VIRENDER AGGARWAL Vs. DIRECTORATE OF CENTRAL GOVT HEALTH

JUDGEMENT

(1.) THIS case relate to the reimbursement of medical expenses required by the petitioner for Cochlear Implant surgery of his son in RML hospital, New Delhi. The petitioner is a CGHS beneficiary being a Central government employee working in Intelligence Bureau, Ministry of Home, government of India, New Delhi. The petitioner obtained an estimate of the expenses required for Cochlear Implant surgery of his son from RML hospital in 2005. The RML hospital gave an estimate of Rs. 4. 80 lacs to the petitioner required for the surgery of his son and he accordingly applied for sanction of the said amount to the concerned authorities in the Ministry of Health, government of India. Since the expenses required by the petitioner for the surgery of his son were not sanctioned by the respondent, the petitioner filed a case being Case No. 13809/2007 before the Chief Commissioner for Persons with disabilities wherein the respondents were directed by the Chief Commissioner vide its order dated 13. 06. 2007 to grant sanction to the petitioner at a ceiling rate of Rs. 4. 80 lacs, required by the petitioner for the surgery of his son. In compliance of the said order of the Chief Commissioner for Persons with disabilities, the respondents are stated to have sanctioned Rs. 4. 80 lacs to the petitioner vide letter dated 17. 06. 2008. By the time this amount was sanctioned, the cost of Cochlear Implant surgery has gone up from Rs. 4. 80 lacs to Rs. 5. 35 lacs and therefore the petitioner prays that the respondents may be directed to reimburse the revised amount of Rs. 5. 35 lacs by granting additional sanction.

(2.) THIS court in an identical case vide its order dated 05. 09. 2008 passed in WP (C) No. 2155/2008 had allowed the petitioner to go ahead with the cochlear Implant surgery of his son and submit the medical bill of expenses that may be incurred by him towards the cost of implant surgery to the respondents for reimbursement and the respondents were directed to reimburse the balance amount over and above Rs. 4. 80 lacs in accordance with the applicable rules and the policy on the subject.

(3.) MR. Mehra, learned counsel appearing on behalf of the respondents says that the directions given by this court in the above referred case were not in an identical case because according to him, in that case the petitioner's child who was to undergo Cochlear Implant surgery was 4 years old, whereas in the present case the petitioner's son is 14 years old. According to Mr. Mehra, the respondents have proposed some draft guidelines for reimbursement of expenses for Cochlear Implant surgery and according to that draft guidelines, children between 1-5 years will be entitled to reimbursement at the ceiling rate of Rs. 5. 35 lacs, children between the age group of 5-10 years would be entitled to reimbursement @ 80% of the ceiling rate of Rs. 5. 35 lacs whereas children in the age group of 10-16 years would get reimbursement only to the extent of 50% of the ceiling rate. The proposed draft guidelines, which make the age of the child/patient, a criteria for granting full or partial reimbursement, are not before the court. Admittedly, the said guidelines are still in the formulative stages and has not yet been crystallized into statutory rules or administrative instructions. Till the time any guideline laying down the age criteria of the patient for granting full or partial reimbursement takes the shape of statutory rules or administrative instructions, the respondents are bound to comply with the existing policy of medical reimbursement. They cannot be permitted to discriminate on case to case basis. The courts have repeatedly held that a government employee is entitled to full medical reimbursement in terms of policy of the Government governing medical reimbursement.