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Rajasthan High Court · body

2014 DIGILAW 2150 (RAJ)

Ashok Kumar Mehta v. State of Rajasthan

2014-12-17

SANDEEP MEHTA

body2014
JUDGMENT 1. - By way of the instant writ petition, the petitioner seeks a direction to the respondents to make reimbursement of medical expenses borne by him in the treatment of his cardiac problem for which he was subjected to Coronary Artery Bypass Graft surgery at the Apollo International Hospital Ahmedabad. 2. It is not in dispute that the petitioner is a member of Employees State Insurance Fund. The petitioner claims that after he was subjected to surgery, he submitted the bills etc. to the respondents for reimbursement but the respondents adopted a hyper technical approach and insisted that the bills would be honoured only if the petitioner furnished an affidavit stating that he would accept whatever amount is paid to him and will not raise any objection. 3. Counsel for the petitioner brought to the notice of this Court the affidavit submitted by the petitioner to the respondents along with his reimbursement application Annexure-2 dated 24.6.2008 wherein it has been specifically mentioned that he will follow all the Rules & Regulation of ESI Act, 1948 as amended from time to time. 4. Counsel for the petitioner submits that the petitioner is ready to accept the reimbursement of the medical bills as per the rates prescribed for a similar treatment at the AIIMS or CGHS whichever is higher. He further prays that the petitioner deserves to be awarded interest on the amount because the respondents have adopted a dilatory tactic in not reimbursing the medical bills of the petitioner for the last six years. 5. Learned counsel for the respondents agree that the petitioner is entitled to reimbursement of the medical bills as per the rates prescribed for similar treatment at AIIMS or CGHS but dispute the claim of interest. They submit that the petitioner is not entitled to raise the plea of delay because he did not furnish the requisite affidavit in time and that is why reimbursement could not be made to him. 6. I have considered the arguments advanced at the bar and have gone through the material available on record. 7. There is no prescribed proforma of affidavit under the Employees' State Insurance Act, 1948 and the Rules of 1950 framed thereunder. 6. I have considered the arguments advanced at the bar and have gone through the material available on record. 7. There is no prescribed proforma of affidavit under the Employees' State Insurance Act, 1948 and the Rules of 1950 framed thereunder. The insistence of the respondents that the petitioner was required to file the affidavit in a specified format has no foundation of any provision under the Act of Ashok Kumar Mehta 1948 or the Rules of 1950. Be that as it may. The petitioner has already submitted an affidavit to the respondents stating that he was ready to follow all the Rules and Regulations of ESI Act, 1948 as amended from time to time. This clause of the affidavit amounts to sufficient compliance of the condition imposed by the respondents upon the petitioner and accordingly the respondent's action in delaying the reimbursement of the petitioners medical bills is totally unjustified. 8. As a consequence, the writ petition is accepted. The respondents are directed to reimburse the medical bills of the petitioner at the rates prescribed for similar treatment at the AIIMS/CGHS rates whichever is higher. Reimbursement shall be made to the petitioner within a period of two months from the date of receipt of copy of this order. Furthermore, the amount shall carry interest @ 9% w.e.f. the date on which the bill was presented to the date of realisation.No order as to cost.Petition Allowed. *******