New Delhi- 110002
- withdraw illegal guidelines
putting upper limit of medical expenses of Rs.10 lac per year per beneficiary
and allow Blood Caner Patient Smt. Ayesha to continue her treatment at Action
is another case out of several cases coming to our notice where the ESI has
failed to fulfil its constitutional and statutory duty to provide free and
continuous treatment to the workers and their dependents by resorting to
illegal and unconstitutional guidelines framed by the administrative
authorities defeating the entire object of the ESI Act.
Sh. Azad Ali r/o C 67, Prem Nagar-3, New
Delhi-110086 is employed in a factory since the year 1991 and is presently
working on the salary of Rs. 10,000/- per month. He with his family is an ESI
beneficiary under I.P. No. 2204342514.
Ayesha wife of the Sh. Azad Ali is suffering from Acute Lymphoblastic Leukaemia
(Blood Cancer). She being a beneficiary
under the said I.P. number for being the wife of the workman, has been
undergoing treatment at the ESI Hospital, Rohini. She was ultimately, referred
by the ESI Hospital to its empanelled hospital, namely, Action Caner Hospital
for the super speciality treatment.
Ayesha was given treatment at the Action Cancer Hospital from 27.07.2015
pursuant to the ESI reference. However, after the 25 days of treatment, the
bill of the hospital crossed Rs. 9, 12, 817/- . The moment the bill of the said
hospital crossed Rs. 10/- lacs, the ESI stopped giving approval for treatment.
The Action Cancer Hospital discharged the said patient in absence of further
sanction of treatment by the ESI. The ESI authorities’ relying upon the clause
5 of the ESI guidelines dated 29.08.2014, refused to sanction further treatment
of the patient. The said guideline is reproduced as under:-
“5.1 Upper limit on the expenditure for procedures
not covered under CGHS package rates would be Rs. 10 Lakh per beneficiaries per
ESI has stopped approval of the treatment of Smt. Ayesha as the expenditure has
nearly crossed the limit of Rs. 10 lacs. Smt. Ayesha is in urgent need of
treatment. Any delay at this stage could be fatal to her life. At present, Smt.
Ayesha has been admitted in the Delhi State Cancer Institute run by the Delhi
Government. However, it does absolve you from your legal obligations towards
her. She wants to continue her treatment at Action Cancer Hospital.
said provision of your guidelines is illegal, unjustified, unconstitutional,
hit by Art. 21 of the Constitution and is contrary to the provisions of the ESI
Act. The ESI has no authority or power to issue such guidelines under the
provisions of the ESI Act. It is pertinent to mention herein that the said guidelines
have already been challenged in W.P. (C) No. 8445/2014 titled “Mohd. Kalim V ESIC”. The Hon’ble Delhi
High Court in the said writ petition has passed some interim orders against
you. However, the matter is pending for decision.
are therefore called upon by this notice to approve the treatment of Smt.
Ayesha w/o Sh. Azad Ali irrespective of the cost of treatment crossing the said
limit and continue the same unabated in future. You are also called upon to
withdraw the said illegal and unjustified guidelines and not to deny treatment
to any patient on the basis thereof. In case, you fail to provide treatment to
Smt. Ayesha as demanded above, she shall be constrained to move the Hon’ble
Delhi High Court for relief.