UNION OF INDIA Vs. NAU NIHAL SINGH RANA

JUDGEMENT

(1.) ALLOWED subject to just exceptions. 1. Having heard learned counsel for the petitioner we are not inclined to interfere with the impugned order.

(2.) OUR reason for so doing.

(3.) THE competent authority of the petitioner was of the opinion that it was not a case of emergency, but later on changed the opinion and conceded to the point that it was a case of emergency. The difference in the two situations being that a member of the Health Scheme in question was not entitled to go to a private hospital and avail medical treatment unless the member was referred to a private hospital by a panel doctor in a hospital established by the Railway authorities. In case of emergency a member of the Scheme could avail the benefit of medical treatment at a private hospital. Yet in spite thereof the claim was disallowed on the ground that reimbursement had to be as per Government Approved rates, which for retina detachment surgery would be Rs.19,300/- and since the respondent had been reimbursed Rs.33,529/- by the Oriental Insurance Company with whom respondent had obtained a medi-claim policy, it was opined that as the claim allowed was less than what was obtained as medical reimbursement from the Insurance Company, nothing had to be paid.