Full Judgment
IN THE HIGH COURT OF KERALA AT ERNAKULAM
PRESENT THE HONOURABLE MRS. JUSTICE ANU SIVARAMAN TUESDAY, THE 25TH DAY OF FEBRUARY 2020 / 6TH PHALGUNA, 1941 PETITIONERS: 1 ABRAHAM T.THOMAS S/O.LATE.T.A.THOMAS, AGED 56 YEARS, THURUTHIYIL PUTHEN VEEDU(CHITHRALAYAM), EDAYARANMULA .P.O., ARANMULA VILLAGE, KOZHENCHERY TALUK, PATHANAMTHITTA DISTRICT REPRESENTED BY P.A.HOLDER MARIAMMA VARGHESE, W/O.M.P.VARGHESE, AGED 60 YEARS, MATTHATHU VADAKKETHIL HOUSE, CHERIMUKKU, KONNI.P.O., PATHANAMTHITTA DISTRICT-689691 2 SHIRLY T.THOMAS D/O.LATE T.A.THOMAS, THURUTHIYIL PUTHEN VEEDU(CHITHRALAYAM), EDAYARANMULA .P.O., ARANMULA VILLAGE, KOZHENCHERY TALUK, PATHANAMTHITTA DISTRICT REPRESENTED BY P.A.HOLDER MARIAMMA VARGHESE, W/O.M.P.VARGHESE, AGED 60 YEARS, MATTHATHU VADAKKETHIL HOUSE, CHERIMUKKU, KONNI.P.O., PATHANAMTHITTA DISTRICT-689691
BY ADVS. SRI.MANU RAMACHANDRAN SRI.T.S.SARATH SRI.M.KIRANLAL SRI.R.RAJESH (VARKALA) SHRI.AJAY JAYACHANDRAN RESPONDENTS: 1 UNION OF INDIA REPRESENTED BY SECRETARY TO GOVERNMENT, MINISTRY OF HEALTH AND FAMILY WELFARE, ROOM NO.156-A, A WING, NIRMAN BHAVAN, NEW DELHI-110011 2 THE ADDITIONAL SECRETARY AND DIRECTOR GENERAL CENTRAL GOVERNMENT HEALTH SCHEME, ROOM NO.254 A, NIRMAN BHAWAN, MAULANA AZAD ROAD, NEW DELHI-110011 3 THE JOINT DIRECTOR, OFFICE OF THE JOINT DIRECTOR, CENTRAL GOVERNMENT HEALTH SCHEME, 2/117, MOSQUE LANE, KESAVADSAPURAM, THIRUVANANTHAPURAM-695004 R1 BY ADV. SMT.HEMALATHA M., CGC THIS WRIT PETITION (CIVIL) HAVING BEEN FINALLY HEARD ON 25.02.2020, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:
JUDGMENT
This writ petition is filed seeking the following prayer:-
“To issue a writ of mandamus or any appropriate writ or direction directing to the respondent No.3 to accept Ext.P11 claim form along with the accompanied documents under proper receipt and process the claim in accordance with the directions contained in Ext.P6 and Ext.P10 orders, within a time frame fixed by this Hon'ble Court.”
2. Heard the learned counsel for the petitioner and the learned Central Government Counsel appearing for the respondents.
3. It is submitted by the learned counsel for the
petitioner that the petitioner's mother was entitled to avail a benefit under the Central Government Health Scheme (CGHS) and that the 3rd respondent is to be directed to accept Ext.P11 claim form and to dispose of the same taking note of Ext.P6 and P10.
4. A statement has been placed on record by the 3 rd
respondent. It is stated that the enclosures of the original bills along with Ext.P11 form had not been received by the respondents. It is stated that the respondents have no objection to accept the claim raised by the petitioner, if the claim was accompanied by the documents as stated therein, which are as follows:-
1. Photocopy of the CGHS card of the principal card holder along with patient's CGHS card.
2. Emergency certificate (original) in case of emergency.
3. Copy of discharge summary in original.
4. Original bills/cash memo/vouchers etc for the reimbursement amount claimed.
5. Bank account - pass book copy first page showing IFSC code etc.
6. Break up of investigation from the hospital/
diagnostic centre/ imaging centre (details and rates of individuals tests and the exact number of test. X- ray films etc) as the reimbursable amount is calculated as per approved rates per test.
The learned counsel for the petitioner submits that the documents as required will be produced by the petitioner before the respondents. On submission of the documents as directed above, the 3rd respondent shall issue an acknowledgment to the petitioner for receipt of such records. Ext.P11 claim shall be taken on record by the respondents and appropriate orders shall be passed, taking note of Exts.P6 and P10, within a period of one month from the date of receipt of a copy of this judgment. This writ petition is ordered accordingly. Sd/- ANU SIVARAMAN JUDGE Bng/26.02.2020 APPENDIX PETITIONER'S EXHIBITS: EXHIBIT P1 THE TRUE COPY OF THE IDENTITY CARD VIDE CGHS CARD NO.23587/TVM ISSUED TO LATE T.A.THOMAS UNDER CGHS SCHEME EXHIBIT P2 THE TRUE COPY OF THE ORDER DATED 30.10.20009 IN CC NO.51/2009 OF CDRF, PATHANAMTHITTA EXHIBIT P3 THE TRUE COPY OF THE ORDER DATED 20.12.2011 IN CC NO.96/2010 OF CDRF, PATHANAMTHITTA EXHIBIT P4 A TRUE COPY OF THE COMPLAINT NO.40/2014 FILED BY THE 1ST PETITIONER BEFORE THE CDRF, PATHANAMTHITTA EXHIBIT P5 THE TRUE COPY OF THE LETTER/STATEMENT DATED 07.04.2014 ADDRESSED TO CDRF, PATHANAMTHITTA IN EXT.P4 PROCEEDINGS. EXHIBIT P6 A TRUE COPY OF THE ORDER DATED 21.06.2014 IN CC NO.40/2014 OF CDRF, PATHANAMTHITTA EXHIBIT P7 THE TRUE COPY OF THE EXECUTION APPLICATION FILED BY THE PETITIONERS INITIALLY ON 06.08.2014 BEFORE CDRF, PATHANAMTHITTA EXHIBIT P8 THE TRUE COPY OF THE E.A.NO.41/2016 BEFORE THE CDRF, PATHANAMTHITTA EXHIBIT P9 THE TRUE COPY OF THE CLAIM FORM DATED
29.09.2018 SUBMITTED BY THE PETITIONERS IN THE FRESH FORMAT AS PER THE DIRECTIONS AND SUBMISSIONS MADE BEFORE CDRF, PATHANAMTHITTA IN EXT.P8 PROCEEDINGS EXHIBIT P10 THE TRUE COPY OF THE ORDER DATED 31.12.2018 IN EXT.P8 EXECUTION PROCEEDING BEFORE CDRF, PATHANAMTHITTA EXHIBIT P11 THE TRUE COPY OF THE CLAIM FORM DATED 06.02.2019 ATTEMPTED TO SUBMIT BY THE PETITIONERS IN THE FRESH FORMAT BEFORE THE