Central Administrative Tribunal
Principal Bench, New Delhi
O. A. No. 2464/2005
Wednesday, this the 3rd day of May 2006
Hon’ble Shri Shanker Raju, Member
Shri. Surinder Singh
S/o Shri Kanwar Singh
Working as Tech Grade
Under Section Engineer (Works)
S & T Northern Railway
DRM Office, New Delhi
(By Advocate: Shri Amit Anand)Applicant
Versus
Union of India
1.The General Manager
Northern Railway
Baroda House, New Delhi
2.The Division Railway Manager
Northern Railway
State Entry Road, New Delhi
3.The Chief Medical Superintendent
Northern Railway
Divisional Railway,
New DelhiRespondents
(By Advocate: Shri Saba Raman)
ORDER (ORAL)
1Heard the learned counsel for the parties :
2.Litigation in two OAs earlier filed by the applicant culminated into an order passed on 29-09-2005 wherein the reimbursement of medical expenses has been granted to the extent of AIIMS rates.
3.Learned counsel for applicant seeks full reimbursement o the medical calim by placing reliance on a decision of the Tribunal in OA-978/2002 in S. R. Jha V. Unior of India & Others, decided on 29-01-2003 wherein it had been held that if the concerned ………… hospital, which is recognized by the Government charges more than the package rates then it is within the prerogative
of the railway authorities or the Government to reimburse the actual expenses incurred by the Government servant and rest of the amount can be recovered from the hospital or the recognition of such hospital be revoked.
4.In furtherance of this a decision of the Apex Court in Suman Rakheja Vs. State of Haryana & Others (2004) To SCC 563 laid down that in case of emergency, even in a private non-recognized hospital, the Government servant is entitled to get refund not only 100% medical expenses at the AIIMS rates but also 75% of expenditure in excess thereto.
5.As the aforesaid decision is latest in line, the same is binding on me.
6.In the light of the aforesaid the present OA partly allowed Respondents are directed to reimburse the 75% of the actual expenses incurred by the applicant over and above the AIIMS rates, which has already been reimbursed to the applicant, within a period of two months from the date of receipt of a copy of this order no cost.
7.In the light of the above, the only objection raised in the present OA as to with dated essentially certificate hearing already been adjudicated upon and ruled out by the Tribunal earlier in OA-563/2004 decided on 17-08-2004 has attained finality and cannot be re-agitated.
Shanker Raju
Member (J)
CENTRAL INFORMATION COMMISSION
BLOCK IV, OLD JNU CAMPUS, NEW DELHI 110067
Appeal No.30/ CPB/2006
June 13, 2006
In the matter of Right to Information Act, 2005 – Section 19.
Appellant: Ms. M.N. Trivel, Pune
Public Authority: Central Government Health Scheme, Pune
Shri J.P. Gupta, CPIO
Dr. G.T. Thawani, Appellate Authority.
Facts
The father of the appellant who is a CGHS beneficiary pensioner was admitted in
Ushakiran Hospital which is a recognized hospital under CGHS Scheme on 1.12.2003 as an
emergency case. On paying the hospital charges, the appellant submitted a claim application for
Rs.4272.64 to CGHS, Pune on 9.12.2003. His claim was rejected on the ground that the
treatment was not of an emergency nature and as such the patient could not have been admitted
without the prior permission of CGHS. Aggrieved with the decision of CGHS, on 18.7.2005,
the appellant filed a case in Pune District Consumer Forum against CGHS, Pune, CGHS, New
Delhi and one Dr. Gaikwad of Ushakiran Hospital, Pune. Stating that to gather evidence in
connection with that case, she filed an application under the Act seeking for certain documents
on 24.10.2005.
In the application, the appellant had sought for the following information:
(1) Details of hospitalization of her father from 1.12.1995 to till date giving details like hospital name, duration of hospitalization, admitted for which ailment, claim admitted by hospital or
amount reimbursement to pensioner.
(2) Copies of memo issued by Dispensary-III on 27.12.1995 and 28.12.1995.
(3) Copy of local purchase, indent for medicines prescription provided by Shri Narayan on
6.12.2003 and received by pensioner’s son on 9.12.2003.
(4) Whether Ushakiran Hospital had admitted the claim or not of her father’s admission
in the hospital from 26.12.2003 to 28.12.2003 and if admitted the amount of claim paid
towards the bill and the details thereof.
