JUDGMENT : Prayer: Appeal filed under Section 82 of the ESI Act, 1948, against the Fair order and decree dated 18.06.2015 made in E.S.I.O.P.No.27 of 2012, on the file of the Employees State Insurance Court (Labour Court), Madurai in respect of disallowance of the amount to an extent of Rs.4,38,663/- (Rupees Four Lakhs Thirty Eight Thousand Six Hundred and Sixty Three). 1. The appellant was employed as driver in M/s. Suriaprabha Hosieries, Tiruppur. The said establishment was covered by ESI Act, 1948. The appellant was also covered by the Act since 01.04.1998. On his transfer to Kalvarpatti Branch of the establishment, his insurance number was also changed and he was attached to branch office of ESI Corporation, Dindigul. The appellant met with a very serious accident during the night hours of 25.03.2009. Since the accident occurred very near to the factory premises, his fellow employees rushed to the spot and took him to City Hospital, Dindigul in time. Since his condition was very bad, he was shifted to Appollo Speciality Hospital, Madurai. He took treatment from 26.03.2009 to 18.05.2009. He had to spend a sum of Rs.10,16,760/- (Rupees Ten Lakhs Sixteen Thousand Seven Hundred and Sixty only) towards his medical treatment. Though the appellant claimed that after taking treatment in these two hospitals, he submitted his bill for reimbursement without any delay, it has been specifically denied in the counter filed by the ESI Corporation. 2. The stand of the ESI Corporation is that the bill was submitted only on 24.01.2011 i.e. after a delay of more than 20 months. There is no record to show that the bill was submitted in time. Even though the claim for reimbursement was apparently time barred, the second respondent took a lenient view and sanctioned a sum of Rs.5,78,097/-(Rupees Five Lakhs Seventy Eight Thousand and Ninety Seven only) as per the C.G.H.S. rates (Central Government Health Scheme). It was contended that the ESI Corporation has mechanically disallowed a substantial portion of the claim. The appellant herein filed E.S.I.O.P.No.27 of 2012 under Section 75(g) of ESI Act, 1948, before the Labour Court, Madurai. The appellant sought a declaration that disallowance of Rs.4,38,663/- (Rupees Four Lakhs Thirty Eight Thousand Six Hundred and Sixty Three only) is illegal and wanted a further declaration that he is entitled for full reimbursement of Rs. 10,16,760/- (Rupees Ten Lakhs Sixteen Thousand Seven Hundred and Sixty only). The appellant sought a declaration that disallowance of Rs.4,38,663/- (Rupees Four Lakhs Thirty Eight Thousand Six Hundred and Sixty Three only) is illegal and wanted a further declaration that he is entitled for full reimbursement of Rs. 10,16,760/- (Rupees Ten Lakhs Sixteen Thousand Seven Hundred and Sixty only). He sought direction for payment of sum of Rs.Rs.4,38,663/- (Rupees Four Lakhs Thirty Eight Thousand Six Hundred and Sixty Three only) with interest. 3. The claim of the appellant was opposed by the Corporation. The stand of the Corporation was that the Corporation had acted reasonably by reimbursing as per C.G.H.S. rates. The ESI Court by order dated 18.06.2015 remanded the matter to the file of the respondents for reconsideration. The ESI Court has adopted such course, in view of the fact that the respondents did not pass any speaking order for disallowance of portion of the claim of the appellant herein. It was made clear that while reconsidering the matter, it would not be open to the respondents to recall or reverse the earlier order allowing the reimbursement claim to the tune of Rs.5,78,097/- (Rupees Five Lakhs Seventy Eight Thousand and Ninety Seven only). In other words, the appellant will not be put to prejudice on account of reconsideration. Either the respondents could sanction the claim of the appellant little more or in full and but it was not open to them to tinker with the earlier order granting reimbursement to the extent of Rs. 5,78,097/-(Rupees Five Lakhs Seventy Eight Thousand and Ninety Seven only). Aggrieved by the same, the appellant has filed this appeal. This Court has ordered notice of motion in the matter. The appeal was not admitted. 4. The learned counsel appearing for the appellant would contend that ESI Court ought to have allowed the E.S.I.O.P as prayed for and erred in remitting the matter to the file of the respondents. This is because the facts are not in dispute. The appellant is a covered employee. He met with an accident. He got treated in two hospitals, both of which are having tie up with ESI Corporation. In other words, he took treatment only in approved institutions. He incurred an expenditure of Rs.10,16,760/- (Rupees Ten Lakhs Sixteen Thousand Seven Hundred and Sixty only) and the same is also accepted as evidenced by the bills which he produced. He got treated in two hospitals, both of which are having tie up with ESI Corporation. In other words, he took treatment only in approved institutions. He incurred an expenditure of Rs.10,16,760/- (Rupees Ten Lakhs Sixteen Thousand Seven Hundred and Sixty only) and the same is also accepted as evidenced by the bills which he produced. He drew the attention of this Court to an unreported decision of the Division Bench of Kerala High Court dated 10.08.2017 in Appeal No.5 of 2015 (Secretary, State Government Labour Department Vs. S.Gopakumar and two others). The factual matrix in the said case was more or less similar to one on hand. In the said case also, the covered employee had undergone a treatment and incurred certain sum by way of medical expenditure. When a claim was submitted before the Corporation for getting reimbursement, the Corporation allowed only what according to it the applicant was eligible as per C.G.H.S. rates. Since, the claim for the balance amount was rejected, the employee moved the ESI Court. The ESI Court held that the employee was entitled to get the balance