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Judgment
Pratima K Gupta, Member (J)
I have joined this Bench online through video conferencing.
Shri Harsh Gopal, learned counsel for the applicant and Shri Arvind Singh, learned counsel for the respondents are present.
In the present OA the applicant seeks the following reliefs:-
“i. Call for original service record of petitioner and quash the impugned order dated 16.05.2019 (Annexure No. 1 to compilation No.1).
ii. Suitable order or direction, directing and commanding the respondents to rele3ase medical reimbursement amount due upon respondent for payment to petitioner and 14% compound interest on total amount annually.
iii. any other or further order as it deem fit and proper in the circumstances of the case.
iv. Award cost of petition to the applicant.”
The brief facts of the case are that the applicant while in service was admitted, in Saraswati Heart Care Hospital, Allahabad on 13.09.2016 due to severe chest pain. Subsequently, he was shifted in emergency to Medanta Hospital, Guragram, Haryana on 17.09.2016. At the Medanta Hospital, Gurugram the applicant underwent a coronary bypass surgery and was discharged on 25.09.2013. At the Medanta Hospital the applicant has paid Rs. 221350/- (Rs. 186350/- as Hospital charge and Rs. 35000/- as Ambulance charges). The applicant being a CGHS beneficiary preferred a claim for release of the said amount. The applicant submits that the Accounts Officer had sought for the emergency certificate issued by The Medanta Hospital, Gurugram while admitting him. The applicant duly submitted the same on 30.03.2017 to the Accounts Officer in order to process the claim. However, the claim of the applicant has been rejected by the respondents. Learned counsel for the applicant submits that this application is not accompanied by the rejection order passed by the competent authority rejecting his medical reimbursement claim, as it was not in his possession. He preferred an appeal against the said order and the same is rejected by a non-speaking order dated 16.05.2019 which is impugned in the present OA (annexed at page 17). The said order is reproduced as under:-
“Sub: Regarding grant of “Ex-post-facto” approval for out of Circle treatment – Appeal of Shri Krishna Gopal (HR No. 198212651), Retired Executive Engineer (E), Gorakhpur.
Kindly refer to your appeal dated 14.03.2019 addressed to CGMT, BSNL IP(East) Circle, Lucknow on the subject matter received in this office on 18.03.2019.
In this regard it is to inform you that your above appeal has been regretted by the competent authority.”
The learned counsel for the applicant submits that the impugned order passed by the appellate authority is non speaking and as it does not stipulate any reason for rejection of the claim of the applicant of the medical reimbursement.
Learned counsel for the respondents relies on the counter reply and submits that the reason for rejecting the claim was that in order to streamline and regularize the indoor medical claim for speedy reimbursement guidelines were issued vide “medical cell/M-11/Gen Pratachar/17/2 dated 07.02.2018. He further submits that the applicant applied for ‘post facto approval’ of the competent authority i.e. CGMT but it was turned down as there is no such provision of ‘post facto approval’ by the department.
Heard learned counsel for the parties and perused the record carefully.
It is not in dispute that the applicant was duly admitted in Medanta Hospital, Guraugram. It is also not in dispute that the hospital has charged the alleged amount which is as per the CGHS rates and rules. The applicant has paid the said amount to the hospital. It is also not in dispute that the applicant did suffer a massive heart attack and he was admitted to a local hospital and immediately thereafter within four days he was admitted to Medanta Hospital, Gurugram for a coronary bypass. It is clear that the dependents of the applicant in fact were running pillar to post to save the applicant rather getting into the formalities of the approval of the authorities, The same is substantiated from the fact that the dependents were forced to deposit of more than 3 lacs before the surgery and part of it was refunded after the alleged amount was adjusted by the Medanta Hospital. It is also clear that at the appropriate time it was quite necessary that the applicant is attended. The order dated 16.05.2019 being non speaking order is quashed. The respondents are directed to process the claim of the applicant for the amount so paid by the applicant at page No. 36 (Rs.186350/-) to the Medanta Hospital, Gurugram, within a period of four months.
In view of the above direction the OA is allowed. No costs.