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Case Number

O.A. No. 1272 of 2014,M.A. No. 2326 of 2015

Advocates

Ms. Ritika Chawla
For the Applicant: In Person

Judges

Raj Vir Sharma, Member (Judicial)

Acts

sub-rule(10) of Rule 2 of the Supplementary Rules,
Rule 2(a)(A) of the CS (MA) Rules, 1944
Rule 2 of the CS (MA) Rules, 1944,
Rule 2(a)(A) of the said Rules.
Rule 2(a)(B) of the said Rules
Rule 2(a)(B)

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Smart Summary

Structured Summary of the Tribunal Opinion

Factual and Procedural Background

The applicant is a retired Government employee who retired on attaining superannuation on 31.7.2007. While in service he was a member of CGHS. His wife required medical treatment on two occasions: first in August 2001 (treated by Dr. Subash Tyagi; bills totalling Rs.10,410.15, claimed on 19.6.2002) and again in 2006–2007 (treated by Dr. Subash Tyagi; bills totalling Rs.14,330, claimed on 20.7.2007). The respondent-Department, by memo dated 16.6.2004, sanctioned only Rs.363 for the first claim. The applicant repeatedly made representations (11.5.2008; 8.12.2010 forwarded on 20.12.2010; further representations on 6.7.2012 and 30.5.2013 and RTI enquiries) but did not obtain full reimbursement.

The applicant filed Original Application (O.A.) No. (filed on 20.1.2014) seeking reimbursement of Rs.10,410 and Rs.14,330 (total Rs.24,740), interest for delay, and exemplary costs. He relied on the Delhi High Court decision in Kishan Chand v. Govt. of NCT & others (W.P. (C) No. 889 of 2007, decided 12.3.2010).

Respondents filed separate counter replies: respondent no.1 pointed out that the cause of action arose in 2001–2003 and that the applicant's residence was not in an area covered by CGHS; respondent no.2 stated that the applicant was residing in a non-CGHS covered area and was therefore entitled to facilities from an Authorized Medical Attendant under the CS (MA) Rules, 1944.

The applicant filed Miscellaneous Application (MA) No.2326 of 2015 seeking condonation of delay, explaining ongoing correspondence with the Department between the dates of the claims and 2013.

Legal Issues Presented

Whether the applicant is entitled to reimbursement of medical expenses incurred for treatment obtained from a private medical practitioner (Dr. Subash Tyagi) who was not an Authorized Medical Attendant under the CS (MA) Rules, 1944.
Whether the applicant's Original Application filed in 2014 is barred by delay and laches (i.e., whether the cause of action arose earlier and whether limitation bars the claim), and whether condonation of delay should be granted.
Whether the exception for emergent cases (Appendix VIII to the CS (MA) Rules, 1944) applies to the applicant's claims such that reimbursement is admissible despite treatment by a private practitioner.

Arguments of the Parties

Applicant's Arguments

The applicant contended that he was a CGHS member and was paying CGHS contributions but was not provided CGHS facilities for his area of residence (Nand Nagri), which was not covered by CGHS.
Because no Authorized Medical Attendant was appointed by the respondent-Department for his area, his wife was treated by Dr. Subash Tyagi in an emergency and he is entitled to reimbursement for expenses incurred (claimed sums: Rs.10,410.15 and Rs.14,330).
He pursued the matter through departmental representations and RTI requests up to 2013 and relied on Kishan Chand v. Govt. of NCT & others (W.P. (C) No. 889 of 2007) as supportive precedent.
In MA No.2326 of 2015 he argued that no prejudice would be caused if delay in filing the O.A. was condoned given the continuous correspondence with the Department.

Respondents' Arguments

Respondent no.1 argued that the cause of action (insofar as denial of reimbursement is concerned) arose as early as 2001–2003 and, in particular, the first claim was partially settled by memo dated 16.6.2004 sanctioning Rs.363 — hence limitation runs from that point.
Both respondents pointed out that the applicant resided in an area not covered by CGHS and was therefore entitled under the CS (MA) Rules, 1944 to medical attendance by an Authorized Medical Attendant (AMA) and should have availed AMA or Government/approved hospitals; reimbursement for treatment by a private practitioner who was not an AMA is not provided under those rules.

Table of Precedents Cited

Precedent	Rule or Principle Cited For	Application by the Court
Kishan Chand v. Govt. of NCT & others, W.P. (C) No. 889 of 2007, decided 12.3.2010	High Court ordered reimbursement where the petitioner suffered serious heart ailment and underwent bypass surgery; the Court regarded denial of reimbursement as inhuman in the particular facts.	The Tribunal found the decision distinguishable on facts (the present case involved extended periods of treatment by a private practitioner rather than a discrete emergent major surgery) and held that Kishan Chand did not assist the applicant.

Court's Reasoning and Analysis

The Tribunal proceeded in two main strands: limitation/delay and substantive entitlement under the CS (MA) Rules, 1944.

1. Limitation / Delay:

The applicant's first claim (Rs.10,410.15) was submitted on 19.6.2002 and respondent no.1 issued a sanction memo dated 16.6.2004 allowing only Rs.363. The Tribunal treated the cause of action for denial of full reimbursement as arising on 16.6.2004. The applicant was aware of that sanction even though he alleged non-receipt of the Rs.363; he did not deny knowledge of the sanction.
As to the second claim (Rs.14,330) submitted on 20.7.2007, if the Department did not settle the claim within a reasonable period the applicant should still have approached the Tribunal within the period of limitation prescribed under the Administrative Tribunals Act (A.T. Act).
The Tribunal applied the established principle that making repeated representations and correspondence with the Department after the cause of action has arisen does not excuse delay in approaching the Court/Tribunal and does not extend or save the period of limitation under the statute.
Accordingly, the Tribunal rejected MA No.2326 of 2015 seeking condonation of delay and held the O.A. filed in 2014 to be barred by delay and laches.

2. Substantive entitlement under CS (MA) Rules, 1944:

It was admitted that the applicant resided in an area not covered by CGHS. Under the CS (MA) Rules, 1944, when CGHS facilities are not provided the employee is entitled to medical attendance by an Authorized Medical Attendant (AMA) appointed by the Department (Rule 2 and its subparts).
The Tribunal examined Rule 2(a)(A) and 2(a)(B) and noted that if no AMA was appointed as per subparagraph (A) the employee should avail of medical officers as specified in subparagraph (B) (e.g., Principal Medical Officer of the District, Assistant Surgeon Grade I/II depending on pay scale and availability).
The applicant's contention that no AMA was appointed for his area was not substantiated. The Tribunal stated that, in that situation, the applicant ought to have approached the concerned medical officers specified in Rule 2(a)(B) or taken the patient to a Government hospital or a private hospital approved by the Government under CGHS/CS(MA) Rules, 1944.
The Tribunal referenced Appendix VIII (Reimbursement in Relaxation of Rules in Emergent Cases) to the CS (MA) Rules, 1944 which allows, in emergent cases where no Government or recognized hospital is nearer than the private hospital, discretion to use a private hospital and permit reimbursement. However, it noted that there is no provision allowing reimbursement for treatment by a private medical practitioner who is not an AMA under Rule 2(a)(A).
On the facts, the Tribunal observed that the bills and treatment periods (first claim for dates from 26.8.2001 to 12.5.2002; second claim from 25.8.2006 to 31.5.2007) did not persuade the Tribunal that urgent life-saving treatment was required “all the times” during those extended periods. Therefore, the emergent-case exception under Appendix VIII did not operate to entitle the applicant to reimbursement for these treatments by a private practitioner who was not an AMA.
Given absence of statutory entitlement to reimbursement for treatment by a private practitioner not appointed as AMA and the factual record, the Tribunal found no scope for interference on merits even apart from the limitation bar.

Holding and Implications

Core Ruling: The Tribunal dismissed the Original Application and rejected MA No.2326 of 2015 seeking condonation of delay. The O.A. is dismissed. No costs were awarded.

Implications:

Direct effect on the parties: The applicant's claims for reimbursement of Rs.10,410.15 and Rs.14,330 are not granted; the applicant's application was dismissed as being barred by delay and laches and also for lack of entitlement under the CS (MA) Rules, 1944. The prayer for interest and exemplary costs was not granted. No costs were awarded to either side.
On precedent or broader law: The Tribunal explicitly distinguished the applicant's reliance on Kishan Chand (W.P. (C) No. 889 of 2007) on factual grounds and did not treat that decision as binding support for the applicant. The opinion does not announce or lay down any new legal principle beyond application of existing rules (CS (MA) Rules, 1944), limitation doctrine and the emergent-case provision in Appendix VIII as interpreted on the facts.

