Concern regarding mandatory linking CGHS with ABHA

Railways told to reimburse employee’s medical bills

TNN Sep 6, 2012, 05.26AM IST---

http://articles.timesofindia.indiatimes.com/2012-09-06/chennai/33648318_1_southern-railway-private-hospitals-medical-reimbursement

CHENNAI: The Central Administrative Tribunal has asked the Southern railways to reimburse the medical bills of an employee with a heart condition. The man was denied medical reimbursement on the ground that he had taken treatment at a private hospital and not at the railway hospital. The tribunal has asked the railways to reimburse Rs 2 lakh to the employee.

In November 2008, M Mohamed Salia, deputy chief engineer at southern railway, experienced discomfort while returning home and had difficulty in breathing. He was rushed to the nearest private hospital - Frontier Lifeline Hospital - since the railway hospital was 10km away from his house.

He was diagnosed with a heart attack and was admitted in the intensive care unit. He underwent a bypass surgery on December 4, 2008 and had to stay in the hospital till December 12, 2008. The hospital charged him Rs 3.1 lakh towards medicines, tests etc.

When Salia submitted a claim for reimbursement of Rs 2 lakh, the Southern Railway returned the application saying the claim was not qualified. Salia then furnished a certificate from the private hospital, which too was rejected without any reason being assigned. He then approached the Madras bench of the CAT seeking appropriate orders.

Justifying the rejection, the Southern Railway told CAT that Salia had gone to a private hospital on his own volition and not on a referral basis. Noting that the Perambur railway hospital was a referral hospital for all cardiac problems, he could go to an hospital only if the treatment is not available at the railway facility or at a recognized private hospitals.

Rejecting the arguments, the CAT's judicial member G Shanthappa said the application had been rejected without even taking into account the emergency certificate furnished by Salia. He further pointed out that though the Railway Board norms stipulate that such claims could be rejected only by a speaking order (an order narrating reasons), Salia's application was rejected in a brief order, that too when his claim was not a false one.

Noting that Salia's wife rushed him to the nearest private hospital, even though it was not a recognized private hospital by the railway administration, due to emergency, Shanthappa said the southern railway was not justified in rejecting the claim. He then asked Salia to re-present the claim within 15 days, and directed the southern railway to reimburse Rs 2 lakh within one month from the date of receipt of the claim.

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