In Covid-19 emergency with no beds available, CGHS pensioner entitled to full reimbursement of actual hospital expenses beyond state room rates; authorities must handle approvals, not patient.

ORDER

The applicant is a senior citizen. He has approached this Tribunal under Section 19 of the Administrative Tribunals Act, 1985 to claim the following reliefs :

“8.1. To declare the impugned order of medical reimbursement issued by Respondent No.2; vide its letter No.CGHS/NP/CMO(H)/2022/475 dated 09^th May 2022 and thereby denied reimbursement of full expenditure incurred in the private hospital as a covid-19 patient as an emergency case, as illegal and set it aside to the extent of its illegality (Annex. A-1).

8.2. To direct the respondents to pay balance amount of reimbursement of Rs.1,04,379/- = [Rs.1,71,723 (-) Rs.67,344/-] with simple interest @ 9% per annum to the applicant w.e.f. the date of submission of the bill as on 24^th May 2021 till the balance payment is made.

8.3. To also direct the Respondents to pay Rs.50,000/- for causing mental and physical harassment, by not granting the amount of medical reimbursement to the full extent of actual medical expenses incurred.

8.4. To further grant Rs.40,000/- or a reasonable amount as cost of the instant case before this Hon’ble Tribunal and incidentals thereto and any other benefits as deem fit and proper in the facts and circumstances of the case.”

2. The brief facts of the case as stated by the applicant in the OA are that on 07.04.2021, the applicant being a member of CGHS for whole life, firstly visited the CGHS Dispensary at Wadi, Nagpur for RT-PCR test. He was referred to Dhruv Pathology, Nagpur where RT-PCR test certified that he was Covid-19 positive. The applicant, therefore, approached the OPD of KRIMS Hospital, Nagpur for further treatment of Covid-19 being one of the CGHS authorized hospitals at Nagpur. He was advised for home-isolation and given medicines for five days.

2(a). On 14.04.2021, he was again checked in the OPD of KRIMS Hospital, Nagpur and he was advised by the Doctor to get admitted to any of the hospital immediately as his health was being deteriorated and KRIMS Hospital was not having vacant bed for admission at that time.

2(b). The applicant’s relatives and friends searched for a vacant bed in a number of hospitals in and around Nagpur city for getting him admitted immediately for the treatment of Covid- 19 as an emergency case. At around 13:00 hours, the applicant got a telephone call from Kingsway Hospital, Nagpur that a bed was going to be vacant shortly and advised him to come to the hospital with preparation of getting admitted there. Accordingly, the applicant was taken to the Kingsway Hospital and was admitted there at about 13:35 hours. He had to pay Rs.50,000/- for the admission on the spot through his debit card.

2(c). The Kingsway Hospital admitted the applicant and allotted him a room earmarked for Covid-19 patients exclusively, in which two other patients were already admitted. The applicant was entitled for a separate room as per his entitlement for medical treatment under the CGHS Scheme. The Kingsway Hospital treated the applicant as per requirement of his health condition upto 21.04.2021 and discharged him from the Hospital at 11:00 PM on 21.04.2021.

2(d). The applicant submitted medical reimbursement bill of Rs.1,71,723/- duly supported with an emergency certificate issued by the Kingsway Hospital on 19.05.2021. However, the respondent No.2 passed the medical reimbursement of Rs.67,344/- only and credited the amount directly in applicant’s Saving Bank Account on 20.07.2021 without any information to him. Thus, it is the case of the applicant that his medical bill of Rs.1,71,723/- whi