O R D E R

The instant original application has been filed seeking following relief:

“(i) This Hon’ble Tribunal may be pleased to direct the respondents for

MANISH KUMAR

SRIVASTAVA

payment of medical reimbursement claim i.e. Rs. 5,73,848.01 paisa forthwith.

(ii) This Hon’ble Tribunal may be pleased to direct the respondents to pay the admissible interest in the condition of delay payment of the medical reimbursement.

(iii) Any other relief, which this Hon’ble Tribunal may deem fit and proper in the circumstances of the case may be given in favour of the applicant.

(iv) Award the costs of the original application in favour of the applicant”

The brief facts of the case are that the husband of the applicant was employed as a Fireman. During the course of his service, he fell seriously ill and was admitted to Jeevan Jyoti Hospital, Allahabad. Considering the serious condition of her husband, the applicant duly informed the CMO, CGHS Dispensary, Naini about his illness. Due to the critical condition of the applicant’s husband, the treating doctor of Jeevan Jyoti Hospital referred him to SGPGI, Lucknow for advanced treatment. However, in view of the emergency, he was admitted to Sahara Hospital, Lucknow. The applicant immediately informed respondent No. 3 about the emergency admission of her husband through fax message and also submitted an application seeking advance payment for treatment, as her husband was entitled to medical reimbursement under the applicable rules. Thereafter, on 17.09.2014, the applicant’s husband was admitted to Astha Hospital, Lucknow for further treatment. Unfortunately, despite continuous medical treatment, he expired on 21.09.2014. After the death of her husband, the applicant submitted a medical reimbursement claim in the prescribed format before respondent No. 3 along with all relevant medical documents, claiming a total amount of Rs. 5,73,848.01/- on 17.12.2014. Since no decision was taken on her claim, the applicant repeatedly approached the respondents by submitting reminders dated 17.12.2014 and 15.04.2015. Thus, despite submission of a medical reimbursement claim amounting to Rs. 5,73,848.01/-, the respondents released only Rs. 3,99,585/- to the applicant by cheque dated 18.08.2017.

Per contra, the respondents have filed a counter affidavit stating that the Ministry of Health & Family Welfare, Department of Health & Family Welfare, Government of India, issued an Office Memorandum dated 30.12.2014 delegating powers to the Heads of Departments for granting permission or ex post facto permission for treatment in private or

MANISH KUMAR

SRIVASTAVA

empanelled hospitals and for sanction of medical reimbursement claims in accordance with CGHS rates. It has been stated that, in terms of the said Office Memorandum, the competent authority is empowered to examine medical bills and to sanction reimbursement strictly as per admissible CGHS rates. In the present case, after receipt of the medical reimbursement claim and supporting documents from the applicant, the competent authority forwarded the same to the Area Accounts Office, Prayagraj for audit and payment. The respondents have further stated that the applicant had submitted a medical reimbursement claim amounting to ₹5,73,848.01/-. After due audit by the Area Accounts Office, an amount of ₹3,99,585/- was found admissible as per CGHS rates and the said amount was passed and paid to the applicant by cheque dated 18.08.2017. It has been contended that the applicant has already been paid the admissible amount in accordance with the applicable rules and no further amount was found payable.

The applicant has filed Rejoinder Affidavit to the Counter Affidavit as filed by the respondents refuting the contentions made by the respondents in their Counter Affidavit while reiterating the averments made in the O.A. and nothing new has been added.

I have heard Shri Ashish Srivastava, learned counsel for the applicant and Shri Rajni Kant Rai, lear

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