Appeal No.976/09


1.Member Secretary,

Rajasthan Pension Medical Relief Fund,

Jyoti Nagar,Jaipur. 2.Treasury Officer,Sriganganagar Appellants


V.

S.P.Behal r/o 92,Vinoba Basti,Sriganganagar Respondent



Before:


Mr.Justice Sunil Kumar Garg-President

Mrs.Vimla Sethiya-Member


Shri M.L.Vyas,counsel for the appellants

Shri Ajay Tantia,counsel for the respondent




Date of Judgement: 16.7.09



Heard at admission stage.


This appeal has been filed by the appellants which were ops before the District Forum,Sriganganagar against the order dated 4.6.09 passed by the District Forum,Sriganganagar in complaint no.3/09,by which the complaint of the complainant respondent was allowed against the appellants in the manner that the appellants were directed to pay a sum of Rs.1,98,786/- with interest @ 9% p.a on the above amount wef 19.7.08 and to pay Rs.1100/- as amount of cost of litigation and Rs.5000/- as amount of compensation to the complainant respondent.

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It arises in the following circumstances:


That the complainant respondent had filed a complaint before the District Forum,Sriganganaar against the appellants interalia stating that he is a pensioner of the State of Rajasthan as he was a Government Servant and thus he is entitled to get free medical treatment at the expenses of the State Govwenment. It was further stated in the complaint that his wife Smt.Santosh had gone to Jallandhar to see their daughter,where she had felt pain in her chest and thereafter she was taken to the emergency ward of Tagore Heart Care & Research Centre,Jallandhar on 26.5.08 where the cardiologist advised immediate admission since it was an emergency case,therefore,she was being admitted in the hospital and angiography of her left artery was done and a blockage of 95% was found and a stunt was affixed in her heart and in such treatment she had incurred a sum of Rs.1,98,786/- and since the case was of emergent in nature,therefore,no formal approval was taken from the government and for that certificate (annex.1) was produced. Thereafter on 19.6.09 through annex.2 the complainant respondent had claimed a reimbursement of the medical treatment taken at Jallandhar and the same was returned by the appellants on 28.6.08 with certain objections and thereafter the complainant respondent had resubmitted the claim on 17.7.08 after complying with all the formalities and since medical bills were not reimbursed,therefore,a notice was given by the complainant respondent on 23.10.08 to the appellants and ultimately the present complaint was filed.


A reply was filed by the appellants before the District Forum,Sriganganagar admitting the fact that no doubt, a pensioner is entitled to get a concession in medical treatment and the pensioner or his spouse is entitled to get concession in medical treatment out of the State only if Medical Board of Rajasthan State

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Government duly approved for that and in absence of that the Government servant is not entitled to be reimbursed and further the Tagore Heart Care & Research Centre,Jallandhar is not in the approved list of the Government of Rajasthan and the claim was kept under consideration.


The District Forum after hearing both the parties,through the impugned order dated 4.6.09 had allowed the complaint as stated above,interalia holding that in case of emergency, a pensioner is entitled to get the treatment from outside of the State of Rajasthan and since in this case,there was a cardiac problem to the wife of the complainant respondent and one artery was found blocked upto 95%,therefore,the present case was a case of emergent in nature and the complainant respondent is entitled to the sum incurred by the complainant respondent at Jallandhar.


Aggrieved from that order,this appeal has been filed by the appellants.


In this appeal,the main contention of the learned counsel for the appellants is that in case a pensioner undergoes by-pass surgery or open heart surgery outside the State in emergent circumstances and without recommendation of the Medical Board,he may be allowed 80% of the hospital expenses and the same is limited upto 48,000/- and thus the findings of the District Forum are erroneous one and could not be sustained and appeal be allowed.


On the other hand,the learned counsel for the complainant respondent has supported the impugned order.


We have heard the learned counsel for the parties and perused the record.

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It may be stated here that this Commission in a case Rajasthan State Pension & Pensioners Welfare Department & anr. V. Sachinand Pandey reported in IV(2007) CPJ 122 has held that in case of treatment undertaken in case of grave emergency outside the State,the complainant would be entitled to 80% of the amount incurred outside.The present case is squarely covered with the decision of the case of Rajasthan State Pension & Pensioners Welfare Department supra. Thus the complainant respondent would be entitled to 80% of Rs.1,98,786/- that comes to Rs.1,59,028.80 in place of Rs.1,98,786/- and to that extent,the impugned order dated 4.6.09 deserves to be modified and this appeal deserves to be allowed partly.


For reasons as stated above,this appeal filed by the appellants is partly allowed in the manner that the appellants now would pay 80% of Rs.1,98,786/- that comes to Rs.1,59,028.80 in place of Rs.1,98,786/- and to that extent,the impugned order dated 4.6.09 passed by the District Forum,Sriganganagar is modified. Rest order is maintained.




Member President