Central Administrative Tribunal Principal Bench, New Delhi This the 17^th day of November, 2025 Hon’ble Shri B. Anand, Member (A)

NISHA W/0 VINAY MALIK H NO. 198/28, GARHI GHASITA, PRIMARY SONIPAT, HARYANA-131001 AGED 34 YRS.

(GROUP B) (TEACHER).

... Applicant (By Advocate: Mr. JS Mann)

Versus

1. MUNICIPAL CORPORATION OF DELHI THROUGH THE COMMISSIONER DR. SHYAMA PRASAD MUKHERJEE CIVIC CENTRE, JAWAHAR LAL NEHRU MARG, NEW DELHI 110002.

2. CHIEF ADMN. MED. OFFICER, NARELA ZONE, NORTH DMC, ZONAL OFFICE, PRIMARY HEALTH CENTRE, NEAR ALIPUR, NARELA, DELHI- 110040 ... Respondents (By Advocate: Mr. Akshit Gupta)

O R D E R (ORAL)

Hon’ble Mr. B. Anand, Member (A)

1. By way of the present O.A. filed under Section 19 of the Administrative Tribunals Act, 1985, the applicant has sought the following relief(s):-

“a) To set aside the impugned order dated 16-07-

2020 (ANNEXURE -A-1) and/or;

b) To direct the respondents to make payment of medical reimbursement claim of the applicant of Rs. 2,20,734/- ( Two Lakhs twenty thousand seven hundred thirty four only) alongwith grant interest @ 12% or as deemed fit in respect of delayed payment and/or;

c) Any other relief or direction which this Hon'ble Tribunal deems fit and proper in view of the facts and circumstances of the case may be granted/passed in favor of the applicant and against the respondents.”

Facts in a Nutshell:-

2. Brief facts of the case are that the applicant who is a Primary Teacher with the respondents’ department had applied for reimbursement of the medical expenses connected with the Laproscopic Sleeve Gastrectomy surgery of her husband conducted at BL Kapoor Hospital, New Delhi, on 21.06.2019. The total expenditure incurred was Rs. 2,20,734/-. Learned counsel for the applicant contends that she had followed the prescribed procedure and initially contacted the North Delhi Municipal Polyclinic from where her husband was referred to Hindu Rao Hospital of Municipal Corporation of Delhi (MCD). Since the facilities for the requisite surgery of the disease was not available there, he was referred to a panel hospital, that is, BL Kapoor Hospital, New Delhi, which is one of the several hospitals under the CGHS facility for the government employees. After the successful surgery, when the applicant approached the respondents for reimbursement of the expenses connected with the surgery, the respondents through their internal noting which is forming part of the impugned order negative her request. The applicant by referring to the internal file noting of the respondents between 25.06.2020 to 18.11.2020, which is taken as the impugned order, submits that the respondents have rejected her claim in toto. The applicant is relying upon the OM dated 06.11.2013 issued by the Ministry of Health and Family Welfare which contains the guidelines and the ceiling rates for reimbursement for bariatric surgery under the CGHS/CS(MA) Rules, 1944.

Applicant’s Submissions:

3. Learned counsel for the applicant submits that the applicant had filed for reimbursement of the expenses connected with the surgery of her husband performed at BL Kapoor Hospital as per the OM dated 06.11.2013. Four types of bariatric surgery figures in the OM dated 06.11.2013 are as follows:-

(i) Laparoscopic Gastric Banding Surgery (ii) Laparoscopic Sleeve Gastrectomy (iii) Laparoscopic Gastric Bypass (GBP)

(iv) Other cases – as per examination and recommendations of an expert committee.

4. He submits that inasmuch as the applicant’s husband had undertaken the surgery which is listed here in the above OM there was no necessity for the respondents to obtain recommendation of an expert committee for allowing the said medical reimbursement claim. He also submits that initially the applicant’s husband had gone to a government poly clinic from where he was referred to another government hospital and from there, he was referred to a private hospital empanelled under CGHS by an expert. Therefore, he submits that all the procedures have been followed and the res