amount also. The Division Bench of Kerala High Court took the view that as per Section 57 of ESI Act, it is for the State Government or the Corporation to fix the scale for reimbursement of any medical benefits that can be extended to a person/insurer or his or her family members in connection with any medical treatment undergone. There is no provision anywhere in the Act or under Section 57 of the Act to adopt the amount fixed under C.G.H.S. or to bring the same within purview of Section 57 of the Act. No decision has been taken by the State Government or the Corporation for adopting C.G.H.S. or any other scheme for the purpose of Section 57 of the Act. Mere issuance of a letter by the ESI authorities in this regard would not satisfy the requirements under Regulations 96 and 97 of the Act which mandate previous publication. After extracting Section 56 and 57 of the Act, the Division Bench proceed to hold that there is a liability cast on the Corporation as well as the State Government for meeting the medical expenditure. After extracting Section 56 and 57 of the Act, the Division Bench proceed to hold that there is a liability cast on the Corporation as well as the State Government for meeting the medical expenditure. It was further held that since the Corporation as well as State Government are under the liability to provide medical facility to the insurer and his or her family members, they must discharge the duty by providing them either on their own or by entering into tie up with some hospitals. If the facility that is required is not available either in the hospital run by the ESI or in the tie up hospital, it is open to the insurer to avail the treatment from wherever it is available and claim reimbursement. When such a claim is made, it could not be rejected. In this view of the matter, the appeal filed by the Government was dismissed. 5. The contention of the learned counsel for the appellant is that the said decision applies squarely to the case on hand. He prayed for the admission of the appeal and answering the substantial question of law that has arisen for determination in favour of appellant by following the above said decision of the division bench of Kerala High Court. 6. Per Contra, the learned counsel appearing for the respondent Corporation submitted that there cannot be an absolute right for medical reimbursement. When there is statutory scheme providing for medical reimbursement, the claim for such reimbursement will have to be within four corners there of. In the present case, all that the appellant ought to have done was to have intimated the respondents, after getting admitted in the hospital. In this case, both the City hospital, Dindigul as well as the Apollo Speciality Hospital, Madurai, are having tie up with ESI Corporation. If he had given intimation, the respondent ESI dispensaries/hospital would have issued a referral letter, based on which the tie up hospital would have given cashless treatment. It is not necessary that such a referral letter should be obtained before getting admitted in case of emergency such as the present one. Such a referral letter could be obtained even after admission in the private hospital. The appellant got admitted on 26.03.2009. He was inpatient till 18.05.2009. At least during this period, he could have approached the ESI dispensaries. Such a referral letter could be obtained even after admission in the private hospital. The appellant got admitted on 26.03.2009. He was inpatient till 18.05.2009. At least during this period, he could have approached the ESI dispensaries. Obviously the appellant had his friends and relatives to assist him. He had attenders by his side. In this modern age, communication is not at all difficult. The appellant did not make any effort to communicate with the ESI dispensaries or the respondents to get such a referral letter. The discharge from the hospital was on 18.05.2009. The submission of bill for reimbursement was on 24.01.2011. Even though, the claim was time barred, still lenient view was taken and delay was condoned and the claim to the tune of Rs.5,78,097/- (Rupees Five Lakhs Seventy Eight Thousand and Ninety Seven only) was sanctioned. It is true that the respondents did not pass a speaking order in the first instance. The medical commissioner has subsequently passed an order dated 16.10.2015, informing the appellant that the issue was reexamined and it was concluded that there is no infirmity in the earlier order of sanction and calculation of the amount. The reasons for disallowance have also been enclosed along with the said commucation. 7. Now the question that arises for consideration is whether the respondents were justified in applying the C.G.H.S. rates. 8. As rightly contended by the learned counsel for the respondents the matter falls more in the realm of policy. This Court cannot lose sight of the fact that the issue involves financial liability. The object of having tie up with certain hospitals and insistence on referral letter is that it would serve two purposes: (i) the insurer would get cashless treatment and (ii) the institutions would not be at liberty to charge as they deem fit. Since there is a contractual understanding between the ESI and the concerned hospital, the hospital would not compromise its quality of treatment but the same would be given at the rates already agreed upon. I concite an example. An occasional buyer from a book shop will be billed as per the price mentioned on the cover. But for the same book the regular customer is given a discount. 9. The ESI Corporation went into the issue of incurring of expenditure by ESI beneficiaries for getting speciality treatment. It issued comprehensive instructions vide letter dated 23.07.2008. An occasional buyer from a book shop will be billed as per the price mentioned on the cover. But for the same book the regular customer is given a discount. 