Satish Kumar Gaur v. Principal District and Sessions Judge

1. This hearing has been done through hybrid mode.

2. The Petitioner-Mr. Satish Kumar Gaur has filed the present petition seeking reimbursement of his medical expenses from Respondent No. 2- Directorate General of Health Services (hereinafter, ‘DGHS’), incurred during the COVID-19 pandemic.

3. The Petitioner had joined the Tis Hazari District Court, Delhi as an employee in 1973, and superannuated on 31st October, 2010 as Superintendent North-District Court, Tis Hazari Court, Delhi.

4. During May, 2021, the Petitioner fell ill due to COVID-19 and was admitted to Nulife Hospital and Maternity Center, GTB Hospital (hereinafter, ‘the hospital’). There, he was diagnosed with COVID- 19/Bilateral Pneumonia. He remained in the said hospital between 15th May, 2021 to 25th May, 2021.

5. The total expenses incurred by the Petitioner for his medical treatment at the hospital is to the tune of Rs.5,95,816/-. The Petitioner’s grievance is that only Rs.1,26,500/- has been reimbursed out of the total amount, and the balance Rs.4,69,316/- has not been reimbursed. The Petitioners’ case was covered by the Delhi Government Employees’ Health Scheme (hereinafter, ‘DGEHS’) floated by the DGHS.

6. Upon the claim being lodged for reimbursement by the Petitioner with the District Judge, a Technical Standing Committee had been appointed which in its order dated 17th February, 2022 directed as under: “As per para 33, page no. 7/N, it is a case of COVID 19 pneumonia and found the case fit for full reimbursement. The file may be sent back to the respective department to reimburse the amount as per O.M. dated 20/06/2020. The department may also identify the excess amount and may lodge a complaint with the DM of the respective district where the hospital is located for refund of the excess amount charged by the hospital, thus, violating the order of H&FW, GNCTD dated 20/06/2020.”

7. Vide order dated 7th March 2023, this Court passed the following order: “3. Considering the nature of the matter, the DGHS is impleaded as Respondent No.2 in the present petition. Let the amended memo of parties be filed. Further, an affidavit shall be placed on record by the DGHS as to the extent of reimbursement which has been recommended by it in terms of the said opinion passed by the Technical Committee dated 17th February, 2022.

4. The ld. Counsel for the Petitioner places reliance on an order dated 22nd November, 2022 passed in Writ Petition Civil 15853/2022 titled Dinesh Kumar v. Government of National Capital Territory of Delhi and Ors. A short affidavit shall be placed on record.”

8. Today, the short affidavit on behalf of DGHS has not been filed.

9. Heard. A perusal of the Technical Standing Committee’s above report would clearly show that though there has been overcharging by the hospital. However, the fact that the Petitioner had incurred the expenses set out above, for his medical treatment is not disputed.

10. Under such circumstances, the present petition would be clearly covered by the decision of this Court in Dinesh Kumar v. Government of National Capital Territory of Delhi [2022/DHC/005039] where the Court directed that reimbursement would have to be given to similar placed persons by the DGHS. However, it will be open to the Respondent No. 1- GNCTD to initiate recovery proceedings against the hospital, if it perceives that there has been excess charging of the services offered by the hospitals. The relevant portion of the said judgment is set out below:

11. The above judgment has also been followed by this Court in Mahendra Kumar Verma v. GNCTD [2023/DHC/000131]. In the said case, a petition was filed seeking reimbursement of the remaining medical expenses incurred by the Petitioner for the treatment of his minor son. The DGHS had refused to reimburse the full amount of medical claim, even though the entitlement of the Petitioner was not disputed. In these circumstances, the Court held as under: