Delhi High Court allows appeal for medical reimbursement to retired Delhi govt employee

The Delhi High Court has allowed a petition seeking reimbursement of medical expenses filed by a retired Delhi Judicial Service officer in appeal against the claims rejection.

The Court said the Delhi government could be a little more sensitive when it’s dealing with senior citizens who are their own retired employees who were seeking reimbursement of medical expenses. The petitioner herein is a Delhi Government Employees Health Scheme (DGEHS) member and a retired Judicial Officer of the Delhi Judicial Service.

The single-judge bench of Justice Rekha Palli directed Delhi government to release Rs 4,27,276 (Rs 4.27 lakh) to the petitioner within two weeks, subject to verification of bills submitted by the petitioner as per procedure.

The bench set aside the Delhi government’s order dated March 1, 2021 rejecting the reimbursement claimed by the petitioner. A sum of Rs 4,27,276  was claimed by the petitioner for the amount spent for treating his wife. Justice Palli expressed her anguish over the incidents that how the petitioner’s claim was rejected in a whole cryptic manner altogether.

The bench said the office memorandum says any DGEHS beneficiary can take treatment in a hospital outside Delhi if the facility is CGHS-empanelled. But the Delhi government claims to have rejected the claim for reimbursement citing no provision to repay for treatment taken in OPD of hospital not under DGEHS empanelment. Further, the order doesn’t explicitly say why the claim was rejected either.

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Advocate G. C. Chawla, counsel for the petitioner, submitted that the petitioner’s wife Raj Bala Gupta was diagnosed with Cholongio Carcinoma, a rare type of cancer which cannot be operated upon, after a biopsy at Medanta, Gurugram. She was then referred to Apollo Hospital, Chennai and permission was sought for the same through air ambulance but it was not granted.

Whereas Advocate Sameer Vashisht, on behalf of Delhi Government, contended that Medanta Hospital was empanelled under Central Government Health Scheme, whereas the petitioner is a member under DGEHS hence the reimbursement he is seeking cannot be released. And once the hospital was not empanelled under DGEHS, the petitioner’s claim for reimbursement cannot be faulted for not being accepted.

The bench said the welfare provision of taking treatment under CGHS outside Delhi for DGEHS beneficiaries has to be given full effect and the claim cannot be so summarily be rejected. This is even so because the office memorandum approves CGHS empanelled hospitals outside Delhi for DGEHS beneficiaries very clearly, the order said.

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