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2019 Supreme(P&H) 421
IN THE HIGH COURT OF PUNJAB AND HARYANA
RAJIV SHARMA, HARINDER SINGH SIDHU, JJ.
RAM PAL - Appellant
Vs.
CENTRAL ADMINISTRATIVE TRIBUNAL AND OTHERS - Respondent
Civil Writ Petition No. 22482 of 2017
Decided on : 14-01-2019
Advocate Appeared:
Navkiran Singh, Adv., P.C. Goyal, Adv.
Service Law-Medical Reimbursement-Claim not to be rejected merely on the ground that the treatment was taken in non-panelled hospital or that instructions regarding reimbursement contained on the reverse page of the Referral Slip had not been followed
Headnote:(A) Service Law-Medical Reimbursement-Cochlear Surgery-Daughter of petitioner aged 18 years had under gone cochlear surgery at PGIMER (non-panelled hospital)--Such surgery was essential and it resulted in substantial improvement in her condition--Certificate was also issued by Authorized Medical Officer in this regard-Thereafter, denying her medical reimbursement claim was illegal and unjustified on the ground that instructions regarding reimbursement contained on the reverse page of the Referral Slip had not been followed and further the guidelines regarding Cochlear Implantation have not been complied with. (Paras 9 to 23)
(B) Service Law-Medical Reimbursement-Non panelled hospital-Claim of reimbursement cannot be rejected solely on the ground that the Hospital where the treatment was taken was not included in the Government Order-In such a case the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned-Once that is established, the claim cannot be denied on technical grounds. (Para 16)
(C) Service Law-Medical Reimbursement-Claim not to be rejected merely on the ground that the treatment was taken in non-panelled hospital or that instructions regarding reimbursement contained on the reverse page of the Referral Slip had not been followed
Harinder Singh Sidhu, J.
This writ petition has been filed impugning the order dated 24.3.2015 of the Central Administrative Tribunal, Chandigarh Bench, whereby the Original Application filed by the petitioner seeking release of medical reimbursement claim of Rs.5,78,825/- with interest in respect of Cochlear Implantation Surgery undergone by his daughter has been dismissed.
2. The petitioner is working as Station Master, Chhajli Station of the Ambala Division of Northern Railway. His daughter Ms. Harjit Kaur was deaf and dumb by birth. He contacted ADMO Dhuri on 18.7.2011 for treatment of his daughter. She was referred to D.M.O.(Physician), Ambala for further treatment vide OPD Slip No.3869 dated 18.7.2011. On 19.7.2011, the Chief Medical Superintendent, Northern Railway, Ambala Cantt. referred the daughter of the petitioner to PGIMER, Chandigarh (for short “PGI”) for further evaluation and management. The petitioner along with his daughter visited PGI on 26.7.2011 and continued to visit the Institute as advised after a gap of 15 days/ one month. On 27.9.2011, Dr. Naresh Panda, the Head of Department of ENT, PGI recommended the daughter of the petitioner for Cochlear Implantation Surgery. She was admitted in the PGI on 6.1.2012 and successfully underwent the surgery. She was discharged on 17.1.2012 and thereafter, visited PGI for follow up as advised. An expenditure of Rs.5,78,825/- was incurred by the petitioner on the treatment, which he arranged by pledging his house for Rs.6 lacs. He submitted the bill for reimbursement to Chief Medical Superintendent, Ambala Cantt. on 24.2.2012. Certain objections were raised. The petitioner removed those objections and re-submitted the bill on 27.12.2012. As required by the respondents the petitioner even got his daughter admitted in the Railway Hospital, Northern Railway, Ambala Cantt on 13.05.2013 to assess the result of the treatment given at the PGI. She appeared before the Board and was discharged on 15.05.2013 with a more than satisfactory report. The medical reimbursement claim having not been cleared, he sent legal notices. Finally vide order dated 01.07.2013 his claim was rejected. Hence the Original Application.
3. The case of the respondents was that reimbursement of medical expenses to its employees and their family members is governed by Guidelines dated 31.12.2009 contained in the Indian Railways Medical Manual (IRMM). Para 667 of this IRMM, 2000 is relevant in this regard. The petitioner had not conformed to these guidelines. As per these guidelines before an employee is permitted for go in for Cochlear Implantation Surgery for which reimbursement is to be claimed, a proposal for surgery duly recommended by the Chief Medical Director and concurred by Associate Finance, should be sent to the Railway Board for their sanction. This was not done.
4. It was stated that as per clinical practice, Cochlear Implantation Surgery is usually performed on pre-lingually deaf children below five years of age. Beyond five years of age, the outcome of surgery declines, as the brain looses its natural plasticity. Speech development after surgery also becomes poor if it is performed after five years of age. Reference in this context was made to text book of ENT 'Scoutt Brown's Otorhinolaryngology and Head and Neck Surgery 7th edition Vol.1'. It was contended that the daughter of the petitioner was 18 years old when surgery was performed on her and hence was not entitled to reimbursement. It was also the case of the respondents that as per the letter dated 31.12.2009 there were specified approved centres for Cochlear Implantation Surgery and this list did not include PGIMER, Chandigarh. Hence, also, the claim was not admissible.
5. It was further their case that the petitioner had not complied with the detailed 'Instructions regarding Reimbursement' which were clearly indicated on t