2. By a letter dated 10.11.2005, CPIO advised the appellant to remit Rs.10/- being the
application fee which was remitted by the appellant on 14.11.2005. By a communication dated
30thNovember, 2005, the CPIO requested the appellant to furnish the details of hospitalization of her father i.e. names of hospitals and month/year in which admitted etc. to trace out and retrieve relevant
records so that details of payment made to the hospitals could be provided to her.
By a letter dated 2nd December, 2005, while expressing difficulties in furnishing the exact
details as no records relating to the hospitalization of her father was available with her, the appellant informed the CPIO that her father had been admitted in Rubi Hall Clinic, KM Hospital, Ushakiran
Hospital etc. By a letter dated 16thJanuary, 2006, the CPIO informed the appellant that since she had failed to give the details and particulars of the period of treatment taken in different hospitals, it was not requirement for bilateral hearing Aid on the basis of his/her hearing loss and its attendant disability/speech training requirement in adult may be permitted upto maximum ceiling of Rs. 20,000/-. However the hearing Aid should be recommended by ENT surgeon after considering the hearing loss of a patient and its attendant disability supported by audiometric evidence.
2. On rejection of the claim the respondent filed a complaint before the district Forum.
3.Vide impugned order dated 20-10-2005, the District Forum has directed the appellant to Pay a sum of Rs. 10,000/- towards reimbursement cost of hearing aid keeping in view the ceiling or Rs. 20,000/- and 3,000/- as compensation and Rs. 2,000/- as cost of litigation.
4.Through this appeal the impugned order has been assailed mainly on the ground that the respondent was not a consumer qua the appellant being a government pensioner. The question of reimbursement of medical expense by the subscriber of the scheme does not come within the ambit of consumer dispute.
5.In our view monthly subscription or lump sum subscription received by the appellant towards the scheme is a consideration for availing medical service and since medical service comes within the ambit of service is defined by the Section 2(1)(0) of Consumer protection Act 1986 the respondent assumes the status of consumer qua the appellant.
6.In our view the stand taken by the appellant that the maximum celling was Rs. 20,000/- and the respondent inspite of going to the government hospital abtained the opinion from Private
hospital and did not adhere to other requirement of the scheme. We partly allow the appeal by retaining the direction to pay Rs. 10,000/- set aside the rest of the order. The payment shall be made within one month.
7.The apeal is disposed of in above terms bank guarantee/FDR, if any, furnished by the appellant be returned forthwith.
8.A copy of this order as per the statutory requirements be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to record room.
Anounced today on 20th day of April 2006.
(Justice J. D. Kapoor)
President
(Rumnita Mittal)
Member
IN THE STATE COMMISSION : DELHI
(Constituted under section 9 clause (b) of the Consumer Protection Act 1986)
Date of Decision : 20-04-06
First Appeal No. 1009/2005
Arising from the order dated 20-10-2005 passed by District Forum (East) saini Enclave, Delhi in Complaint Case No. 673/2005
Union of IndiaAppellant
Through Director, Through Mr. A. N. S. Murti
Central Government Health Scheme Advocate
Nirman Bhawan, New Delhi
Versus
Sh. Puran Singh
A-117, FF, Swasthya Vihar Respondent
Delhi
CORAM
Justice J. D. KapoorPresident
Ms. Rumnita Mittal Member
1.Whether reporters of local newspapers be allowed to see the judgments.
2.To be refered to the Reported or not.
Justice J. D. Kapoor, President (ORAL) : Yes
1.Appellant runs a health scheme for its employees known as C. G. H. S. deducts monthly charges from their salaries as subscription, Respondent being the beneficiary of scheme incurred expenses of Rs. 21.500/- for purchasing hearing aid for both ears of his wife. Appellant sanctioned only Rs. 10,000/- and rejected the remaining amount, in view of the policy of the appellant with regard to reimbursement of hear aids enunciated in office memorandum No F. No. S.14025/36/93/MS dated 17-08-1999 which is as under:
The undersigned is directed to say that a committee was appointed to consider the issue of revision of rates of Hearing Aids fixed by this Ministry Vide Om No. S.14025/36/93/MS dated 26- 09-1994 and also to determine a time period for replacement of the hearing aids. On the recommendation of the committee of expert. It has been decided to fix the maximum ceiling rate upto Rs. 10,000/- for body worn/pocket/behind the ear type in the canal type (Conventional) as per requirement of the patient for one sided hearing Aid. Any patient
requirement for bilateral hearing Aid on the basis of his/her hearing loss and its attendant disability/speech training requirement in adult may be permitted up to maximum ceiling of Rs. 20,000/-. However the hearing Aid should be recommended by ENT surgeon after considering the hearing loss of a patient and its attendant disability supported by audiometric evidence.