Madhya Pradesh High Court
Mithilesh Kumar Pandya vs Central Bank Of India & Ors. on 28 October, 2022
Author: Subodh Abhyankar
Bench: Subodh Abhyankar
1
IN THE HIGH COURT OF MADHYA PRADESH AT INDORE
BEFORE
HON'BLE SHRI JUSTICE SUBODH ABHYANKAR
ON THE 28TH OF OCTOBER, 2022
WRIT PETITION No. 9471 of 2009
Between:-
MITHILESH KUMAR PANDYA S/O LATE
KANHAIYALLA, AGED ABOUT 61 YEARS,
OCCUPATION: RETED. 26-B,MAHABALI
NAGAR KOLAR ROAD BHOPAL (MADHYA
PRADESH)
.....PETITIONER
(BY SHRI A. S. KUTUMBALE, SENIOR COUNSEL WITH SHRI B. S.
GANDHI, ADVOCATE)
AND
CENTRAL BANK OF INDIA & ORS. THR.ITS
CHAIRMAN & MANAGING DIRECTOR
1.
CENTRAL BANK OF INDIA (MAHARASHTRA)
G.M.(HRD) CENTRAL BANK OF INDIA
CHANDERMUKHI, NARIMAN POINT,
2.
MUMBAI (MAHARASHTRA)
DY.G.M. CENTRAL BANK OF INDIA ZONAL
OFFICE, 9,ARERA HILLS, JAIL ROAD,
3.
BHOPAL (MADHYA PRADESH)
R.M., CENTAL BANK OF INDIA 6/3, RACE
4. COURSE ROAD, INDORE (MADHYA
PRADESH)
.....RESPONDENTS
(BY SHRI S. K. SHARMA, ADVOCATE)
2
..............................................................................................................
Reserved on 28.07.2022
Passed on 28.10.2022
.........................................................................................................
This petition coming on for orders this day, the court passed
the following:
ORDER
Heard finally with the consent of the parties.
2. This petition has been filed by the petitioner, a retired bank employee under Article 226 of the Constitution of India seeking the following reliefs:-
"i. Allow the present petition.
ii. Direct respondent to reimburse hospitalization
expenses i.e., difference of cost of AICD Machine implanted item of Rs.3,29,500/- and CBAG expenses of Rs.36,264/- plus interest from respective dates 2-3-05 and 12-06-96 till payment.
iii. Award the cost of petition.
iv. Pass any order in favour of the petitioner as may be deemed fit, just and expedient in the interest of justice."
3. The grievance of the petitioner is that after serving the respondent/Central Bank of India around 35 years, he retired on 31.03.2006, while he was serving as Manager of the respondent-bank. Admittedly, the petitioner has undergone a coronary bypass surgery for the treatment of severe triple vessel coronary artery disease in April, 1996 for which he incurred the total expenses of Rs.1,32,514/-. However, the bank has sanctioned only a sum of Rs.96,250/- and the 3 difference amount of Rs.36,264/- payable from SWS (full form) was duly recommended from Zonal Office Bhopal, vide letter dated 27.08.1996, which has not been paid to the petitioner till date despite various representations.
4. The petitioner's contention is that the General Secretary, All India Central Bank Officer's Association also recommended the reimbursement of the said difference amount to the respondents vide its letter dated 29.10.1996, but no action was taken on the same. The case of the petitioner is that due to his heart disease, he was advised implantation of AICD (Prism II) i.e., "Automatic Implantable Cardioverter Defibrillators". For the treatment of which the petitioner also sought advance amount from the respondents and an estimate of Rs.5,10,000/- was also submitted by the petitioner including the cost of AICD machine of Rs.4,40,000/-. The draft regarding which was to be made in favour of M/s. Advance Micronics Devices Ltd. The petitioner was allowed 75% of the estimate submitted as advance payment amounting to Rs.3,82,500/- through a Demand Draft dated 15.12.2004, in favour of Batra Hospital and Research Centre, New Delhi. The case of the petitioner is that since the bill was sanctioned in the name of Batra Hospital and Research Centre, New Delhi instead of M/s. Advance Micronics Devices Ltd., hence, a 5% tax was also applied and the cost of machine increased to Rs.4,62,000/- from Rs.4,40,000/-.
5. Admittedly, petitioner has already undergone the treatment. The case of the petitioner is that the respondents, while sanctioning the bill 4 submitted by the petitioner considered only Rs.1,32,500/- into account as the cost of AICD machine misconstruing it as a pacemaker as per old schedule of AIIMS, whereas the case of the petitioner is that this machine was not pacemaker and was valued at Rs.4,62,000/- i.e. Rs.4,40,000/- cost and Rs.22,000/- (5% tax). Because of this wrong estimation, the advance payment made to the petitioner has been recovered from his salary and thus, the amount of Rs.3,29,500/- has still not been reimbursed to the petitioner. In this regard, certain representations were also submitted by the petitioner and vide their letter dated 09.02.2005 (Annexure P/4), the respondents informed that "since IRP department has not received the latest schedule of charge from AIIMS Delhi the cost implanted items may be reimbursed at the rates not exceeding those available in existing AIIMS schedule i.e., highest rate of pacemakers (implanted item) Rs.1,32,500/- for dual chamber. It was also stated that if there is any upward revision of the said price, the same will be conveyed to the petitioner and will be paid accordingly.
6. It is also the case of the petitioner that vide letter No.CO/HRD/IRP/2006-07/45 dated 26.03.07, respondent No.1 issued clarifications regarding schedule for reimbursement of hospitalization informing that, "We have been getting numerous queries from Regional Offices and Zonal Offices as to the rates being charged by AIIMS, New Delhi, we were informed that AIIMS Charges for the implanting items but the implanted items are purchased by the patients from the market as per the prescription.
57. After through deliberation at our end after taking advice from Indian Bank's Association (I.B.A.) on the said matter, it is hereby advised as under:-
"As regards cost of implanted items which do not form part of package charges, Regional Offices and Zonal Offices may reimburse the actual cost on submission and verification of original purchase bills, with the rates being certified by the concerned hospital, which should be as per prevalent market rate. In case the implanted items are imported, copy of the invoice from the importer apart from the purchase bills from the claimant, should also be obtained and scrutinized."
8. The aforesaid circular is also placed on record Annexure P/7. However, the respondents have informed the petitioner that as the petitioner was hospitalized from 17.12.2004 to 21.12.2004, circular dated 26.03.2007 is not applicable to the petitioner's case as the circular has come into force with effect from 02.06.2005. Subsequent notices issued by the petitioner for reimbursement have also not been considered by the respondents.
9. Shri A. S. Kutumbale, Senior Counsel appearing for the petitioner has submitted that despite all the documents placed on record demonstrating that the petitioner is entitled to the reimbursement, the respondents have deliberately and arbitrarily has rejected the petitioner's claim. Senior counsel has further submitted that the machine AICD (Prism II) is an imported item and does not fall within the category of pacemaker and thus, its reimbursement ought to have been considered by the respondents without being influenced by the earlier schedule of the AIIMS in respect of pacemaker. It is also submitted that the respondents have acted arbitrarily in not following the clarifications made vide circular dated 26.03.2007.
610. A reply to the aforesaid petition has also been filed by the respondent - bank refuting the averments of the writ petition.
11. Counsel appearing for the respondents/bank has submitted that no illegality has been committed by the respondents in declining the petitioner's claim as the bank has acted only as per the guidelines issued in this behalf by the respondent/bank and thus, the respondent/bank is not liable to pay the additional amount of medical expenses incurred by the petitioner.
12. Counsel has reiterated that the petitioner's claim for payment of actual cost of AICD machine was not considered as the same was not in terms of the policy/circular of the respondent/bank. Counsel has also drawn the attention of this Court to the documents filed along with the reply and more particularly towards the letter dated 13.05.1996 issued by the General Manager regarding reimbursement of the hospitalization expenses to Officers/employees, and also the Central Bank of India. Attention of this Court is also drawn to the Central Bank of India (Officers') Service Regulations, 1979, in particular, Clause 11 of the same. Counsel has also drawn the attention of this Court to the Schedule for reimbursement of the Hospitalization expenses. Thus, it is submitted that no case for interference is made out and the petition being devoid of merits, is liable to be dismissed.
