The main legal point established in the judgment is that the entitlement to medical claim cannot be denied solely on the ground that the hospital is not included in the Government Order. The real test must be the factum of treatment supported by records duly certified by doctors/hospitals concerned.

JUDGMENT :

ANOOP KUMAR MENDIRATTA, J.

1. The challenge in this petition is to an order dated September 03, 2021 passed by the Central Administrative Tribunal (hereinafter referred to as the “Tribunal”) in O.A. No.4664/2018 whereby the petitioners were directed to reimburse the respondent, the balance amount against his claim for the expenditure of Rs.2,60,000/- incurred by him on medical treatment at Rancan Gamma Knife Centre-VIMHANS Hospital, Nehru Nagar, Delhi after adjusting the amount of Rs.31,556/- already paid to the respondent.

2. In brief, as per the facts noticed in O.A. No.4664/2018, the respondent retired as Senior Carpenter on March 30, 2016 and is a pensioner availing the CGHS facility. On November 03, 2017, respondent fell unconscious and was taken to Mata Chanan Devi Hospital, Janak Puri, Delhi wherein he was examined in the Neurology Department and advised further treatment at Rancan Gamma Knife Centre-VIMHANS Hospital, Nehru Nagar, Delhi specializing in Neurosurgery cases. The wife of the respondent accordingly took him in emergency to VIMHANS Hospital wherein respondent underwent a surgery on November 04, 2017 and was discharged on November 05, 2017.

3. Respondent thereafter submitted the medical bills amounting to Rs.2,60,000/- as raised by VIMHANS, for reimbursement on November 14, 2017 along with the emergency certificate at CGHS Dispensary, Rajouri Garden. However, respondent was reimbursed only an amount of Rs.31,556/- against the claim for Rs.2,60,000/-.

4. Aggrieved by the rejection of his claim, vide letter dated October 16, 2018, respondent preferred O.A. No.4664/2018 before the Tribunal.

5. The claim of the respondent was opposed by the petitioners herein and it was submitted before the Tribunal that emergency certificate was not submitted by the respondent from Mata Chanan Devi Hospital, wherein he took the treatment on November 03, 2017. The case of the respondent was also examined by the Standing Technical Committee on October 10, 2018 which did not find justification in the treatment availed by respondent, as it was not a case of medical emergency and the treatment is stated to be available in several Government hospitals at lower price.

6. Considering the records of treatment at VIMHANS, the Tribunal observed that there is no reason to refute the emergency as indicated in the certificate issued by VIMHANS and the fact that the respondent was operated on November 04, 2017 makes it clear that this was a medical emergency. Further, relying upon the judgments passed by Hon”ble Supreme Court in Shiva Kant Jha Vs. Union of India, (2018) 16 SCC 187 and Basant Dabas Vs. Government of India & Others, W.P. (C) No.9849/2015 decided on July 31, 2019 by High Court of Delhi, the O.A. preferred on behalf of the respondent was allowed and the impugned order dated October 16, 2018 rejecting the claim of the respondent was set aside.

7. Learned counsel for the petitioners assails the impugned order passed by the Tribunal on the ground that there was no emergency prescription from Mata Chanan Devi Hospital dated November 03, 2017 and the prescription dated November 03, 2017 from VIMHANS stated that the patient complained of Severe Rt V1V2 Trigeminal Neuralgic since last four months and is conscious/awake/oriented. It is contended that the case of the respondent was placed before the Standing Technical Committee for full reimbursement on October 10, 2018 and as per the opinion of experts, the condition of the respondent was not a case of emergency. Further, treatment for the same is available at many Government hospitals at lower price. It is contended that the treatment was undertaken by the respondent at VIMHANS, a non empanelled hospital at his own choice and as per the policy and Standing OMs, the respondent is not entitled to reimbursement as it may open flood gates for similar cases. Reliance is also placed upon a subsequent report of the Standing Technical Committee dated October 13, 2022 which observes as under:-

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