Govt worker entitled for mediclaim in hospital
Railway employees are entitled to statutory reimbursement of medical expenses even if they are treated in a private hospital in an emergency situation, the Central Administrative Tribunal (CAT) has held.
The judicial member of CAT, G. Santhappa, directed applicant M. Mohamed Salia to resubmit his claim within 15 days and the Southern Railways shall consider this and sanction the amount within a month.
Salia said that he suffered a heart attack while going home from office on November 20, 2008. His wife admitted him to the nearby Frontier Lifeline Hospital because of the urgency of the situation as the railway hospital was 10 km away. Salia said that he spent Rs3.10 lakh on a bypass surgery and applied for reimbursement of the eligible amount of Rs2 lakh.
However, on July 14, 2009, the Railways rejected the claim stating that if the employee is treated in a non-recognised private hospital without referral by the authorised medical officer, he will not be entitled to claim the money spent.
The CAT held that the Railways has not considered the emergency certificate produced by the employee. The Personnel Branch Circular (PCB) dated May 4, 1994, stated under what circumstances the reimbursement of medical expenses can be sanctioned.
It also deals with situations when a patient falls ill at a place where there were no government or railway hospital available and also when transporting the patient to the nearest government/railway hospital would result in loss of life.
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