AI Structured Summary
Not yet generated for this judgment
Judgment
Mahesh Grover, J.—The petitioner prays for medical reimbursement on account of the treatment that he had to make available to his son who is Haemophilic. Learned Counsel for the petitioner contends that the disease with which his son has been afflicted is chronic Haemophilia ''A'' with pseudotumor with HIV positive since his birth. According to the Learned Counsel for the petitioner the treatment for the aforesaid affliction is available in a hospital in Pune which is the sole hospital catering to such contingencies.
A huge amount of expenditure was incurred on the said treatment out of which the respondents have reimbursed a special claim on the parity of rates as admissible in the PGIMS, Chandigarh.
Learned Counsel for the petitioner contends that his solitary grievance is directed at the denial on the claim under certain heads which have been disputed by the respondents. He further contends that even though heads under this disputed claim as reflected in Annexure P-12 are numerous but he would confine his claim only to the operation charges for which an amount of Rs. 3,04,100/- has been incurred whereas the respondents have reimbursed only an amount to the extent of Rs. 2,000/- on the reasoning that there is no provision for such rates in the rate list of PGIMS, Chandigarh/AIIMS, New Delhi.
Denial of this amount to the petitioner in the considered opinion of this Court is unfair, moreso, when the reasoning reflected in Annexure P-12 is that there is no provision in the rate list of PGIMS, Chandigarh/AIIMS, New Delhi.
If a particular treatment is not available in a hospital such as PGIMS, Chandigarh/AIIMS, New Delhi and for which no rates have been prescribed, the petitioner cannot be denied the operation charges specially when the treatment is not disputed. It is settled proposition of law that availing of medical treatment from a specialized hospital in the cases of chronic diseases, the amount incurred on account thereof cannot be denied.
Having regard to the aforesaid, the instant petition is allowed and the respondents are directed to reimburse the operation charges amounting to Rs. 3,04,100/- after deducting Rs. 2,000/- which have already been reimbursed to the petitioner.