Abha Singh & ANR. v. Central Government Health Scheme & ANR.

$~72 * IN THE HIGH COURT OF DELHI AT NEW DELHI + W.P.(C) 4228/2025 ABHA SINGH & ANR.

.....Petitioners Through:

Ms. Shreyasi Kunwar, Adv. for petitioner nos.1 and 2.

versus CENTRAL GOVERNMENT HEALTH SCHEME & ANR.

.....Respondents Through:

Mr. Rajesh Kumar, SPC and Mr.

Rahul Kumar Sharma, Adv.

CORAM:

HON'BLE MR. JUSTICE SACHIN DATTA

O R D E R

% 09.04.2025 1.

The present petition has been filed by the petitioner seeking a direction that the respondent no.1 be directed to release a sum of Rs. 21,89,639/- (Rupees twenty one lakh eighty nine thousand six hundred and thirty nine) in favour of petitioner no.1 in respect of a medical claim dated 30.12.2021.

2.

The petitioner no.1 retired from Indian Police Services in the year 2018 at the rank of DIG and got both herself and her spouse (respondent no.

2) enrolled for Central Government Health Scheme, on payment of one time premium of Rs. 60,000/- each. It is submitted that the petitioner no.2 who was also an India Police Service Officer got retired from the services in the year 2019 in the apex scale (level 17) and became co-beneficiary in the same scheme with Card No.5799409 on payment of one time premium/fees of Rs.60,000/-.

The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 16/04/2025 at 12:29:49

3.

It is submitted that the petitioner no.2 underwent an emergency procedure (Coronary Angioplasty) with 2 drug eluting stents and transcatheter Aortic Valve replacement (TAVR) with balloon expending valve (Edward S3 Valve) on 19.01.2021 at Medanta, The Medicity Hospital, Gurgaon. The total cost of the medical treatment, including cost of the valve and medicines was Rs.21,11,745/- (Rupees Twenty one lakh Eleven thousand Seven hundred and forty five only). The said amount was borne by the petitioner inasmuch as the surgery/treatment was performed in emergency.

4.

Subsequently, the petitioner no.1 submitted her medical claim being claim no.2314/2022/DEL/EZ/D97 dated 30.12.2021 for reimbursement of the said amount. However, the said claim has not been processed till date. 5.

During the course of hearing, learned counsel for the respondents, who appears on advance notice submits that the only impediment in processing and paying the said claim is that the petitioner has not furnished a proper Heart Team Certificate, duly certified by the entire team of doctors, as per the prescribed format. During the course of hearing, a copy of the format has been handed over to the petitioner. 6.

Learned counsel for the petitioner submits that the Heart Team Certificate, in the format required by the respondent, shall be furnished within a period of three weeks from today. The respondent is directed to process the petitioner's claim dated 30.12.2021 within a period of six weeks thereafter.

7.

The petition is disposed of, in the above terms. SACHIN DATTA, J APRIL 9, 2025/cl The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 16/04/2025 at 12:29:49