Signed by: (RAJ VIR SHARMA) JUDICIAL MEMBER (as per the provided opinion)

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Ram Swarup v. Commissioner Of Police

Brief facts of the applicants case are as follows: 1.1 The applicant is a retired Government employee. He retired on attaining the age of superannuation on 31.7.2007. While in service, he was a member of the CGHS. He states that his wife was diagnosed as suffering from Dilet & Millets e plum Tusworking. On 26.8.2001 he took her to Kapoor Medical Centre under critical condition to save her life. After being attended by Dr.Subash Tyagi and being administered life saving drugs, she recovered from her ailment and was discharged on 26.8.2001. He incurred Rs.10,410/- for medical treatment of his wife towards costs of medicines and tests, etc. He submitted his medical claim for Rs.10,410/-. The respondent-Department, vide memo dated 16.6.2004, sanctioned Rs.363/-, instead of Rs.10,410/-. The said amount of Rs.363/- was not received by him. 1.2 On 25.3.2006 his wife again suffered from Type II Diabetes. She was taken to Dr. Subash Tyagi for emergency treatment. This time, he claimed to have incurred an expenditure of Rs.14,330/- and accordingly submitted his medical claim for reimbursement of the said amount of expenditure. 1.3 It is stated by the applicant that the place of his residence was situated in Nand Nagri area which was not covered by CGHS, nor was any Authorized Medical Attendant appointed by the Department for the area. 1.4 As the respondent-Department failed to make payment of his aforesaid two medical claims, the applicant made a representation dated 11.5.2008 to the Commissioner, Delhi Police. There being no response, he again submitted a representation dated 8.12.2010 to the Deputy Secretary, Administrative Reforms, Ministry of Home Affairs, who, vide his letter dated 20.12.2010, forwarded the same to the Commissioner, Delhi Police. 1.5 The respondent-Department, vide letter dated 10.2.2011 (Annexure X), intimated the applicant that his first medical claim had already been settled in accordance with CCS (MA) Rules. As regards the medical claim submitted by him after retirement, he was informed that medical claim of retired police personnel is dealt by the CGHS/HQ, Bikaner House, New Delhi. 1.6 Thereafter, the applicant made further representations dated 6.7.2012 and 30.5.2013 to the respondents and got certain information from them under the RTI Act. 1.7 As his aforesaid two medical claims were not reimbursed in his favour, the applicant filed the present O.A. on 20.1.2014 seeking the following reliefs: (i) To reimburse medical expenses incurred in emergency of Rs.10,410/- in the first case and Rs.14,330/- in the second case. (Total being Rs.24,740/-).

(ii) To award interest to the applicant for the delay caused by the respondents.

(iii) To impose exemplary cost on respondents for the delay and harassments to the applicant. In support of his prayer, the applicant has placed reliance on the decision of the Honble High Court in Kishan Chand v. Govt. of NCT & others, W.P. ( C ) No. 889 of 2007, decided on 12.3.2010.

2. Opposing the O.A. the respondents have filed two separate counter replies. 2.1 In the counter reply filed on behalf of respondent no.1, it is, inter alia, stated that cause of action, if any, arose in the year 2001-2003, and that as the residence of the applicant was not in the area covered by the CGHS, he was to obtain medical treatment from any hospital other than CGHS dispensary. 2.2 In the counter reply filed on behalf of respondent no.2, it is stated that the applicant was residing in a non-CGHS covered area and hence was entitled to medical facilities from Authorized Medical Attendant under CS (MA) Rules, 1944.

3. In his rejoinder reply, the applicant has stated that although he was paying CGHS contribution, he was not provided CGHS facilities. As he was paying contribution to CGHS, he was entitled for reimbursement of expenses incurred by him for medical treatment. It was the duty of the respondents to provide medical facilities or reimbursement of expenses incurred for medical treatment.

