Sandeep V. Marne JUDGMENT
Sandeep V. Marne, J.
1. Rule . Rule is made returnable forthwith. Heard finally with the consent of learned Counsel for the Petitioner and the learned Counsel for the Respondents.
2. Petitioner assails judgment and order dated 5 April 2019 passed by Central Administrative Tribunal, Mumbai dismissing the Original Application No. 176 of 2018. The Original Application was instituted by Petitioner seeking reimbursement of balance amount of medical expenses of Rs. 3,78,986/-incurred for medical treatment of her late husband at Ruby Hall Clinic, Pune.
3. Petitioner is the spouse of Central Government pensioner, who retired from service in the year 2001 and who was the enrolled as a beneficiary of Central Government Health Scheme (CGHS). Petitioner's husband was suffering from chronic kidney disorder and used to visit CGHS Welfare Centre frequently. On 14 January 2016 he developed acute pain in the urinary bladder and was required to be admitted to Ruby Hall Clinic, which is a CGHS empanelled hospital. After taking treatment for about 17 days, he was discharged from the said hospital on 2 February 2016. He was again required to be admitted to that hospital on 12 February 2016 with complaint of severe pain in the urinary bladder. He was kept in Intensive Care Unit (ICU) of the hospital from 12 February 2016 to 19 February 2016 and was discharged on 19 February 2016. He did not claim any reimbursement for expenses incurred for these two hospitalizations, but took benefit of mediclaim policy. On 24 February 2016 Petitioner's husband again complained of acute pain in the urinary bladder and was required to be rushed to Ruby Hall Clinic in an emergency situation. Petitioner contends that since pain was experienced by her husband in the evening of 24 February 2016, it was practically impossible to take him to CGHS Wellness Centre, which usually closes at 1400 hours. On 25 February 2016 Petitioner's husband was diagnosed urinary bladder cancer. On 9 April 2016 he passed away due to multiple organ failure.
4. An expenditure of Rs. 13,47,879/-was incurred by the Petitioner for medical treatment of her husband at Ruby Hall Clinic during 24 February 2016 to 9 April 2016. Accordingly, she submitted medical reimbursement claim in the prescribed format with Additional Director, CGHS, Pune. However, as against total expenditure of Rs. 13,47,879/-, an amount of Rs. 9,68,893/-came to be sanctioned and reimbursed to the Petitioner.
5. Petitioner filed Original Application No. 176 of 2018 before Central Administrative Tribunal, Mumbai (Tribunal) claiming balance amount of reimbursement of Rs. 3,78,986/-. The Original Application was opposed by the Respondents by filing Affidavit-in-Reply before the Tribunal inter alia contending that for the entire treatment availed by Petitioner's husband amount of Rs. 9,68,893/-was sanctioned and reimbursed as per CGHS rates. Petitioner's claim of admission in emergency situation was also contested by the Respondents. By judgment and order impugned in the present Petition, the Tribunal has proceeded to dismiss the Original Application.
6. Appearing for Petitioner Ms. Nadar, the learned Counsel would submit that Petitioner's husband was required to be admitted to Ruby Hall Clinic in an emergency situation and that it was impossible to collect a Referral Memo from CGHS Wellness Centre. She would further submit that the Tribunal has erroneously dismissed the Original Application by taking into consideration factually incorrect contents of email of the hospital to the effect that the admission of Petitioner's husband was not an emergency case and that patient took treatment in the normal ward. She would invite our attention to the Certificate dated 7 May 2016 issued by Ruby Hall Clinic certifying that the admission was done in an emergency. She would also rely upon the Medi........