P. Somarajan, J.

1. Aggrieved by the judgment dated 28.3.2014, of the Employee's Insurance Court, Kollam, in Insurance Case No. 2 of 2011, the State of Kerala, the additional third Opposite Party, came up with this appeal. An application was submitted under Section 75 of the Employees' State Insurance Act, 1948 (for short 'the Act') for getting reimbursement of the amount incurred on account of treatment of the wife of the applicant.

2. The specific case advanced by the applicant is that he is an insured person registered at ESI dispensary, Chathannur, Kollam under the Act and is working at Steel Industries Kerala Ltd. Kowdiar, Thiruvananthapuram. The applicant's wife sustained right hip joint problem out of a fall and she was initially taken to the ESI Hospital, Peroorkkada, from where she was referred to the Medical College Hospital, Thiruvananthapuram. Later, she was taken to Lakeshore Hospital, Kochi and had undergone treatment there and incurred an amount of Rs. 3,19,324.69 by way of medical bills. A claim was lodged before the Insurance Corporation for getting reimbursement of the said amount. The Insurance Corporation allowed only an amount of Rupees one lakh alleging that the applicant is eligible only for reimbursement of medical expenses calculated as per Central Government Health Scheme (for short 'CGHS') and rejected the claim for the balance amount, which has necessitated the filing of the Insurance Case before the Employees' Insurance Court, Kollam.

3. The Employee's Insurance Court, Kollam, on consideration of the pleadings and evidence and after hearing both the parties, found that the applicant is entitled to the balance amount of Rs. 2,19,324/- after deducting the amount of Rupees one lakh already given under CGHS, by its judgment dated 28.3.2014, against which this appeal is preferred.

4. The first contention raised by the appellant/additional third opposite party is that, even by admitting the claim made by the applicant, an amount of Rs. 90,000/- alone is entitled to by the applicant as it is the maximum amount that can be granted under CGHS, but an amount of Rupees one lakh was granted. The second contention raised is that the applicant's wife had undergone treatment in a hospital without having reference from the ESI Hospital or from the Medical College Hospital. But it was admitted that she was referred by the ESI Hospital, on an earlier occasion, to the Medical College Hospital, Thiruvananthapuram. It was also submitted that the Lakeshore Hospital, wherein she had undergone treatment, is not an empaneled hospital and there was no tie up with the said hospital either by the Corporation or by the State Government at that time.

5. On coming into the first contention, Section 57 of the Act is relevant, which is extracted below for reference:

“57. Scale of medical benefit. - (1) An insured person and (where such medical benefit is extended to his family) his family shall be entitled to receive medical benefit only of such kind and on such scale as may be provided by the State Government or by the Corporation, and an insured person or, such medical benefit is extended to his family, his family shall not have a right to claim any medical treatment except such as is provided by the dispensary, hospital, clinic or other institution to which he or his family is allotted, or as may be provided by the regulations.

(2) Nothing in this Act shall entitle an insured person and (where such medical benefit is extended to his family) his family to claim re-imbursement from the Corporation of any expenses incurred in respect of any medical treatment, except as may be provided by the regulations.”

6. A mere reading of Section 57 would show that it is to the State Government or the Corporation to fix a scale for reimbursement of any medical benefit that can be extended to a person insured or his family members in connection with any medical treatment undergone. It is fairly admitted by the learned counsel for the appellan