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Judgment
The applicant is working as an Office Superintendent in the office of the Defence Security Corps Records, Kannur Unit. While so, he met with a road accident on 12.9.2016 and was severely injured. According to the learned counsel for the applicant, the applicant fell unconscious on the road and somebody had taken him to Kasthurba Medical College Hospital, Mangalore where he had undergone a surgery and had also undergone follow up treatment as inpatient from 13.9.2016 onwards and follow-up treatment from 9.11.2016 to 16.11.2016, 16.11.2016 to 19.12.2016, 28.12.2016 to 30.1.2017 and 22.2.2017 to 24.2.2017. He had spent a total sum of Rs. 4.25 lakhs as treatment expenses and made claims for reimbursing the amount.
The grievance of the applicant is that he was sanctioned only Rs.46,498/- which has no connection whatsoever with the amounts what he had actually spent. According to the learned counsel for the applicant, he had suffered serious injuries to is left leg also. He was lying unconcious due to head injuries and had undergone surgery and was admitted in hospital for nearly one month at the first instance. Therefore, the respondents are liable to meet the entire expenses under CS(MA) Rules. When the above said claim was submitted, Annexure A-6 reply was given and aggrieved by the same, he has approached this Tribunal for quashing Annexure A-6 letter and for issuing a direction to the 3rd respondent to forward the applicant's claim along with the original bills and records to the Director General of CGHS for consideration of the same in accordance with Annexure A-4.
The respondents have opposed the Original Application. According to them, they have already paid an amount of Rs.76,192/-towards medical reimbursement as per the standing instructions and the extant rules, that Annexure A-4 is a subsequent O.M which cannot be applied to the facts of the case.
I heard the learned counsel for the applicant as well as the learned Standing Counsel for the respondents. Inviting my specific attention to Annexure A-1 Discharge Summary it is submitted that he was taken to the Kasthurba Medical College with history of R.T.A, diagonosed to have suffered Type II open bimalleolar fracture dislocation with head injury, neurosurgery reference given to Dr.Arjun Shetty and orders followed. The treatment details are given in Annexure A-1. It is evident from the summary that the patient was initially treated at Pariyaram Medical College Hospital after sustaining injuries in a road traffic accident at 5 p.m on 12.9.2016 near Kannur. Thereafter, he was referred to Kasthurba Medical College. From the treatment details available in Annexure A-1, it is clear that he had suffered very serious head injury and somebody had removed him to the Pariyaram Medical College from where he was referred to a higher centre, to Kasthurba Medical College, Mangalore. Annexure A1 also suggests that he had fracture of left ankle. In Mangalore hospital he was admitted and underwent prolonged treatment including a surgery. Relying on Annexure R-1 series documents, it is submitted that an amount of Rs.76,702/- has been granted towards reimbursement. But it appears from the documents produced that the claim of the applicant has not yet been finally decided by the respondents. They have sought for further documents from the applicant. The learned counsel for the applicant submits that all the documents available with him have already been submitted and if any more documents are necessary, he is prepared to submit the same. In this connection, Annexure A-4 O.M dated 22.5.2018 also should be an eye opener even though it was issued subsequent in point of time. It deals with what are the amounts to be reimbursed in excess of CGHS approved rates if the treatment was obtained from a private unrecognised hospital under emergency and the patient was admitted by others when the beneficiary was unconscious or severely incapacitated and was hospitalised for a prolonged period for treatment of head injury, coma etc. In the nature of the hospital treatment secured by the applicant, it seems that the claim requires to be processed with empathy, bearing in mind the guidelines issued under Annexure A-4 O.M.
Therefore, there will be a direction to the respondents to consider and dispose of the medical reimbursement claim made by the applicant taking into account the guidelines issued in Annexure A-4 O.M within 90 days from the date of receipt of records. The 3rd respondent shall forward the entire documents produced by the applicant to the Director General of CGHS within 30 days and the Director General shall dispose of the claim within a period of 90 days from the date of receipt of records.
The Original Application is disposed of as above. No costs.
List of Annexures
Annexure A1- True copy of Discharge Summery issued by the Kasthurba Medical College Hospital, Mangalore
Annexure A2- True copy of representation dated 24.1.2018 submitted by the applicant before the 2nd respondent
Annexure A3- True copy of letter dated 9.2.2018 from the 2nd respondent to the applicant
Annexure A4- True copy of Office Memorandum dated 22.5.2018
Annexure A5- True copy of letter dated 21.6.2018 from the 3rd respondent to the applicant.
Annexure A6- True copy of letter dated 4.9.2018 from the 3rd respondent to the Office of Defence Security Corps Records, Kannur
Annexure R1- True copies of relevant cheque slips
Annexure R2- True copy of letter No.AN/RTI/Corr dated 10.8.2017
Annexure R3- True copy of the CRO's letter No.LA Civ/1345/SYPB/213 dated 21.6.2018