4. The applicant has filed MA No.2326 of 2015 seeking condonation of delay, if any, in filing of the O.A. It is stated by the applicant that he had submitted medical bills for Rs.10, 410.15 on 19.6.2002 and for Rs.14,330/- on 20.7.2007 respectively. Thereafter, he was continuously making correspondence with his Department regarding reimbursement of medical charges and was pursuing the matter till 2013. No prejudice would be caused to the respondents if the delay in filing of the O.A. in 2014 is condoned and the reliefs claimed by him in he O.A. are granted by the Tribunal. There is no impediment either in law or equity to grant the reliefs prayed for by him in the O.A.

5. I have carefully perused the records and have heard the applicant in person and Ms. Ritika Chawla, learned counsel appearing for the respondents.

6. Admittedly, the applicant submitted his first medical claim for Rs.10,410.15 on 19.6.2002 and second medical claim for Rs.14,330/- on 20.7.2007. As regards his first medical claim of Rs.10,410.15, along with his O.A., the applicant has filed copy of memo dated 16.6.2004 issued by respondent no.1 sanctioning Rs.363/-. Thus, it is clear that respondent no.1 settled the applicants first medical claim of Rs.10,410.15 by allowing and sanctioning Rs.363/- only and by disallowing reimbursement of the balance amount of the said claim, vide sanction memo dated 16.6.2004. Although the applicant claimed that the said amount of Rs.363/- was not received by him, yet he has not stated that the fact of sanction of Rs.363/- was not in his knowledge. Therefore, as regards denial of reimbursement of full amount of medical claim of Rs.10,410/-, the cause of action arose on 16.6.2004 and he should have approached the Tribunal within the period of limitation prescribed under the A.T.Act. As regards his second medical claim of Rs.14,330/- submitted on 20.7.2007, if the respondent-Department did not settle the same within a reasonable period, the applicant ought to have approached the Tribunal within the period of limitation prescribed under the A.T.Act. It is trite law that making representations and correspondences from time to time with the Department, after the cause of action arose, is not sufficient explanation for the delay in approaching Court/Tribunal and does not save limitation or extend the period of limitation prescribed under the statute. In view of this, MA No.2326 of 2015 is rejected. In the circumstances, the O.A. filed by the applicant in 2014 seeking the reliefs, as aforesaid, being barred by delay and laches is liable to be rejected.

7. It is the admitted position between the parties that at the relevant point of time the applicant was residing in an area not covered by CGHS, and that although he was a member of CGHS, he was entitled to medical facilities under the CS (MA) Rules, 1944. Under the CS (MA) Rules, 1944, where CGHS facilities are not provided, a Government employee is entitled, free of charge, to medical attendance by the Authorized Medical Attendant appointed by the concerned Department. This facility is available for the employee and his family. Rule 2 of the CS (MA) Rules, 1944, reads thus: 2. In these rules, unless there is anything repugnant in the subject or context:- (a) Authorized Medical Attendant means (A) in respect of any Government servant or any Group or Groups of Government servants in any station, a Medical Officer, whether or not under the employ of the Central Government, appointed by

(i) the Department of Health of the Government of India, where such persons are under the employ of that Department, or

(ii) any other Department of the Government of India, in relation to persons under the employ of that Department, or

(iii) any authority which is declared by the President, under sub-rule(10) of Rule 2 of the Supplementary Rules, to be Head of a Department, in relation to persons under the employ of that authority, or

(iv) the Chairman of the Central Government Employees Welfare Coordination Committee at station where such Committees are functioning, in relation to the Central Government employees at that station: Provided that where no Medical Officer in the employ of a State Government or the Administrator of a Union Territory shall be appointed as an Authorized Medical Attendant except after consultation with the Government or the Administrator of that Union Territory. (B) Where no Medical Officer is appointed as aforesaid

(i) in respect of a Government servant who belongs to a Central Service, Group A, or whose pay is not less than Rs.2,500/- per mensem, the Principal Medical officer of the District appointed by the Government to attend its officers in the District;

(ii) in respect of a Government servant not belonging to a Central Service, Group A, whose pay is less than Rs.2,500/- but more than Rs.1,200/- per mensem, an Assistant Surgeon, Grade I (medical Graduate), or other Medical Officer, appointed by the Government to attend its officers in the station;

