Mumbai: The State consumer dispute redressal commission held the Additional Director (AD)and the Director General(DG) of the Central Government Health Scheme (CGHS), guilty of escaping from their liability for taking care of the medical needs of a retired IAS officer, Awadesh Prasad Sinha.
The commission has thus asked both the departments to jointly pay the medical reimbursement amount of Rs 23,42,627, which Sinha had caused towards his wife’s medical treatment, along with nine percent interest on the amount from August 2013. The commission has also asked the department to pay an additional amount of Rs 25,000 towards the IAS officer’s litigation charges.
As per the complaint, Sinha, being a central government employee, is entitled to Mediclaim under the Central Government Health Scheme (C.G.H.S.) and it is not only towards himself but also towards his family.
Sinha’s complaint copy said “The officer’s wife, Manimala Raje Sinha, in 2012 was admitted to Bombay Hospital on an emergency basis, after she complained of breathlessness, chest paining and uneasiness. The doctors investigated and diagnosed the case and advised her to undergo Coronary Bypass Surgery (CABG). However, post CABG, Manimala developed a surgical wound, which later turned into an infection. Pursuant to that, Manimala was advised to remain in hospital to undergo an additional medical procedure. The total bill for medical treatment came up to Rs 30,64,486.”
Post the discharge, when Sinha had filed for the reimbursement of his medical bills, the department simply sanctioned a bill of Rs 7,21,859 against his claim. The disbursed claim was justified by saying that it was the amount which was fixed in the bracket of reimbursement for the total cost of CABG.
Even though when the officer had explained to the department that the bill included additional medical treatment, which she was advised by the medical officers, the department still repudiated the claim. Aggrieved by the same, the retired officer had approached the commission seeking reparation for his complaint. The department in its reply said that the officer had failed to file the mediclaim within the stipulated time frame.
The commission, after going through the complaint, held that the CGHS is responsible for taking care of the Central Government employees, its pensioners and their family members. The commission further held that in this case, the department had just considered package wise approval and hence they had partially approved the medical bills.
“The complainant’s wife has not only undergone CABG, she also suffered several other medical complications…. The treatments which were necessary and decided by the treating doctor at the Bombay Hospital. …….thus the Commission is of the view that partially allowing the claim and rejecting the balance amount is not proper and the departments are responsible for it. If the treatment undertaken is genuine, then the department cannot escape from their liability,” the commission added.
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