Medical Reimbursement Claims Beyond CGHS Rates Referred to High Power Technical Committee.

The applicant, Head Constable Kuldeep Singh, filed an Original Application seeking reimbursement for the remaining medical expenses incurred for his son's treatment at Paras Hospital, Gurgaon, Haryana.

The applicant's son was admitted in an emergency condition and treated at the said hospital, incurring a total expenditure of Rs. 7,72,936/-.

The applicant submitted a claim for reimbursement, but the respondents sanctioned only Rs. 4,84,000/- in accordance with CGHS rates.

The remaining amount was not reimbursed, and the applicant's counsel prayed for the matter to be referred to the High Power Technical Committee (HPTC).

The respondents' counsel stated that the sanctioned amount was as per applicable CGHS norms and that the claim for the remaining amount had already been forwarded to the HPTC for consideration and was presently under examination.

Whether the applicant is entitled to reimbursement of the remaining medical expenses incurred for his son's treatment beyond CGHS rates, particularly considering the emergency nature of the treatment.

Whether the Central Administrative Tribunal should adjudicate the matter on merits when the claim for the remaining amount has already been referred to the High Power Technical Committee.

The court based its decision on the principle that when an administrative body, such as the High Power Technical Committee, is already actively considering a claim for reimbursement, especially concerning medical expenses beyond standard rates, no further adjudication on merits by the Tribunal is required at that stage.

The court derived its authority to issue directions for expeditious consideration and reasoned orders from its inherent powers to ensure administrative efficiency and due process.

The CGHS rates are the applicable norms for medical reimbursement.

The court engaged in an analysis of the procedural posture of the case.

It acknowledged the applicant's claim for reimbursement of medical expenses beyond CGHS rates and the emergency nature of the treatment.

Crucially, the court noted that the respondents had already forwarded the claim for the remaining amount to the High Power Technical Committee (HPTC) for consideration.

The court determined that since the matter was actively under examination by the HPTC, judicial intervention by way of adjudication on merits was premature.

Instead, the appropriate course of action was to direct the respondents to ensure the expeditious consideration of the claim by the HPTC and the issuance of a reasoned order thereafter.

This approach effectively defers to the administrative process while ensuring its timely completion.

Accordingly, the Original Application was disposed of with directions.

The respondents shall pursue the matter with the High Power Technical Committee for expeditious consideration of the applicant's claim for reimbursement of the balance medical amount.

Upon receipt of the recommendation/decision of the High Power Technical Committee, the respondents shall pass a reasoned and speaking order in accordance with rules.

This entire exercise shall be completed within a period of four weeks from the date of receipt of such recommendation of the High Power Technical Committee.

No order as to costs was made.