme(hereinafter referred as DGEHS) has approached this Court assailing the order dated 01.03.2021 passed by respondent no.1, rejecting his claim for reimbursement of a sum of Rs.4,27,276/-towards the amounts spent by him for treatment of his wife Smt. Raj Bala Gupta, who being his dependent is also entitled to the benefits under the DGEHS.

2. Learned counsel for the petitioner submits that on 11.03.2020, the petitioner’s wife Smt. Raj Bala Gupta was, pursuant to a biopsy conducted at Medanta, the Medicity Hospital, Gurugram, diagnosed as suffering from Cholongio Carcinoma, a rare type of cancer which cannot be operated upon. After a series of consultations with the doctors, the petitioner’s wife was advised to undergo proton therapy at Apollo hospital, Chennai. However, since permission for undergoing proton therapy at Chennai was being delayed, the petitioner was compelled to approach this Court by way of W.P.(C) 2962/2020 seeking directions to the respondent no.1 to grant permission to his wife for taking treatment at Apollo Hospital, Chennai. The petitioner also sought special permission for his wife to travel to Chennai through air ambulance along with an attendant in case of extreme medical emergency. He contends that even though the respondents had conveyed their no objection for the petitioner’s wife to undergo the said treatment due to medical emergency as also for her transportation through air ambulance, the said permission could not be availed on account of rapid increase in the Covid-19 cases at that stage.

3. In September 2020, the condition of petitioner’s wife started deteriorating and upon being diagnosed with obstructive jaundice, she was in a state of emergency, required to be admitted in Medanta Hospital, Gurugram on 17.09.2020. She was discharged on 23.09.2020 when a bill of Rs.4,27,276/- was raised on her, which amount was paid by the petitioner from his limited savings. The petitioner then submitted his claim for reimbursement which was duly forwarded to respondent no.1 by the respondent no.2/the District Sessions Judge, Tis Hazari (HQ). The same has, however, been erroneously rejected by respondent no.1 under the impugned order without assigning any reasons by merely stating that the hospital where the petitioner’s wife took treatment was not an empanelled hospital under the DGEHS scheme of which the petitioner is a member.

4. Learned counsel for the petitioner submits that while rejecting the petitioner’s claim, the respondent no.1 has ignored its own office memorandum dated 28.07.2010 which was issued on the basis of a Cabinet decision that the beneficiaries under the DGEHS scheme would also be entitled to avail medical treatment in Central Government Health Scheme (hereinafter referred as CGHS)empanelled hospitals outside Delhi. He submits that once it is admitted position that the Medanta Hospital, where the petitioner’s wife had taken treatment is empanelled under the CGHS, the respondent no.1 could not have rejected the petitioner’s claim.

5. On the other hand, Mr. Sameer Vashisht learned counsel for the respondent, while defending the impugned order contends that once the hospital where the petitioner’s wife has taken treatment is not empanelled under the DGEHS, the respondent cannot be faulted for not accepting the petitioner’s claim for reimbursement. He submits that even though Medanta Hospital Gurugram is empanelled under the CGHS, the fact remains that the petitioner is a member of the DGEHS and not that of CGHS and therefore, cannot seek reimbursement for the expenses incurred at the Medanta Hospital. Mr.Vashisht is however not in a position to justify as to why, while passing the impugned order, the effect of the OM dated 28.07.2010 which in certain situations permits treatment at a hospital outside Delhi empanelled under the CGHS, was not c