NIRMALA DAHIYA Vs. UNION OF INDIA AND ORS.

JUDGEMENT

(1.) IN this Original Application, the applicant has prayed for the following reliefs:

(2.) BRIEF facts of the applicants case, as projected in her O.A., run thus: The applicant is a Government employee. On 28.6.2013, her husband developed severe pain in urinator with high grade fever and started dark black urine. He was admitted to Prashant Hospital, Prashant Vihar, New Delhi. As per the advice of the treating physician, he was immediately taken for urgent investigations including KUB From Saral Diag. Upon investigation, a decision was taken to immediately go for surgery. The surgery, named, PYELOUTHOTOMY & PYELOPLASTY was done on 1.7.2013. He remained in the hospital up to 7.7.2013. During hospitalization, a total amount of Rs. 1,04,562/ - was incurred as medical expenses for the said treatment of her husband. On 23.7.2013 the applicant submitted the medical reimbursement claim to the respondent -Department. The audit authority, vide its memo dated 30.9.2013, passed payment of Rs. 16,200/ - only as per CGHS rate as against her claim of Rs. 1,04,562/ -. Thereafter, the respondent -Department forwarded the applicant's claim to the Director, CGHS, Bikaner House, New Delhi, to reexamine the applicant's claim and submit a report on the entitlement of the applicant. The CGHS, vide its letter dated 22.11.2013, reported that Rs. 20,250/ - only was reimbursable to the applicant. On the basis of the CGHS's report, the respondent -Department, vide letter dated 22.11.2013 (annexure A/1), resubmitted the applicant's claim to respondent No. 4 for admitting the same at Rs. 20,250/ -. Being aggrieved, the applicant has filed the present O.A. seeking the reliefs, as aforesaid.

(3.) RESPONDENT No. 3 -Director, CGHS, has filed a separate counter reply opposing the O.A. It is stated by respondent No. 3 that in emergency the husband of the applicant got admitted to Prashant Hospital, Prashant Vihar, which is not empanelled under the CGHS. He underwent the Procedures of Peylolithotomy & Pyeloplasty, both of which are listed Procedures in CGHS, 2010 List. Out of an expenditure of Rs. 1,04,562/ - incurred, the respondent -Department approved Rs. 16,200/ - as medical claim. Since the applicant was dissatisfied, the file was sent to the Ministry of Health & Family Welfare for its opinion. The Ministry of Health & Family Welfare (R&H) has calculated the amount as under: <FRM>JUDGEMENT_59_LAWS(CA)4_2015.htm</FRM>