Ghaziabad hospital told to pay retired railway employee s 17k for claim process delay
While payment of Rs 12,398 has been ordered as treatment reimbursement for cataract surgery, that of Rs 5,000 has been directed as the compensation for delaying the payment of the claim.
The commission also directed the payment to be made within 45 days of the order, failing which interest calculated at 6% would have to be paid.
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Passing the order on June 23, the commission, presided over by Praveen Kumar Jain, said railway authorities should have taken necessary steps to initiate payment instead of rejecting the claim on the grounds of incomplete papers "when the claimant is a retired employee of the railways".
Devilal Singh, who superannuated from the post of chief medical superintendent (CMS) in 2012, had filed an application before the DCDRC for direction to CMS, Delhi divisional office and assistant chief medical superintendent (ACMS) of Railway Hospital Ghaziabad.
The complainant said during retirement, he was provided with a medical card covering him and his family members.
He told the commission, "When I felt some problem with my right eye, I consulted the doctors at JP Hospital, Noida, and underwent a surgery on April 10, 2019, for which I paid Rs 35,890.
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Once again, I had some issues with my right eye and was advised by doctors at JP Hospital to undergo a cataract surgery, which was conducted on Oct 1, 2019. This time, I paid Rs 30,500 towards the bills raised by the hospital. When I applied for reimbursement of the treatment cost with ACMS (Railway Hospital Ghaziabad) with all relevant documents, it was rejected, which was not just a deficiency in services but also illegal.
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The complainant later filed an RTI application and was informed by the railways that his first claim of Rs 35,890 was settled by the railway department by paying Rs 1,786, as was admissible under the policy of Central Govt Health Service (CGHS). The complainant contended that since he was an employee of the railway, his claims could not be dealt with under the CGHS policy and were governed by the railway board.
The counsel for the opponents said that railway authorities follow the railway board policy of 2005, effective since Jan 2007, under which beneficiaries can obtain treatment at hospitals recognised by the railways.
"The beneficiaries are free to obtain treatment at any hospital of their choice, but in that case, reimbursement is done according to CGHS rates as applicable," the counsel said.
He told the commission the second claim was rejected for inadequacy of documents.
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