Air India Ltd vs L M KHOSLA

-THE short issue to be decided in this matter is whether Air India can further restrict reimbursement of medical expenditure incurred by its ex-employee when the latter himself had persuaded the nursing home to substantially reduce the medical bill.

FACTUAL matrix of the case in brief is that Sh. Lalit M. Khosla, who retired as Commercial Manager from Air India in 1990 had undergone emergency operation at Aashlok Hospital, New Delhi for removal of infected gall bladder. Though the complainant was billed for a sum of Rs. 1,29,963, in view of the personal relationship with the Director of the hospital, the bill was drastically reduced to Rs. 59,967. Complainant had also spent a sum of Rs. 1,714 towards medicines, surgeon fees, etc. As Air India reimbursed only a sum of Rs. 27,528, the complainant filed a complaint praying for direction to Air India to pay him the balance sum of Rs. 34,163. Air India contested the complainant''s case and submitted that as per the rules of Medical Benefits Scheme the complainant was entitled to reimbursement of an amount of Rs. 6,000 towards surgeon''s fee along with 33% of surgeon''s fee as operation theatre charges and 45% of the surgeon''s fee towards anaesthesia charges along with actual cost of drugs administered to him. Therefore, the complainant was reimbursed a sum of Rs. 27,528 to which he was entitled.

District Forum allowed the complaint and directed Air Inia to reimburse the entire amount of expenditure along with Rs. 5,000 as compensation for mental and physical harassment and Rs. 2,000 as cost of litigation.

AGGRIEVED by order of District Forum Air India filed an appeal before the State Commission. The State Commission after a close scrutiny of rules relating to hospitalization in non-panel institutions held that the embargo restricting expenditure is limited to 7days of hospitalization only. Further held that "emergency is an emergency. No person is expected to first go to the authority to take approval when his life is in danger nor is he expected to intimate the department about the expenses he may incur for seven days because of his being in such a emergent condition. In our view the purpose of putting an embargo of seven days was not confined to the reimbursement of the expenses as per schedule of the panel hospital. The purpose was only to see that for more than one week confinement of a person in a hospital he was entitled to reimbursement of expenses incurred for seven days". In case of surgical treatment required by the retired staff in such stations where Air India''s medical arrangements are not available, the employee is permitted to have the surgery done from a private nursing home/hospital also and the cost of such surgery will be reimbursed as per our laid down schedule and subject to hospital bills, other supporting documents and reports of investigations undergone are attached to the claim, in addition to the admission and discharge card after prior permission from the Director, Medical Services.

BUT this clause is applicable only to such stations where Air India medical arrangements are not available i. e. , especially remote stations. Whereas in this case the complainant has undergone medical surgical treatment in a non-panel institutions at a place in an emergency in a place like Delhi where Air India''s medical arrangements are available. Hence the aforementioned clause is not applicable. Assuming for a moment that this clause is applicable then also the ex-employee has persuaded the hospital/nursing home to drastically reduce the bill. Air India''s attempt in further reducing it by making the schedule attached to the clause (supra) applicable appears to be too harsh. Accordingly, we do not find any merit in this revision petition. The revision petition is dismissed as there is no material irregularity or jurisdictional error in the order passed by the State Commission. There shall be no order to the costs. Revision Petition dismissed.