9. The ESI Corporation went into the issue of incurring of expenditure by ESI beneficiaries for getting speciality treatment. It issued comprehensive instructions vide letter dated 23.07.2008. It is specifically mentioned in the said letter that the tie up arrangement should be maintained in C.G.H.S. Hospitals and institutions whether public or private on the C.G.H.S. rates. Now the question is whether this Court should follow the decision of the Division Bench of Kerala High Court rendered in Appeal No.5 of 2015 dated 10.08.2017 (Secretary, State Government Labour Department Vs. S. Gopakumar and two others). 10. Section 56 of the Act states that the insurer person shall be entitled to receive medical benefit but Section 57 of the Act sets out the scale of medical benefit. Section 57 reads as follows: “57.Scale of medical benefit.-(1) An insured person and (where such medical benefit is extended to his family) his family shall be entitled to receive medical benefit only of such kind and on such scale as may be provided by the State Government or by the Corporation, and an insured person or, where such medical benefit is extended to his family, his family shall not have a right to claim any medical treatment except such as is provided by the dispensary, hospital, clinic or other institution to which he or his family is allotted, or as may be provided by the regulations. (2)Nothing in this Act shall entitle an insured person and (where such medical benefit is extended to his family) his family to claim re-imbursement from the Corporation of any expenses incurred in respect of any medical treatment, except as may be provided by the regulations.” Since the said provision states that reimbursement shall be done as per the provisions laid down in ESI (General) Regulations, 1950, it is necessary to go to the Regulations. Regulations 96(A) states that claims for reimbursement of expenses incurred in respect of medical treatment of insured person may be accepted in circumstances and subject to such conditions as the Corporation may by general or special order specify. 11. The expression 'specify' means specified by instructions issued from time to time by the Corporation or any authorities officer (vide (2) (v)ESI (General) Regulations,1950). 11. The expression 'specify' means specified by instructions issued from time to time by the Corporation or any authorities officer (vide (2) (v)ESI (General) Regulations,1950). It is true that Section 97 of the Act mandates that the Regulations made by the Corporation should be published. It cannot be in anybody's case that the ESI (General) Regulations, 1950 were not published. It is not necessary that even general or special orders of the Corporation issued under Section 96(A) of the ESI (General) Regulations, 1950 should also be published. The requirement of prior publication is only for the general Regulation and not for each and every general or special orders issued in terms of Regulations 96(A). I therefore am not in a position to follow the aforesaid decision of the Hon'ble Division Bench of Kerala High Court. 12. The appellant chose to take treatment in the approved private hospitals but without getting any referral letter from ESI dispensaries/hospitals. In fact a full fledged E.S.I hospital is functioning at Madurai. The respondent Corporation has adopted a very reasonable and positive stand in favour of the appellant. It is not as if the appellant was not aware of the ESI coverage. He was earlier working in Thiruppur. Insurance number was allotted to him. He got transferred to Dindigul District. Consequently, ESI number was also changed. He was attached to ESI Vedasandur. Therefore with full knowledge what is required to be done by him, he chose to bye pass the procedures. If the appellant had taken referral letter from ESI dispensaries, he would have got the same treatment and it would have been cashless. The ESI Corporation would have paid the hospital directly at the agreed rates. It is not open to the appellant to saddle the ESI Corporation with extra financial liability. The appellant was not only reimbursed to the tune of Rs.5,78,097/-(Rupees Five Lakhs Seventy Eight Thousand and Ninety Seven only) but was also paid temporary disablement benefit of Rs.17,822/- (Rupees Seventeen Thousand Eight Hundred and Twenty Two only). He is getting Permanent Disablement Benefit (PDB) from 11.08.2009 which is a little above Rs.2000/- (Rupees Two Thousand only). This amount is likely to be revised upwards. This monthly benefit will be paid to the appellant during his entire lifetime. He is getting Permanent Disablement Benefit (PDB) from 11.08.2009 which is a little above Rs.2000/- (Rupees Two Thousand only). This amount is likely to be revised upwards. This monthly benefit will be paid to the appellant during his entire lifetime. All these benefits are extended in terms of a certain policy taken by the ESI Corporation pursuant to the statutory mandate set out under Section 57 r/w. Rule 96(A) General Regulations, 1950. The appellant will have to necessarily rest his case only within four corners of the said statutory scheme. He has no independent right outside the said scheme. 13. I am of the view that the respondent Corporation has acted in reasonable manner. The ESI Court merely remanded the matter to the file of the respondents during the pendency of the appeal. The respondents have passed a speaking order explaining the reasons for disallowing a portion of the appellant's claim. Therefore, as on date no cause of action survives for the appellant. No substantial question of law arises for determination in this appeal. This appeal is therefore liable to be dismissed. I must place on record the excellent assistance I received from Shri. P. Ganapathisamy, the learned standing counsel for ESI Corporation. 14. The appeal stands dismissed. No Costs.