Decided on February 16,2009

Indraprastha Power Generation Co. Ltd. Appellant
Hari Prakash Gautam Respondents


J.D.KAPOOR,PRESIDENT (ORAL) - (1.)LIMITED grievance of the appellant against the impugned Order dated 15.5.2008 whereby the appellant was directed to reimburse the entire medical expenses incurred by respondent No. l, under the scheme, of which he was a member, is that the respondent was well aware of the fact that as per his pay scale he was entitled for semi -private ward whereas he intentionally availed of an A/C single room and further that in spite of having written so many letters the respondent failed to provide the bill and details of surgical instruments which were purchased by him from open market
(2.)THE case of the respondent leading to the impugned Order in brief were that the respondent No. 1 was working with the appellant as Assistant Controller and took VRS on 31.10.2003. He suffered from Post -traumatic Non -union Intra Capsular with Post -traumatic Knee Stiffness and on 23.11.2006 he got himself admitted in respondent No. 2 hospital for treatment and remained there for ten days and was discharged on 21.2.2006 after operation. The respondent No. 2 hospital billed him for total amount of Rs. 73,410 and the respondent was entitled for reimbursement of the said amount under the Delhi Government Health Scheme. However, the appellant reimbursed him only a sum of Rs. 36,939. Feeling aggrieved he moved instant complaint before the District Forum for directions to the appellant to make the balance payment relating to medical expenses, resulting in the impugned order.
(3.)AS against this the version of the appellant in brief was that the reimbursement was made as per rules which was further scrutinized and audited by AGCR. The respondent had himself failed to supply the details/particulars of the surgical implant along with purchase vouchers, etc. for processing the reimbursement in respect of the same. Further that the respondent was entitled for reimbursement as per CGHS rate list and guidelines according to which his claim was settled.
However, we only find force in the contention of the Counsel that the respondent got himself admitted in A/C single room whereas he was entitled for semi private ward for which the charges were Rs. 1,000, and we do not find any merit in the other contention as it was the respondent's right to get all the medical expenses incurred towards his treatment reimbursed.

Click here to view full judgement.
Copyright © Regent Computronics Pvt.Ltd.