L.K. BATRA Vs. UNION OF INDIA

JUDGEMENT

(1.) The petitioner has filed the present petition, inter alia, praying that an order be issued to the respondent to reimburse the medical expenses due to the petitioner in terms of the OM No.S.11011/4/2003-CGHS(P) dated 19.02.2009.

(2.) The petitioner who is a senior citizen met with an accident on 28.07.2008 and fractured his hip. The petitioner underwent a surgery on 01.08.2008 and remained in hospital till 06.08.2008. In terms of the policy in vogue at material time, all members covered under the CGHS Scheme would be entitled for medical expenses upto a particular limit as specified for different treatments. However, in cases where the persons were also covered by a medical insurance policy in addition, any payment received from the insurance company would be deducted from the amount payable under the CGHS Scheme.

(3.) This policy underwent a material change with the issuance of the OM dated 19.02.2009 and the members covered under the CGHS who also had purchased medical insurance policy, would also be entitled to reimbursement of medical expenses under the CGHS scheme, which they were otherwise entitled to for treatment, without taking into account any payment received from the insurance company; this was subject to the condition that the cumulative amount received by them would not exceed the actual medical expenses.