JAYANTIBHAI M. JOSHI Vs. UNION OF INDIA

JUDGEMENT

(1.) THIS OA has been filed by a retired SDE who underwent heart treatment at Krishna Heart Institute, Green City, Ghuma, Ahmedabad. The aforesaid hospital is an institute recognized by the respondents. The applicant submitted medical reimbursement claim to the respondent. The respondents allowed only Rs. 1,38,000/ - but not paid Rs. 70,000/ - towards the cost of valve used in the treatment. The applicant approached this Tribunal with OA/112/2009. This Tribunal as per the order dated 28 -7 -2010 in the said OA had directed the respondents to re -examine the matter and to pass an appropriate reasoned order. On 10 -8 -2011, the respondents issued a communication, Annexure A -1, refusing to pay the cost of valve used in the heart treatment. The applicant approached the Minister concerned, but without any avail. Therefore, the applicant prays for quashing and setting aside the impugned order dated 10 -8 -2011 and to direct the respondents to consider/grant the claim of Rs. 70,000/ - towards the cost of extra valve with 12% interest and with exemplary costs. In the reply filed on behalf of the respondents, it is stated that the Department has introduced BSNL Medical Reimbursement Scheme where the applicant had exercised option adopting the scheme. The Ministry of Health & Family Welfare issued the O.M. dated 9 -7 -2002 (Annexure R -1) which specified fixation of the package rates to be charged, recognition of private hospitals etc. The aforesaid instructions were sent to all recognized hospitals including Krishna Heart Institute. The applicant underwent treatment of "Mitral Valve Replacement Operation" at Krishna Heart Institute from 15.12.2006 to 26 -12 -2006 (Annexure R -2) and submitted the bill for reimbursement of Rs. 2,08,113/ -. The Competent Authority while considering the applicants case found that the hospital as per Annexure R -1 O.M. was required to charge as per CGHS rates, but has ignored the same. As per the CGHS rates specified in 2006, the applicant was entitled to Rs. 1,20,000/ - plus 15% addition for private ward, totaling Rs. 1,38,000/. The remaining amount of Rs. 70,000/ - claimed by the applicant was not within the limit prescribed and hence has not been sanctioned. These being the facts of the case, the respondents pray for dismissal of the OA with costs.

(2.) BOTH sides were heard in extenso. Documents produced by both sides were perused very carefully.

(3.) LEARNED Counsel for the applicant brought my attention to a decision dated 14 -5 -2007 of Hon'ble High Court of Delhi in Jaiprakash v. U.O.I. Writ Petition (C) No. 18218/2004. In that decision, Hon'ble Delhi High Court referred to the following judgments: