Punjab-Haryana High Court
Bhoti Devi vs State Of Haryana & Ors on 28 October, 2014
Author: Amol Rattan Singh
Bench: Amol Rattan Singh
CWP No.39 of 2014 -1-
IN THE HIGH COURT OF PUNJAB AND HARYANA
AT CHANDIGARH
CWP No.39 of 2014
Date of decision : 28.10.2014
Bhoti Devi
...... Petitioner
Versus
State of Haryana and others
...... Respondents
CORAM : HON'BLE MR.JUSTICE AMOL RATTAN SINGH
***
Present:- Mr. Madan Pal, Advocate
for the petitioner.
Mr. Ashish Kapoor, Addl. Advocate General, Haryana
***
AMOL RATTAN SINGH, J.(Oral)
The petitioner in this case is the widow of the late Dalip Singh, who retired as a Social Science Master from the respondent-Department of the Government of Haryana on 31.03.2002. She is seeking reimbursement of medical expenses borne on the treatment of her husband between the period 03.09.2009 and 30.09.2009, on account of the disease of Metastatic Renal Cell Carcinoma, that he unfortunately suffered from.
The said treatment was received by her husband from the Post Gratuate Institute of Medical Education and Research, Chandigarh, which fact is not disputed by the respondents. In fact, medical reimbursement of expenditure made after 30.09.2009, i.e. w.e.f. 01.10.2009, has been reimbursed by the respondents but for the period in question, i.e. from AMIT RANA 2015.04.27 15:58 I attest to the accuracy and authenticity of this document Chandigarh CWP No.39 of 2014 -2- 03.09.2009 to 30.09.2009, it is being refused on the ground that the certificate issued by the Medical Board constituted under the Chairmanship of the Civil Surgeon, Kurukshetra, declaring that the petitioners' late husband actually suffered from the said chronic disease, was so issued on 24.09.2009 and consequently the option for change of the medical reimbursement scheme, from a fixed medical allowance to reimbursement of actual expenses incurred on treatment of a chronic disease as an outdoor patient, was issued on 08.01.2010 by respondent No.2, w.e.f. 01.10.2009.
2. The petitioners' husband unfortunately died on 17.03.2010 but before that date he had moved various representations to the respondents seeking reimbursement for expenses incurred on his treatment, copies of which have been annexed with the petition.
3. Mr. Madan Pal, learned counsel for the petitioner, submitted that though the respondents have not denied that the petitioners' late husband was suffering from the said chronic disease, i.e. Metastatic Renal Cell Carcinoma, and have even reimbursed all sums as were due w.e.f. 01.10.2009, a rather strange stand is being taken, that because an order was passed about four moths after the petitioners' husband made his first representation on 15.09.2009, immediately after having been diagnosed with the above named disease and having been issued a certificate to that effect by the PGIMER, Chandigarh on 10.09.2009, such reimbursement can be made only with effect from the date that the option was ordered to be changed by respondent No.2.
4. After the petitioners' husband died, she herself moved representations on 02.06.2010 and 09.06.2010, seeking reimbursement for AMIT RANA 2015.04.27 15:58 I attest to the accuracy and authenticity of this document Chandigarh CWP No.39 of 2014 -3- the expenses incurred on his medical treatment during the period in question, which were eventually rejected by respondent No.2 on 29.10.2013, vide a communication, Annexure P-21, addressed to the District Elementary Education Officer, Kurukshetra. The said communication simply states that the case of the petitioners' husband was sent to the Health Department, Haryana, seeking clarification and advice whether the option can be changed from 01.10.2009 to 03.09.2009 but "as per clarification and advice, received from Health Department, Haryana" dated 18.07.2013, the change of option could not be considered from 03.09.2009 and stood rejected.
This is so despite the fact that the Civil Surgeon, Kurukshetra, had vide his letter dated 15.03.2012 (Annexure P-18), addressed to the District Elementary Education Officer, Kurukshetra, stated that the patient was suffering from Renal Cell Carciconoma with Metastasis from 03.09.2009.
