Mihir Kumar Ray Barman vs Ministry Of Health And Family Welfare & Anr.

Leave granted.

The spouse of the appellant was admitted during the course of a medical emergency at the BM Birla Heart Research Centre, Kolkata which is an

empanelled private hospital under the Central Government Health Scheme [“CGHSâ€]. It is common ground that the patient was covered by the

CGHS. She was admitted in a condition which required emergency medical care. Hence on 15 July 2013 the appellant informed the Chief Medical

Officer-HQ (CGHS) of the institution in which his spouse was admitted, involving multi-organ failure and heart disease. Since the treatment was

expected to be prolonged, the appellant stated that she would require to be treated under the CGHS. In his letter dated 15 July 2013, the appellant

stated that considering the serious nature of the ailment, treatment was being taken in  a non-empanelled hospital under emergency, in a higher type

of accommodation. A copy of the letter was addressed to the BM Birla Heart Research Centre, Kolkata. As a matter of fact, it has emerged before

this Court from the counter affidavit, which has been filed by the Additional Director, CGHS, Kolkata, that the BM Birla Hearth Research Centre,

Kolkata is an empanelled hospital. The spouse of the appellant died during the course of the treatment on 20 August 2013. An amount of Rs 7,71,533

was paid to the appellant in settlement of the claim leaving a balance amount of Rs 3,39,467. The balance, the Court has been informed, is after taking

into account the amount which was received by way of settlement under the Medi-claim policy. The appellant moved the State Consumer Disputes

Redressal Commission and upon the petition being rejected, unsuccessfully pursued his claim before the National Consumer Disputes Redressal

Commission.

The facts which have come on record indicate that there is no dispute about the fact that the appellant and his spouse were covered under the

CGHS. The appellant has explained that the delay in intimating that his spouse shall be covered by the CGHS was as a result of the extreme medical

emergency under which she was admitted for treatment. In view of the aforesaid facts and circumstances, it would be appropriate if the balance of

Rs 3,39,467 is reimbursed to the appellant, in the peculiar facts of the case. This will, however, not be construed as an adjudication of this Court on the

rules and regulations, which is unnecessary for the purpose of the present appeal. The balance amount be paid over to the appellant within a period of

two months from the date of receipt of the certified copy of this order.

The appeal is accordingly allowed. No costs.