Rajinder Kumar Saxena vs Union Of India And Ors

The applicant in the O.A. was working as a Mail Guard at Saharanpur with the respondents. In 2013, he developed some illness relating to Kidney and was shifted from Central Hospital, Northern Railway, Delhi to Institute of Liver & Billiary Sciences (ILBS) Hospital.

The applicant went to IBLS Hospital on 01.01.2013 and was admitted in the hospital on 05.11.2013. After some initial treatment, his actual operation for kidney transplant took place on 07.11.2013. He was discharged from the hospital on 05.12.2013.

2.1 The applicant was again admitted to the hospital on account of some complications. He was admitted to the hospital on 21.02.2014 and remained in the hospital upto 10.03.2014. Subsequently, the applicant was again taken ill and he got admitted to the Railway Central Hospital on 13.03.2014. Since there was no relief in his condition, the applicant was again shifted to ILBS hospital on 16.03.2014 where he remained under treatment till 24.03.2014.

2.2 The applicant states that because of the post operative complications, an amount of Rs. 6,37,086/- was incurred in addition to the amount of Rs.4,25,000/-, which had been paid in advance to the applicant by the respondents.

The applicant submitted four bills duly verified by the hospital to the respondents. Details of the same are as under:-

(a) Details of day-wise and item-wise break up of Bills amounting to Rs. 2,63,455.94.

(b) Details of day-wise and item-wise break up of Bills amounting to Rs. 1,84,581.37.

(c) Details of day-wise and item-wise break up of Bills amounting to Rs.1,89,110.65.

(d) Cash payment done for an amount of Rs. 22,340.

These bills were returned to the applicant with the objection that he had not contacted Railway Central Hospital, New Delhi and got prior approval for admission. He was also directed to get the essentiality certificate issued duly verified by Railway Central Hospital, New Delhi. Subsequently, the applicant was asked to get the delay condoned for late submission of medical bills, which was also done by him. After doing the needful, the applicant resubmitted the bills to the ACMS Saharanpur.

3.1 The applicant represented to the Chief Medical Director, Northern Railway, Baroda House, New Delhi (Annexure A-4) regarding his pending medical bills. He was informed by ACMS, Saharanpur that two bills amounting to Rs. 1,84,521.30 and Rs. 1,89,110.65 have been accepted but bills amounting to Rs. 2,63,455.94 and Rs. 22,340.00 were rejected. The applicant submits that considerable time has lapsed but no action has been taken by the respondents regarding reimbursement of his pending medical claims.

3.2 The applicant has placed reliance upon the decision of the Hon'ble High Court of Delhi in the case of Union of India Vs. Yogesh Nirala and Ors. [WP(C)-10157/2015].

In the counter affidavit, the respondents state that initially the applicant took the initial treatment from ILBS Hospital after he was sent there by Railway Central Hospital, New Delhi. Subsequently, the case was non-referred. Despite this, the case of the applicant was duly processed by Divisional Finance Headquarters and could not be passed due to non referring of his case to a private hospital.

At the time of hearing, the learned counsel for the applicant Ms. Meenu Mainee submitted that the applicant did not go to ILBS Hospital on his own. It was only when the Railway Central Hospital, New Delhi was unable to treat him and he was referred to ILBS Hospital that he got his treatment done.

Per contra, the learned counsel for the respondents Sh. Shailendra Tiwary reiterated that the applicant's case was one of taking treatment from private hospital without being referred there by the Railway Hospital. He argued that the Railway department has as many as 121 hospitals and 586 Railway Health Units all over the country where state of the art treatment is available for railway employees. In case, every employee chooses to go to non-recognized hospitals of their own and start claiming medical reimbursement, it will open flood gates of unauthorized medical claims having unmanageable financial repercussions.

I have gone through the facts of the case carefully and considered the rival submissions of both sides. It is not in dispute that the applicant was actually ill and was initially referred by the Railway Authorities to ILBS Hospital, for his Kidney Transplant. Subsequently too, the applicant had got himself admitted in the Railway Central Hospital, New Delhi who again were unable to treat him for his ailments whereupon he went to ILBS Hospital for treatment. The applicant was been asked by the respondents to submit various documents so that his claim could be processed and settled by the Railways. Delay in filing of medical claim by the applicant has been duly condoned by the respondents after considering the genuineness of his case.

It appears that each time the applicant approached the Railway Central Hospital, New Delhi for treatment, they kept referring him back to IBLS Hospital. It is not the case of the respondents that the claim of the applicant is fraudulent or inflated. They themselves have condoned the delay in respect of the four bills submitted by him on his treatment. Two out of the four bills submitted by the applicant have already been sanctioned by the respondents. The claim in respect of the other two bills appears to have hit a road block on the ground that the applicant has not submitted a discharge summary, and that he was not duly referred by the Railway Hospital. No categoric reasons for non-sanction are available on record.

The respondents should have issued a detailed order giving reasons as to why the medical claim has not been sanctioned till now instead of mentioning it in piece meal in the counter affidavit. The respondents are directed to give specific reasons for non sanction of the medical reimbursement of the applicant within one month from now. The applicant may then rectify the procedural lapses (like furnishing discharge summary etc.), if any, to enable the respondents to expeditiously process his case. This exercise may be completed within a span of two months from the date of receipt of such documents from the applicant. O.A. is allowed with these directions. No costs.