Mr. Madan Pal therefore submitted that the impugned orders dated 08.01.2010 (Annexure P-8) and the subsequent letter dated 29.03.2013 (Annexure P-21 rejecting the allowance of change of option with effect from 03.09.2009) deserve to be quashed.
In this regard, he also cited a judgment of a coordinate Bench passed in CWP No.8469 of 2011 on 06.11.2012, titled as Ombai vs. State of Haryana and others.
5. Per contra, Mr. Ashish Kapoor, learned Addl. Advocate General, Haryana, referred to the written statements filed by the respondents, to submit that as per the instructions and policies of the AMIT RANA 2015.04.27 15:58 I attest to the accuracy and authenticity of this document Chandigarh CWP No.39 of 2014 -4- Haryana Government on medical reimbursement, of the year 2005, reimbursement for expenses incurred on medical treatment for a chronic disease, with the patient being an outdoor patient, can only be granted with effect from the date of change of option of the employee is accepted. Thus, learned State counsel reiterated the stand of the respondents, as already noticed, that the case of the petitioners' husband cannot be accepted for the reason that the option stood changed only with effect from 01.10.2009 vide the first order passed by respondent No.2, on 08.01.2010 (Annexure P-8).
Mr. Kapoor also cited from the reply, the judgment of the Supreme Court in State of Rajasthan Vs. Mahesh Kumar Sharma, dated 02.03.2011, passed in Civil Appeal No.2278 of 2011, wherein, while referring to the earlier judgment of the Apex Court in State of Punjab and others Vs. Ram Lubhaya Bagga and others (1998) 4 SCC 117, it was held that once Government has formulated the necessary rules permitting reimbursement of medical expenses in certain situations and up to a certain limit, it would not be proper for a Government employee or his relatives to claim reimbursement of medical expenses otherwise than as provides in the Rules.
Mr. Kapoor, therefore, prayed that the writ petition be dismissed as the respondents had only acted in terms of the Policy of 2005 of the Government, referred to above, as also the subsequent policy annexed with the petition itself, dated 31.01.2006 (Annexure P-27).
6. Having heard learned counsel for the parties and having gone through the pleadings, I find that the stand of the respondents is wholly untenable and without logic and reasoning.
AMIT RANA2015.04.27 15:58 I attest to the accuracy and authenticity of this document Chandigarh CWP No.39 of 2014 -5-
What the respondents are attempting to do, actually amounts to twisting the policy against the spirit of the same. Though no malafide intention can be overtly discerned, however, what is being done is that just because the second respondent, for no valid reason whatsoever, ordered the change of option to be effective from 01.10.2009 instead of from the date that the disease has been admitted to be diagnosed, i.e. 03.09.2009, reimbursement is being denied to the petitioner for the earlier period.
This is despite the fact that the letter of the Civil Surgeon, dated 15.03.2012, gives reference of the certificate issued on 24.09.2009 by the Medical Board headed by the Civil Surgeon himself, certifying the disease of the petitioners' late husband to be chronic disease. Though, undoubtedly, the said certificate does not specifically state that it is to be treated as a chronic disease w.e.f. 03.09.2009, whereas the Civil Surgeons' subsequent letter dated 15.03.2012 does say so, however, it is not in dispute that even as per the OPD Card of the PGIMER, Chandigarh (Annexure P-2), dated 03.09.2009, it has been clearly stated therein that the patient has a 'Metastasis'.
