MASTER VISHAL KUMAR (MINOR) Vs. EMPLOYEES STATE INSURANCE

JUDGEMENT

(1.) Present writ petition has been filed by Master Vishal Kumar. As the petitioner-patient is suffering from a rare genetic disorder named MPS Type-I, he seeks extension of medical cover for life saving Enzyme Replacement Therapy on the ground that his father is insured with Employees State Insurance Corporation (for short 'ESIC').

(2.) In the present writ petition, it has been averred that ESIC had denied medical treatment to the petitioner citing Clause 5.1 of the ESIC Decisions on Medical Services-July, 2014 inasmuch as it imposed a ceiling limit of Rs.10 lacs per beneficiary per year.

(3.) During the pendency of the present writ petition, the impugned Clause 5.1 has been amended by way of a Circular dated 07 th November, 2016 wherein it has been stipulated that for all the cases where expenditure incurred/to be incurred is more than Rs.10 lacs per beneficiary, the same shall be examined on case to case basis by a Committee constituted by ESIC Headquarter office and a decision with the approval of Chairman ESI Corporation shall be taken.