Medical reimbursement denied for non-emergency treatment at private hospitals without prior permission or government referral under CS(MA) Rules; ignorance no excuse; precedents fact-specific.

ORDER 

PER:- AJAY PRATAP SINGH, MEMBER [JUDICIAL]

1. Heard learned counsel for parties through video conferencing mode.

PRAYER

2. By way of present Original Application filed under Section 19 of Administrative Tribunals Act 1985, applicant has sought the main relief (as extracted from OA) as under:-

“8(i) Your Lordships may graciously be pleased to quash the rejection order issued by respondents under O/o CPMG Bihar, No. Acctts/Med/Nilam Sharma/Gaya Dn/2018 dated 27.08.2019 (Annexure A-2;

8(ii) That your Lordship may graciously be pleased to direct the respondents to sanction and pay the medical claim of applicant.

8(iii) Cost of the case may please be awarded to the applicant for sorrow, suffering and cost of litigation.

8(iv) Your Lordships may pass any further orders/directions as your Lordships may deem fit and proper and just to end of the justice”

FACTS IN BRIEF

3. Briefly stated facts as adumbrated by applicant in the instant OA are that applicant was appointed as Postal Assistant in Monghyr Postal Division and joined as Postal Assistant in Mukhya Dak Ghar (MDG) Sheikhpura. Applicant fell ill and consulted at SRL Hospital Private Ltd., Sheikhpura and concerned doctor referred her to Medanta (Medicity) Hospital, Gurgaon on 19.09.2017 for further treatment. Consequent upon referral, she was admitted in Medanta Hospital, Gurgaon on 23.09.2017 in emergency. Applicant underwent several rounds of hospitalization and finally discharged on 09.12.2017.

4. As applicant was transferred to Gaya Postal Division and she joined there on 18.02.2018, she submitted her medical bill in the office of SSPOs, Gaya on 05.03.2018, which was returned to her on 28.01.2020 under O/o SSPOs Gaya. It is the case of the applicant that respondents rejected her medical claim only on the sole ground of not following due procedure for treatment vide O/o Chief Postmaster General, Bihar Circle, dated 27.08.2019 (Annexure A/2) which act of the respondents, as per the applicant, is against the rules. To buttress her claim, applicant has relied upon the decision of Hon’ble High Court of in the case of Ajit Kumar Mishra vs. Union of India & Ors. [CWP No.13377 of 2017 decided on 02.05.2017].

5. It is also the case of applicant that respondents have not even bothered to controvert the treatment and identity of hospitals where she underwent the treatment. More so, as applicant was appointed on compassionate ground, she was not fully aware of the procedure for treatment.

6. Per contra, opposing the claim of the applicant, respondents have filed written statement and stated that applicant, who has been working as Postal Assistant, Sheikhpura MDG, fell ill and consulted a private hospital namely SRL Hospital on 19.09.2017 from where she was referred to another private hospital, namely, Medanta the Medicity Hospital, Gurgaon for needful. She was admitted in Medanta Global Health Private Limited on 23.09.2017 and took treatment in different spells of period in that hospital. In the meantime, applicant has been transferred under Rule-38 of P&T Man.Vol.IV in Gaya Division and posted as Postal Assistant, Purani Godown S.O. She joined there on 18.02.2018, and submitted her medical bill for Rs.3,64,600.99 on 05.03.2018, which was forwarded to C.O., vide letter dated 06.03.2018. Some objections had been raised by the C.O., vide letter dated 24.08.2018, which was sent to the applicant for compliance vide letter dated 04.09.2018. Applicant submitted her reply stating that she