(O R D ER)

BY JUSTICE OM PRAKASH-VII, MEMBER (J)

The present Original Application has been filed by the applicant under section 19 of the Administrative Tribunal Act, 1985 seeking following reliefs:-

(i) Issue a writ, order or direction in the nature of mandamus concerned commanding respondent directing and authorities to the make payment of Rs.1,90,000/ of reimbursement of medical claims under the Central Government Health Scheme (CGHS) to the applicant as early as possible.

(ii) Issue a writ, order or direction in the nature of and directing the mandamus commanding concerned respondent authority/Respondent No.2 to decide the representation dated 19.01.2019 followed by reminder dated 19.02.2019 by passing a reasoned and speaking order within stipulated period of time as framed by this Hon'ble Tribunal.

(iii) Issue any other order or direction as this Hon'ble Tribunal may deem fit and proper in the circumstances of the case.

(iv) Award the cost in favour of the applicant being harassment by the respondents

The brief facts of the case are that the applicant, a retired railway employee and 65% physically handicapped, incurred medical expenses of Rs. 3,17,939/- during emergency treatment in November 2017. He duly submitted his claim, however, the respondents reimbursed only about Rs. 1,27,800/- and withheld the remaining amount without assigning proper reasons. Despite repeated representations and RTI queries, no reasoned decision was taken. Aggrieved by the arbitrary action and non-payment, the applicant has filed the present OA seeking release of the balance medical reimbursement.

Per contra, the respondents have filed counter affidavit wherein it has been stated that the applicant failed to promptly inform the competent medical authority regarding his admission and treatment, as the intimation dated 10.11.2017 was sent belatedly on 01.03.2018, for which no satisfactory explanation has been provided. It is further stated that the medical reimbursement claim was duly examined and the bill was processed and sanctioned by the competent authority strictly in accordance with the applicable Railway Board guidelines. The payment has already been made to the extent admissible under the rules and the deduction in the claimed amount was carried out as per prescribed norms. Hence, no further amount is payable to the applicant.

In reply to the counter affidavit, applicant has filed rejoinder affidavit opposing the contentions as made in the counter affidavit while reiterating the averments as already advanced in the OA. Nothing new has been averred in the rejoinder affidavit.

I have heard Shri Shri S.J Ishtiaque, learned counsel for the applicant and Shri Mahendra Prasad Mishra, learned counsel for the respondents and perused the records.

Submission of learned counsel for the applicant is that the applicant had incurred substantial medical expenditure during a medical emergency and had duly submitted the claim strictly in accordance with the applicable rules and procedure. It is contended that once the claim is found admissible, the respondents are under a legal obligation to reimburse the same and non-payment of the legitimate dues is wholly arbitrary and unjustified. It is further submitted that although the respondents have sanctioned a part of the claim, a substantial portion has been disallowed without assigning any cogent or reasoned justification. Thus, such action is in clear violation of the principles of natural justice as no speaking order has been passed indicating the basis of deduction. Learned counsel for the applicant further argued that the applicant had incurred the entire expenditure from his own resources for life-saving treatment and denial of full reimbursement defeats the very object and purpose of medical reimbursement schemes. It is also submitted that the respondents have withheld the balance amount on vague and unspecified grounds, which renders their action arbitrar