13. In rejoinder, counsel for the petitioner has submitted that the Bank has admitted the medical advance of Rs.3,82,500/- in favour of Batra Hospital and Research Centre, New Delhi for the treatment of the petitioner inclusive of cost of AICD machine that is the implanted 7 item, but subsequently denied that and because of which the payment of the said advance amount of Rs.3,82,500/- to the Batra Hospital & Research Centre, New Delhi instead of M/s. Advance Micronics Devices Ltd. 5% tax was applied to the petitioner and cost of machine was increased to Rs.4,62,000/- i.e. (Rs.4,40,000/- + Rs.22,000/-) as Bank has sanctioned Advance on the basis of the estimated dated 07.12.2004 given by the Hospital in which it is stated that if the payment is made through Hospital of the implanted item, the cost of Rs.4,40,000/- would fetch 5% tax i.e. Rs.22,000/-. Thus, it is submitted that if the actual payment was not reimbursable to the petitioner and was to be borne by himself, he would have preferred to remit the value of implanted item directly to the seller and saved burden of 5% extra tax.
14. Respondents have also placed on record certain documents including the Central Bank of India (Officers') Service Regulations, 1979 to substantiate its case. Respondents have also placed on record a circular dated 13th of May, 1996 regarding reimbursement of hospitalization expenses to Officers, employees governed by Regulation 24 (1) (b)(i) of the Officers' Service Regulations 1979/1982 in which regarding the operation charges the following provision has been made regarding the expenses. It reads as under:-
"Expenses for dialysis, blood transfusion, Heart valve replacement, implanted items during surgery, Angiography and pace-maker may be reimbursed at the rate of 75% for family members and 100 % for officer himself. Schedule of charges for the same shall be as per the rates applicable to lowest paying bed of AIIMS, New Delhi."
15. Reference is also made to a circular issued by the respondents 8 Bank on 11.05.2007 which is in respect of Eighth Bipartite Settlement signed between the Indian Banks' Association and representative award staff unions on 2nd June, 2005 - Reimbursement of Hospitalization Expenses, which also provides the cost of pacemaker (Dual Chamber) to be Rs.1,15,500/- or the actual cost, whichever is less. The relevant para of the same reads as under:-
"As regards cost of implanted items which do not form part of package charges, Regional Offices and Zonal Offices may reimburse the actual cost on submission and verification of original purchase bills, with the rates being certified by the concerned hospital, which should be as per prevalent market rate. In case the implanted items are imported, copy of the invoice from the importer apart from the purchase bills from the claimant, should also be obtained and scrutinized."
16. Heard counsel for the parties and perused the record.
17. The question before this Court is whether the aforesaid circular would be applicable in the case of the petitioner whose operation was conducted from 17.12.2004 to 21.12.2004. In this regard, the circular issued by the Bank filed as Annexure P/4 dated 09.02.2005 would be relevant for the decision of this petition. The same reads as under:-
"Reg:-Reimbursement of Hospitalization Expenses Implanted Items Rates AICD (Prism II) Ref:- Your letter RO/PRS/33/04/05/1488 dated 8.1.05. With reference to the captioned subject, we have to inform you that the matter was referred to IRP Dept, who have informed that since they have not received the latest Schedule of Charges from AIIMS, Delhi, the cost of implanted items, if not covered under 'package' the same may be reimbursed at the rates not exceeding those available in existing AIIMS Schedule where the highest rate for pace makers in 'implanted items schedule' is Rs.1,32,500/- for dual chamber.
However, if there is any upward revision, the same will be conveyed to all concerned after receipt of latest Schedule of Charges of AIIMS and the difference will be paid accordingly."9
(emphasis supplied)
18. It is not disputed that the respondents have still not received the existing AIIMS schedule. This court is of the considered opinion that the welfare scheme of circular dated 13.05.1996 would be applicable to the petitioner's case and as such the remaining amount claimed by the petitioner to tune of Rs.3,82,500/- is not liable to be paid by the respondents/Bank as the rates applied cannot be more than the applicable rates to the lowest paying bed of AIIMS, New Delhi. And there is no other document available on record which may allow the respondent/bank to process the aforesaid claim on actual basis. In such circumstances, no case for interference is made out and the petition being devoid of merits is hereby dismissed.
(SUBODH ABHYANKAR) JUDGE Pankaj Digitally signed by PANKAJ PANDEY Date: 2022.10.28 16:54:54 +05'30'