Shiv Ram Singh Naulakha vs Union Of India And Ors

This Original Application (OA) has been filed by the applicant under Section 19 of the Administrative Tribunals Act, 1985, praying for the following relief:

"8.2 That the Hon'ble Tribunal may also be graciously pleased to direct the respondents to reimburse the amount spent by the applicant in Pushpanjali hospital, Agra for which the bill be deemed fit and proper on the facts and circumstances of the case."

The factual matrix of the case, as noticed from the facts, is as under:

2.1 The applicant was appointed as a Postal Assistant on 01.04.1963. He secured his regular promotions. He retired from service on 30.11.2003 from the post of Sub Post Master. After his retirement, the applicant has been residing at Mathura, which is not a CGHS covered city. He was thus entitled for grant of Fixed Medical Allowance (FMA). The Department of Pension and Pensioners' Welfare (DP&PW), Ministry of Public Grievances and Pensions, Govt. of India, have issued OMs dated 10.12.1997, 24.08.1998, 30.12.1998 and 18.08.1999 on the issue of FMA. Vide Annexure R-1 OM dated 19.11.2014 (p.94), the FMA has now been fixed at Rs.500/- per month. The FMA is meant for defraying day-to-day medical expenses and obviously does not cover the cost of hospitalization.

2.2 Apparently, after receiving representations from retired employees not residing in CGHS covered areas, the Ministry of Health and Family Welfare, vide its OM dated 05.06.1998, gave one time option to the employees after retirement for opting for medical coverage under CGHS or to remain under Central Services (Medical Allowance) Rules, 1944. All the retired Government servants opting for CGHS facilities were required to be registered with the nearest CGHS city for availing the hospitalization facilities. The Additional Director of the concerned CGHS City was designated as the competent authority for reimbursement of the medical claims.

2.3 The applicant vide his Annexure A-3 letter dated 19.10.2015 wrote to Senior Superintendent of Post Offices, Mathura Division (respondent No.3) stating that he and his wife were suffering from various diseases and they need CGHS facilities. He also inquired as to how much amount he has to pay for getting the CGHS card issued to him.

2.4 Unfortunately, the applicant suffered with a heart-attack on 06.11.2015. He was taken to Pushpanjali Institute of Cardiac Sciences (hereinafter referred to as Pushpanjali hospital) at Agra where he was hospitalized from 06.11.2015 to 11.11.2015. The hospital vide its letter dated 19.12.2015 (Annexure A-4) issued a certificate, which reads as under:

"This is to certify that Mr. Shiv Ram Singh Naulakha, 72 old male, normotensive, non-diabetic, with no family history of ischemic heart disease, presented on 06.11.2015 as a case of CAD, ACS, Acute AWMI. Subsequently Patient underwent CAG and Primary PTCA+stent to LAD on 07/11/2015 in same sitting. Later patient was discharged on 11/11/2015. He has been under my treatment on OPD basis since then."

2.5 The hospital also presented a bill of Rs.2,34,344/- towards medical expenses.

2.6 The applicant wrote to respondent no.3 vide letter dated 05.12.2015 seeking reimbursement of the medical expenses. The respondent no.3 vide the impugned Annexure A-4 communication dated 09.12.2015 informed him that pensioners are not given CGHS benefits nor is there any provision for reimbursement of his medical expenses.

2.7 Aggrieved by the Annexure A-4 communication dated 09.12.2015 from respondent no.3, the applicant has approached the Tribunal in the present OA seeking the relief as indicated in para-1 supra.

Pursuant to the notices issued, the respondents entered appearance and filed their reply in which they have broadly made the following averments:

3.1 The applicant has been getting FMA @Rs.500/- per month since he is residing at Mathura, which is not a CGHS covered city. He is thus not entitled for reimbursement of his medical bills. Accordingly, the respondent no.3 vide letter dated 09.12.2015 informed him that there is no provision for granting him the medical reimbursement. The respondent no.3 had consulted respondent no.2 in the matter.

3.2 The Central Government beneficiaries living in non-CGHS covered cities have an option to apply for the CGHS benefits in the nearest CGHS covered city. The applicant was accordingly informed by respondent no.3.

