Succinctly put, relevant facts are that petitioner – Board, to mitigate sufferings of its erstwhile employees, adopted Central Services (Medical Attendance) Rules, 1994, by introducing a Scheme and thereby extended medical reimbursement facilities to its Pensioners/Family Pensioners. Respondent – Banarsi Dass, since deceased, who is represented by respondents who are his LRs, was an erstwhile employee of petitioner Board, having retired from service on 30.04.1982, opted Membership of Scheme on 12.11.1999 for which he was allotted registration. Deceased respondent was hospitalized in Sir Ganga Ram Hospital and period of treatments were for short tenure for two spells. First, for 12.01.2000 to 18.01.2000 and second for December, 2002 to January, 2003. After respondent – deceased moved petitioner Board for reimbursement of medical expenses incurred over second spell of treatment, later turned voltae face holding that Sir Ganga Ram Hospital, New Delhi was not on approved panel of hospitals of petitioner Board. When door of consumer fora was knocked, filing complaint, District Forum, having over-ruled contentions raised on behalf of petitioner Board, while accepting complaint, directed petitioner Board to reimburse medical expenses of Rs. 1,66,000/- incurred over treatment along-with ancillary reliefs of interest and litigation cost of Rs. 5,000/-. State Commission too, in appeal, affirmed basic finding of District Forum, deleting interest and reducing litigation cost to Rs. 2,500/-. Claim of respondent is sought to be defeated by petitioner Board primarily on two premises – firstly that when respondent took treatment in Sir Ganga Ram Hospital, it was not on approved panel of hospitals of Board, and secondly, since Membership of respondent had discontinued and he ceased to be a Member of Medical Reimbursement Scheme from 31.03.2002, he cannot agitate his claim, he no longer covered under the Scheme during the aforesaid period. We are satisfied that though Sir Ganga Ram Hospital was not on the approved panel of hospitals recognized by Government of India, it was approved w.e.f. 07.09.2001. Though respondent would not be eligible for reimbursement of medical expenses for first spell of treatment for the period from 12.01.2000 to 18.01.2000, his case was squarely covered for the second spell of treatment when Sir Ganga Ram Hospital was taken on approved panel of hospitals w.e.f. 07.09.2001. Added to this, though petitioner ceased to be a Member of Scheme w.e.f. 31.03.2002, he having discontinued contribution towards scheme to avail benefit of reimbursement, validity of Membership was extended by none-else by petitioner – Board on receipt of requisite charges for the period from 01.04.2002 to 31.03.2004. Now petitioner Board, in view of extension of validity of membership of respondent from 01.04.2002 cannot legitimately argue that it would not operate retrospectively to enable respondent to avail benefit of scheme. Petitioner Board, in our view, cannot walk out of contract to which it is a party. Respondent as such, was eligible for coverage of extension of medical facilities for reimbursement of medical expenses for second spell of treatment which he took at Sir Ganga Ram Hospital. Impugned order of State Commission is well within parameters of the Scheme and also validity period of Membership of the respondent. Resultantly, Revision Petition bearing no merit, is dismissed. However, there shall be no order as to cost.
......................JB.N.P. SINGHPRESIDING MEMBER ......................S.K. NAIKMEMBER | |