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Bina Saxena Vs. Union of India and Ors. - (High Court of Bombay) (26 Jun 2023)

Any amount over and above Central Government Health Scheme rates can’t be reimbursed



Petitioner assails judgment and order passed by Central Administrative Tribunal, Mumbai dismissing the Original Application. The Original Application was instituted by Petitioner seeking reimbursement of balance amount of medical expenses of Rs. 3,78,986 incurred for medical treatment of her late husband at Ruby Hall Clinic, Pune.

While exercising power of superintendence over the decision of the Tribunal within contours specified in the Constitution Bench judgment in L. Chandra Kumar vs. Union of India, present Court is not expected to sit in appeal over finding of fact recorded by the Tribunal. Two sets of documents were presented before the Tribunal by the rival parties in support of their respective contentions. The Tribunal has proceeded to accept the contents of specific email sent by the hospital certifying that the admission of the patient was not in emergency situation. The said email was addressed by the hospital to the Respondents in the light of specific query relating to reimbursement of medical expenses. Thus, 'emergency' within the context of reimbursement of medical expenses was required to be certified by the hospital and has been so certified by way of Email dated 25thJuly, 2017. As against this, the Certificate dated 17thMay, 2016 is in a standard format and is not issued in the context of reimbursement of medical expenses. The Tribunal has proceeded give more weightage to the contents of the email over the certificate. The Tribunal was entitled to do so.

Even if it is to be assumed that, admission of Petitioner's husband was an emergency case, the only amount to which Petitioner would be entitled to is as per Central Government Health Scheme(CGHS) rates. Expenditure for the entire treatment availed at Ruby Hall Clinic by Petitioner's husband is reimbursed, albeit at CGHS rates. No rule or administrative instruction is placed on record by Petitioner to show that any amount over and above CGHS rates can be reimbursed. Therefore, no fault can be found in the action of the Respondents who have taken sympathetic view of the matter and have reimbursed the entire costs of medical treatment (at CGHS rates) by ignoring the fact that Referral Memo was not obtained from CGHS Wellness Centre and Petitioner's husband was not admitted in emergency situation. Substantial amount of Rs. 9,68,893has been reimbursed to the Petitioner. Petitioner's claim for reimbursement of additional amount over and above Rs. 9,68,893is not supported by any rule or administrative instructions. The judgment and order of the Tribunal to be unexceptionable. Petition dismissed.


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