E-Paper
Centre fined over employee’s unpaid medical reimbursement
Directed to pay ₹50,000 for mental harassment and ₹20,000 as litigation costs for not paying the full medical reimbursement to Sahdev Kaushik of Sector 44-D in addition to paying the leftover reimbursement
The District Consumer Disputes Redressal Forum 2 directed Union of India, ministry of external affairs, through its regional passport officer, Sector 34, and central government health scheme through its additional director, in Kendriya Sadan, Sector 9, to pay ₹50,000 for mental harassment and ₹20,000 as litigation costs for not paying the full medical reimbursement to Sahdev Kaushik of Sector 44-D in addition to paying the leftover reimbursement amount.
The complainant, Kaushik is presently posted as superintendent in the office of Regional Passport Office, Sector 34-A. He is a member of the Central Government Health Scheme and has a health card. His wife, Partigya Kaushik was undergoing treatment for strangulated ventral hernia at Max Super Speciality Hospital, Mohali, which is an empanelled Hospital under the scheme. She underwent surgery and was discharged three days later.
The total medical bill for the treatment was ₹1,64,069 and was paid by the complainant. When he claimed reimbursement, only an amount of ₹33,868 was sanctioned after which he submitted the complaint to the forum.
In their reply, the passport office, which admitted to the factual matrix of the case, said an employee who is covered under the scheme can directly approach the super specialty hospital if there is a severe urgency or with a recommendation. It was submitted that the claim was filed in time, but as per the policy of the government the medical bills have been restricted as per CGHS rates.
CGHS Chandigarh also filed a reply stating that the card alone does not make an individual entitled to treatment at CGHS rate from an empanelled hospital. It was added that the complainant’s wife underwent emergency treatment for which the admissible amount as per CGHS Rates is ₹28,663. Medical claim of ₹33,868 is already above the CGHS-approved rates and they requested that their name be dropped as an opposite party.
The forum, however, observed that when the CGHS beneficiary has taken treatment from a hospital empanelled by the OPs, there was no justification for them to deny full reimbursement on grounds of package or fixed rates. It further added that in case the amount exceeds the fixed package or rates of CGHS, it is for the opposite parties to take up the matter with the concerned hospital or authorities.
“There is clear cut deficiency in service, which certainly caused physical harassment, mental agony and financial loss,” the forum observed, while directing the opposite parties to pay the leftover ₹1,30,202 along with the ₹70,000 compensation.
