CGHS told to reimburse Rs 85,000 to Patiala couple

Tribune News Service

Chandigarh, December 6

The District Consumer Disputes Redressal Forum has directed the Additional Director, Central Government Health Scheme (CGHS), to reimburse nearly Rs 85,000 to a Patiala couple and pay Rs 15,000 as compensation for causing mental agony to them.

In a complaint, Uttam Kaur, and her husband Ravinder Singh, residents of Patiala, submitted that before his superannuation, Ravinder had subscribed to membership of the Central Government Health Scheme (CGHS). He paid an amount of Rs 60,000 for life membership. Uttam Kaur, who retired from the Punjab Government and was earlier drawing fixed medical allowance, later on gave up the said option along with her husband and enrolled themselves with the CGHS.

On March 22, 2017, Ravinder Singh suffered stroke/cardiac arrest and approached the PGIMER, Chandigarh, as outpatient in the Department of Cardiology, and was treated accordingly. He again suffered cardiac arrest and under emergency was admitted to the PGIMER on December 11, 2017, and discharged on December 17, 2017. 

Under compelling circumstances, he had to purchase medicines from authorised medical store for treatment. He also took treatment for knee joint pain and skin allergy from Government Hospital, Sector 16, Chandigarh.

Uttam Kaur also suffered severe cardiac arrest and in emergency was admitted to the PGIMER, Chandigarh, on March 6, 2017. She was discharged after coronary angioplasty treatment on March 11, 2017. 

Ravinder submitted different bills of Rs 44,642 for medical reimbursement in respect of his wife and Rs 50,518 for himself. These were the genuine claims and besides, the complainants also claimed other bills for treatment at Government Hospital, Chandigarh, and medicines prescribed while she was abroad. 

However, the Additional Director, CGHS, Ministry of Health and Family Welfare, Government of India, Chandigarh, did not reimburse the bills as being outdoor patient it was not reimbursable under the rules. 

In its reply, the Additional Director, CGHS, stated that per relevant rules and instructions, bills as OPD patient were not reimbursable. However, the items for Rs 9,792 and Rs 646 were passed and sent to the Pay and Accounts Office, New Delhi, for payment.

“Part amount of the two bills has already been ordered to be paid. This itself shows the claim is genuine. Not only this, the treatment was taken allegedly under compelled circumstances for her as indoor patient and then post operative care,” observed the forum.

“Clearly, in the present case, by taking a very inhuman approach officials of the CGHS have denied medical reimbursement in full to the petitioner forcing him to approach this court,” observed the forum and directed the Additional Director, CGHS, to reimburse the amounts of Rs 34,850 and Rs 49,872 to complainants along with interest at the rate of 9 per cent per annum from the date of denial of claim till realisation and Rs 15,000 as compensation for causing mental agony and harassment to them and Rs 10,000 as the cost of litigation.