(iii) in respect of any other Government servant, an Assistant Surgeon, Grade II (Medical Licentiate), or where he is not available, an Assistant Surgeon, Grade I (Medical Graduate), similarly appointed. xx xx It is the contention of the applicant that as no Authorized Medical Attendant was appointed by the respondent-Department for the area where he was residing, his wife was treated by Dr.Subash Tyagi and he was entitled for reimbursement of the expenditure incurred by him for such medical treatment of his wife in emergency. I do not find any substance in the contention of the applicant. If no Authorized Medical Attendant was appointed under Rule 2(a)(A) of the CS (MA) Rules, 1944 for the area where he was residing, the applicant ought to have approached the concerned Medical Officers who were Authorized Medical Attendants for him in terms of Rule 2(a)(B) of the said Rules for medical treatment of his wife. Besides, he ought to have taken her wife to any Government hospital, or any private hospital approved by the Government under the CGHS/CS(MA)Rules, 1944. It is not the case of the applicant that no Authorized Medical Attendant in terms of Rule 2(a)(B) of the CS (MA)Rules, 1944, was available in or near the area where he was residing at the relevant point of time. It is also not the case of the applicant no Government Hospital or private hospital approved under the CGHS/CS(MA)Rules, 1944, was available in or near the area where he was residing at the relevant point of time. As per Appendix VIII(REIMBURSEMENT IN RELAXATION OF RULES IN EMERGENT CASES) to the CS (MA) Rules, 1944, in emergent cases involving accidents, serious nature of disease, etc., the person on the spot may use his discretion for taking the patent for treatment in a private hospital in case no Government or recognized hospital is available nearer than the private hospital, and reimbursement of expenses incurred on treatment obtained from private hospital is admissible. There is no provision in the CS (MA) Rules, 1944, that a Government employee can claim reimbursement of expenditure incurred by him for treatment by any private medical practitioner who is not appointed as Authorized Medical Attendant under Rule 2(a)(A) of the said Rules. This apart, it transpires from the applicants first medical claim of Rs.10,410.15 that his wife obtained medical treatment from Dr.Subash Tyagi, and he purchased medicines, etc., on various dates during the period from 26.8.2001 to 12.5.2002. From the applicants second medical claim of Rs.14,330/-, it appears that his wife obtained treatment from Dr.Subash Tyagi, and he purchased medicines, etc., on various dates during the period from 25.8.2006 to 31.5.2007. Considering the nature of disease(s) the applicants wife suffered from and the period of treatment by Dr.Subash Tyagi, no one will be persuaded by the submission of the applicant that his wife required urgent medical treatment to save her life all the times during the aforesaid period and hence the medical expenses incurred by him for such treatment was admissible to him. In the absence of any provision in the CS (MA) Rules or CGHS that a Government employee is entitled to reimbursement of expenses incurred by him for obtaining medical treatment from private medical practitioner, who is not appointed as Authorized Medical Attendant, I do not find any scope for interference in the matter.

8. In Kishan Chand v. Govt. of NCT & others, W.P. ( C ) No. 889 of 2007, decided on 12.3.2010, the petitioner got a heart attack and was admitted to Amar Leela Hospital, Janakpuri, New Delhi, on 2.4.2005 and was discharged on 7.4.2005. He again suffered from severe chest pain and breathlessness and was admitted to Sir Ganga Ram Hospital, New Delhi and underwent a bypass surgery on 9.4.2005. Considering the serious nature of disease the petitioner suffered from and the bypass heart surgery undergone by him, the Honble High Court of Delhi held that by taking a very inhuman approach, the respondents denied reimbursement of medical expenses to the applicant. Accordingly, their Lordships directed the respondent-Department to reimburse the medical expenses to the petitioner. Therefore, I find that the decision in Kishan Chands case (supra) being distinguishable on facts does not come to the aid of the applicant.

9. In the light of the above discussions, I hold that the O.A., besides being hit by doctrine of delay and laches, is devoid of merit and liable to be dismissed. Accordingly, the O.A. is dismissed. No costs. (RAJ VIR SHARMA) JUDICIAL MEMBER

Ram Swarup v. Commissioner Of Police

Structured Summary of the Tribunal Opinion

Factual and Procedural Background

Legal Issues Presented

Arguments of the Parties

Applicant's Arguments

Respondents' Arguments

Table of Precedents Cited

Court's Reasoning and Analysis

Holding and Implications

Ram Swarup v. Commissioner Of Police

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