The factum of treatment must be the real test for reimbursement, and the authorities cannot deny the claim on technical grounds.

JUDGMENT

Prathiba M. Singh, J. (Oral)--This hearing has been done through hybrid mode.

2. The Petitioner is a retired officer of the Indian Air Force who has a valid health cover issued by the Ministry of Defence bearing ECHS No. DLI000002796125. It is the case of the Petitioner that he is entitled to comprehensive Medicare under the Ex-Servicemen Contributory Health Scheme (ECHS). He seeks reimbursement for his medical expenses during the period when he was diagnosed with Covid-19 Pneumonia and needed treatment for eight days, from 28th April, 2021 to 5th May, 2021, in the Covid Isolation Ward at the C.K. Birla Hospital, Gurugram. The case of the Petitioner is that he had to pay the total amount incurred of Rs.3,55,286/- for treatment at the Covid-19 isolation ward. However, the reimbursement which has been given to him is for only Rs.1,83,748/-. He prays for a direction to be issued to the Respondents to reimburse the remaining amount i.e., Rs.1,71,528/- to him.

3. Notice was issued in this matter, and an affidavit was to be filed. No affidavit has been filed. However, ld. Counsel for the Petitioner has pointed out that the only reason why the remaining amount is not being reimbursed is that the Ex-Servicemen Contributory Health Scheme (ECHS) cannot be directed to pay extra amount to the beneficiary besides the government-approved rates.

4. It is not in dispute that the Petitioner was admitted to the C.K. Birla Hospital in Gurgaon. The Respondent's case is that the hospital has overcharged beyond government approved rates. This issue is already covered by orders passed by this Court in various cases, including in Dinesh Kumar v. Government of National Capital Territory of Delhi & Ors., 2022/DHC/005039 and order dated 18th April, 2023 in W.P.(C) 4882/2023 titled Nupur Gupta v. Govt. of NCT of Delhi & Ors.. In Dinesh Kumar (Supra), a ld. Single Judge of this Court held that in such cases, reimbursement has to be given to the beneficiaries and that it was incumbent upon the concerned government or authority to obtain recovery from the hospital. The relevant extracts of the said order are extracted as under:

"7. The Petitioner, who had to spend his hard-earned savings, while undergoing treatment to save his life, cannot be simply told that, since respondent no.5 has failed to abide by the circular dated 20.06.2020 issued by the GNCTD, he should seek refund from the said hospital which saved his life. This Court does not deem it appropriate or necessary to delve into the validity of the circular dated 20.06.2020, in the present petition, where an officer of Delhi Higher Judicial Service is seeking simpliciter reimbursement of the amount for the bona fide expenses incurred by him for treatment at the respondent no.5 hospital for Covid-19, when the city was engulfed with the second wave of the pandemic. I am, therefore, unable to accept Mrs. Ahlawat's plea that the respondent no.5 should be directed to explain its stand in the present writ petition regarding its action of charging amounts higher than the ones prescribed in the circular dated 20.06.2020, or should be directed to refund the amount of Rs.16,93,880/-.

8. In this regard, reference may be made to the decision of this Court in Sqn. Commander Randeep Kumar Rana (supra), wherein the Division Bench while dealing with a case, where the hospital had charged over and above package rates, held that the employer was under an obligation to pay to the government employee, and could make appropriate recoveries in accordance with law, from the hospital which had overcharged him. The relevant extract reads as under:

"5. We have given our careful considerations to the arguments advanced by learned counsel for both the parties. It is not denied that the treatment taken at Escorts Hospital was pursuant to the recommendation made by the Safdarjung Hospital which is a Government hospital. Naturally, when a small child is to be treated for Ventrical Septal Defect involving open heart surgery