Clear medical claim of employee’s widow rejected on technical grounds: CAT to Chandigarh Transport Undertaking

Advertisement

Chandigarh, August 30

While dealing with a medical claim, the approach of the authorities concerned should be liberal. They have to keep in mind that the technicality of the rules and regulations are not required to be followed in a mechanical manner so as to frustrate the very purpose of the scheme. Each case has to be examined on its own facts before taking any final decision.

Observing this, the Chandigarh Bench of the Central Administrative Tribunal (CAT) has directed the Divisional Manager, Chandigarh Transport Undertaking (CTU), Industrial Area, Phase 1, to clear medical claim of Rs 3,24,411 to the widow of an employee within a period of two months.

In an application filed under Section 19 of the Administrative Tribunals Act-1985 through advocate Dhiraj Chawla, Sudershan Kaur (71) had alleged that her medical claim for the treatment of cancer was denied by the department over ‘unjustified’ reasons. She said she took treatment from May 6, 2019, to August 7, 2019, from Sri Guru Ram Das Cancer Hospital, Amritsar, which issued a complicated chronic disease certificate dated December 27, 2019, in her favour. However, the respondents denied the claim on the ground that medical expenses incurred on the treatment of a chronic disease before the issuance of a chronic disease certificate was not reimbursable.

After hearing of the arguments, the Bench of Suresh Kumar Batra, Member (Judicial), quoted various judgments of different High Courts. It observed that the mandate given through the judgments was that before honouring a medical claim, the authorities concerned were to ensure that the treatment had actually been taken by the claimant and the claim was supported with duly-certified records of the doctor/hospital concerned. Once it was established, the claim could not be denied on technical grounds.

The Bench observed that in the present case, the applicant had been suffering from a chronic disease of cancer. After verifying the genuineness of the treatment taken for the disease, the respondents were not right in raising technical objections with regard to the date of issuance of the certificate to deny the genuine claim of reimbursement of expenses incurred on treatment by a senior citizen. “In view of this, the order dated September 3, 2020, rejecting the claim of the applicant for medical reimbursement cannot sustain the test of law and is, therefore, quashed and set aside. The respondents are directed to settle the medical claim of the applicant within a period of two months from the date of receipt of a certified copy of this order,” the Bench ordered.