GOVT. OF NCT OF DELHI Vs. VIKRAMADITYA

JUDGEMENT

(1.) THE Government of National Capital Territory of Delhi (GNCTD) challenges the order of Central Administrative Tribunal (CAT/Tribunal) dated 31.01.2013 in O.A. No. 2148/2012, whereby reimbursement of the treatment cost in respect of the Chemotherapy procedure undergone by the respondent/applicant as per the approved rates, was directed.

(2.) THE brief facts are that the respondent/applicant is a retired Principal. He had apparently undergone some emergent surgery on account of intestinal blockage in Thane during a visit there, sometime in 2009. Acting upon a certificate issued by the hospital which treated him and diagnosed Cancer, he approached Dharamshila Cancer Hospital & Research Centre and after admission in the said institution underwent Chemotherapy. He claimed reimbursement of the cost of the treatment. The applicant relied upon an emergency certificate issued by Dharamshila Cancer Hospital & Research Centre as well as the case summary provided at the time of his discharge. The petitioner/GNCTD turned down his request for reimbursement stating that in terms of clause 10(C)(iii) of the Delhi Government Employees Health Scheme (DGEHS) office memorandum dated 25.10.2007, treatment in unrecognised/non -empanelled hospital was impermissible. The relevant clause stipulating the same is extracted below:

(3.) MR . Salwan, learned counsel for the GNCTD argues that the Tribunal overlooked a salient aspect, i.e. the violation of prescribed procedure which was highlighted in terms of the rules applicable to GNCTD employees/former employees of GNCTD. It was submitted in this regard that in non -emergent situations, Authorised Medical Attendant (AMA) would have to permit the beneficiary to avail the treatment in a hospital, or obtain treatment from diagnostic centres which are not empanelled. In the present case, all the circumstances pointed to respondent/applicant being aware of his condition and consciously approaching a non -empanelled institution.