Tribunal quashes order denying full medical claim to retired railway employee

The Chandigarh Bench of the Central Administrative Tribunal has quashed an order passed by the Chief Medical Superintendent, Northern Railway Divisional Hospital, Ambala Cantt, refusing to reimburse the total medical bill of an 86-year-old retired employee.

Terming the order illegal, the bench directed the respondents railway authorities to review the medical claim of the applicant by passing a reasoned and speaking order within a period of two months from the date of receipt of a copy of this order.

The bench passed the order on an application filed by retired employee Ramesh Chandar Sharma through advocates Surinder Kumar Gupta and Rajeev Gupta .

Sharma said he retired from the Railways on August 31, 1995, from the post of Chief Parcel Supervisor.

On September 5, 2022, he felt acute stomach pain. His son-in-law took Ramesh to a doctor for check-up. He was admitted to emergency of Fortis Hospital, Mohali, on September 6, 2022, where he was diagnosed with the obstructed Incisional Hernia.

He was recommended immediate surgery as the only option to survive. The son-in-law informed the Medical Officer, Northern Railway Hospital, Kalka. The cashless treatment was denied because the case was not forwarded/referred from the Medical Officer.

Ramesh took the treatment in emergency at Fortis Hospital from September 6 to September 17. He incurred an amount of Rs 6,45,172 on his treatment and submitted the medical claim to the authorities for reimbursement out of which he was reimbursed only Rs32,027.

He prayed before the bench to issue directions to the Medical Officer, Northern Railway Hospital, Kalka, and Chief Medical Superintendent, Northern Railway Hospital, Ambala Cantt, to reimburse the balance amount of the claim on the basis of Railway Board’s Letters.

The Medical Officer opposed the application, saying that as per guidelines for the treatment taken in a non-recognised private hospital, the reimbursement should be made at the CGHS rates of that city or nearest city. If one or two minor procedures form part of a major treatment procedure, then package charges would be permissible for major procedure and only procedure at 50% of charges for minor procedure. In the light of above, an reimbursable amount was calculated at the rate of Rs 32,027 and it has been paid to the applicant.

After hearing of the arguments Suresh Kumar Batra, Member (J) of the bench said that the applicant is a senior citizen aged 86 years, who was operated upon in emergency for obstructed Incisional Hernia. It is also admitted by the respondents that the emergency in the applicant’s case is justified. The applicant’s appeal to review the medical claim settlement has been rejected by a non-speaking order dated June 5, 2023, which is hereby quashed and set aside as being illegal.