7. Without a doubt, the PGIMER, Chandigarh, is a premier medical institute of northern India. Naturally, the petitioners' husband could only have applied for a diagnosis by the Board so as to enable him to change his option, after he was diagnosed by the said institute and he could not obviously have done so before that. Therefore, consequent upon diagnosis being confirmed by the Medical Board, Kurukshetra, on 24.09.2009, the petitioners' husband submitted an application on 25.09.2009 itself (Annexure P-7), to respondent No.2, for change of option from a AMIT RANA 2015.04.27 15:58 I attest to the accuracy and authenticity of this document Chandigarh CWP No.39 of 2014 -6- fixed medical allowance to reimbursement of medical expenses of an outdoor patient suffering from a chronic disease, on the basis of actual expenses incurred. That permission having been granted by respondent No.2 only on 08.01.2010, i.e. about 3 ½ months later, it is not understood as to why such permission was granted only w.e.f. 01.10.2009, whereas even the Medical Board had certified, in fact, reiterated, on 24.09.2009, what the PGIMER, Chandigarh, had already diagnosed on 03.09.2009.
8. The cryptic order passed vide the impugned letter dated 29.10.2013, stating that the petitioners' husbands' case has been rejected, gives no reason for rejection, which is only discernible now from the stand taken by the respondents, which again is not based on any reasoning or logic, but simply states that since the option was allowed to be changed only from 01.10.2009, therefore, reimbursement of actual expenses incurred, as opposed to fixed medical allowance, can only be granted from such date.
It is not the stand of the respondents that the policy itself prohibits such reimbursement for expenses incurred as an outdoor patient suffering from a chronic disease, and obviously that cannot be the stand, in view of the fact that reimbursement for expenses incurred after 01.10.2009 have factually been reimbursed to the petitioner/her late husband (during his life time).
It is also not the stand of the respondents that the petitioners' husband had actually not suffered from that disease since 03.09.2009. To again repeat, the only stand is that the option was allowed to be changed only w.e.f. 01.10.2009, with no reasoning given as to why it was only allowed from that date and not from 03.09.2009.
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As to why it was not allowed from the date on which the disease admittedly was diagnosed on 03.09.2009, is something which the respondents have not even begun to explain, because there can be no logical explanation for that.
Therefore, the reference by the respondents to the judgments of the Hon'ble Supreme Court in Mahesh Kumar Sharmas' case (supra) and Ram Lubhaya Baggas' case (supra), is wholly misplaced because those judgments uphold the right of Government to issue a policy and to change a policy, which in any case, is not refuted even by the petitioner.
9. In view of all that has been stated and discussed above, this writ petition is allowed; the order, Annexure P-8, is quashed to the extent that it allows reimbursement of expenses incurred on the allopathic treatment of a chronic disease suffered by the petitioners' late husband only from 01.10.2009. The said letter will be deemed to read that the change of option from a fixed monthly allowance to grant of reimbursement for expenses incurred as an outdoor patient is from 03.09.2009. Consequently, the impugned order/letter dated 29.10.2013 (Annexure P-21) is also quashed.
The respondents are directed to make reimbursement of medical expenses incurred by the petitioner and her late husband, between 03.09.2009 and 30.09.2009, in terms of their policy on the subject, including the policy dated 31.01.2006 (Annexure P-27).
It is made clear that though the reimbursement will be made in terms of the said policy, however, the date of change of option, from a fixed medical allowance to reimbursement of actual medical expenses incurred in AMIT RANA 2015.04.27 15:58 I attest to the accuracy and authenticity of this document Chandigarh CWP No.39 of 2014 -8- respect of a chronic disease by an outdoor patient, will be taken to be 03.09.2009.
10. The petitioner would also be entitled to costs of Rs.10,000/-, which the respondents may recover from the officials/officers responsible for taking an unreasonable stand in rejecting the change of option w.e.f. 03.09.2009 and instead allowing it only w.e.f. 01.10.2009.
The amount to be reimbursed to the petitioner for expenses incurred during the period 03.09.2009 to 30.09.2009 would also carry interest @ 7% per annum, running from the date that the first reimbursement of expenses incurred on her husbands' treatment, was made to the petitioner/her late husband, till the date of this judgment, i.e. 28.10.2014. The payment would be made within a period of two months from the date of receipt of a certified copy of this judgment.
( AMOL RATTAN SINGH ) 28.10.2014 JUDGE vcgarg/dinesh AMIT RANA 2015.04.27 15:58 I attest to the accuracy and authenticity of this document Chandigarh