Arguments of the learned counsel for the parties were heard on 05.02.2018. Ms. Meenu Sharma, learned counsel for the applicant stated that the applicant had prayed for allowing him the benefits of Ministry of Health and Family Welfare OM dated 05.06.1998 (Annexure A-10) according to which one time option was to be given to the applicant for getting himself covered under the CGHS Scheme and accordingly he had written to respondent no.3 vide his Annexure A-3 letter dated 19.10.2015. However, before he could follow up his request with the respondent no.3, he suffered heart-attack on 06.11.2015 for which he had to undergo treatment at the nearby speciality hospital, viz. Pushpanjali hospital, Agra.

4.1 Mrs. Mainee further submitted that the case of the applicant is squarely covered by the judgment of the Jodhpur Bench of this Tribunal in the case of Vinod Kumar Bohra v. Union of India & Others, [OA No.207/2013, decided on 11.02.2014]; the operative part of which reads as under:

"16. Therefore, in my considered view in the light of OM dated 05.06.1998, which has been sent by the respondent themselves to the applicant as at Annexure-A/3 and by which the CS (MA) Rules have been directed to be extended to retired Government officials and the same has been upheld to hold the field as per judgment of the Honble High Court of Gujarat at Ahmedabad in Special Civil Application No.7895/2004 and also in the light of the judgment of the Honble High Court of Karntaka at Bangalore in Writ Petition No.39031/2003 wherein rule regarding non-applicability of CS (MA) Rules, 1944 to retired Government servants has been declared unconstitutional, and in the spirit of judgment of the Honble Delhi High Court in Civil Writ Petition No.4873/2000 that discrimination cannot be made on the basis of the pensioners residing in CGHS area or non-CGHS area, the applicant is entitled to reimbursement of his medical claims for expenditure in a hospitalization case. Accordingly, the respondents are directed to consider the claim of the applicant for reimbursement of medical expenditure for treatment in the Government Hospital (as at Annexure-A/4) and decide the same within a period of four months from the date of receipt of a copy of this order."

Shri Rajinder Nischal, learned counsel for the respondents, reiterating the averments made in the reply field on behalf of the respondents, stated that since the applicant has been getting FMA he cannot be granted medical reimbursement.

I have given my thoughtful consideration to the arguments of the learned counsel for the parties and have also perused the pleadings. Indisputably, the OM dated 05.06.1998 (Annexure A-10) of the Ministry of Health and Family Welfare provides for one time option to a Central Government pensioner to opt for medical coverage under CGHS or under the Central Services (Medical Allowances) Rules, 1944. Since the applicant has been residing at Mathura, which is a non-CGHS covered city, he had Hobson's choice of remaining satisfied with the FMA. However, due to his frailing health and that of his wife, he felt that the CGHS coverage is required for them. Accordingly, vide his Annexure A-3 letter dated 09.10.2015, he wrote to respondent no.3 for getting him covered under the CGHS Scheme and to get a CGHS card issued to him. He has also volunteered to pay the CGHS subscription fee, which apparently is Rs.25,000/-. As the luck would have it, before this request could translate into a concrete action at the end of the respondents, the applicant suffered heart-attack and had to avail treatment at the nearby speciality hospital, viz. Pushpanjali hospital, Agra. For his hospitalization from 06.11.2011 to 11.11.2011 and for undergoing "CAG and Primary PTCA+stent to LAD", medical expenses of Rs.2,34,344/- has been incurred as per the Annexure A-5 medical bills of the hospital dated 11.11.2015. It is understandable that as on date, as the things stand, the respondents could not have granted him reimbursement of the medical expenses. However, considering his case with sympathy and empathy, I am of the view that the applicant deserves financial assistance from the Government by way of medical reimbursement. The judgment of the Jodhpur Bench of the Tribunal in Vinod Kumar Bohra (supra) also supports the case. I also feel that the request of the applicant vide his Annexure A-3 letter dated 19.10.2015 for granting him CGHS coverage needs to be taken to its logical end.

Accordingly I allow the OA in the following terms:

i) The respondents shall reimburse the medical expenses of Rs.2,34,344/- incurred by the applicant at Pushpanjali Institute of Cardiac Sciences, Agra on his treatment within a period of six weeks from the date of receipt of a copy of this order.

ii) The respondents are further directed to process the request of the applicant for CGHS benefits with reference to his Annexure A-3 letter dated 19.10.2015 and issue him a CGHS card within a period of two months from the date of receipt of a certified copy of this order. The applicant shall pay the requisite CGHS subscription fee.

There shall be no order as to costs.