Kerala High Court
Govindan P vs Food Corporation Of India on 17 February, 2025
Author: D. K. Singh
Bench: D. K. Singh
WP(C) NO. 21622 OF 2024 1
2025:KER:13202
IN THE HIGH COURT OF KERALA AT ERNAKULAM
PRESENT
THE HONOURABLE MR. JUSTICE D. K. SINGH
MONDAY, THE 17TH DAY OF FEBRUARY 2025 / 28TH MAGHA, 1946
WP(C) NO. 21622 OF 2024
PETITIONER:
GOVINDAN P.
AGED 72 YEARS
ASST. GRADE-I DEPOT [ RETD], FCI, RESIDING AT
PONDHIYEDATH HOUSE, THALAKKOTTUKARA P.O., TRICHUR
DISTRICT, PIN - 680 501.
BY ADVS.
P.M.MOHAMMED SHIRAZ
KAVYA S.A.
RESPONDENTS:
1 FOOD CORPORATION OF INDIA
REPRESENTED BY IT'S EXECUTIVE DIRECTOR, 3-HADDOWS
ROAD, CHENNAI, PIN - 600 006.
2 THE GENERAL MANAGER [KER]
FOOD CORPORATION OF INDIA, REGIONAL OFFICE,
KESAVADASAPURAM, THIRUVANANTHAPURAM,
PIN - 695 004.
3 THE DIVISIONAL MANAGER
FOOD CORPORATION OF INDIA, DIVISIONAL OFFICE,
TRICHUR, PIN - 678 371.
BY ADV. JOSE KURIAKOSE-SC
THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION
ON 17.02.2025, THE COURT ON THE SAME DAY DELIVERED THE
FOLLOWING:
WP(C) NO. 21622 OF 2024 2
2025:KER:13202
D. K. SINGH, J.
--------------------------
W.P.(C) No. 21622 of 2024
-------------------------
Dated this the 17th day of February, 2025
JUDGMENT
1. Heard Mr. Mohammad Shiraz, learned Counsel for the petitioner and Mr. Jose Kuriakose, learned Standing Counsel for the respondents.
2. The petitioner is a retired employee of the Food Corporation of India (hereinafter referred to as 'FCI') from the post of Assistant Gr. I (Depot) on 31.10.2013 on attaining the age of superannuation after putting in 40 years in the FCI. Petitioner is a member of the FCI Post Retirement Medical Scheme (PRMS).
3. The petitioner was diagnosed to be suffering from low grade Papillary Urothelial Carcinoma and the Doctors treating him suspected the tumor to have malignant tendencies. Initially the petitioner consulted the Amritha Institute of Medical Science, Kochi, one of the hospitals empaneled under the PRMS. However, according to the petitioner, there was delay in the Amrita Institute WP(C) NO. 21622 OF 2024 3 2025:KER:13202 of Medical Science, Kochi to perform the robotic surgery to remove the tumor. As the Cancer is a fast spreading disease, the petitioner went to Aster Medicity, Kochi (not empaneled) and got robotic surgery performed to remove the tumor. Initially the petitioner's claim for reimbursement of Rs. 3,64,126/- which was the medical bill raised by the Aster Medicity, Kochi was denied. However, thereafter an amount of Rs. 1,49,278/- was sanctioned as per the Central Government Health Scheme (CGHS) rate for operation. Only an amount of Rs. 1,08,050/- has been paid to the petitioner on the ground that the petitioner has availed the balance amount and, therefore, he was entitled only for the amount of Rs. 1,08,050/- as per Clause 6.6 and 6.7 of the PRMS.
4. The learned Counsel for the petitioner submits that when the petitioner is the member of the PRMS, he cannot be paid as per the rates prescribed under the CGHS. The petitioner is not a Central Government employee and, therefore, the reimbursement of the medical expenses as per the CGHS rate is wholly unjustified.
5. The learned Counsel for the petitioner further submits that for life threatening diseases, Clauses 6.8 to 6.10 of the PRMS are WP(C) NO. 21622 OF 2024 4 2025:KER:13202 applicable. Cancer is one of the diseases which is specifically mentioned in Clause 6.8 of PRMS and life time limit of Rs. 4,00,000/- has been prescribed.
6. The learned Counsel for the petitioner submits that when the petitioner was facing the grave danger of spreading the Cancer, he could not have waited for long to get the robotic surgery performed to remove the tumor at Amiritha Institute of Medical Sciene, Kochi and, therefore, he went to Aster Medicity where the surgery was performed.
7. The learned Counsel for the respondent however submits that since the Aster Medicity was not an empanelled hospital, they had paid the amount as per CGHS scheme to the petitioner.
8. The petitioner is not a member of CGHS but, he is a member of the PRMS and, therefore, reimbursing the medical bills at the rate of the CGHS is wholly unjustified. When the petitioner was facing the life threatening disease such as Cancer and, there was delay in performing the robotic surgery at empanelled hospital, the petitioner could not have waited to get the Cancer spread to all the organs of the body and, therefore, it was right decision to go to WP(C) NO. 21622 OF 2024 5 2025:KER:13202 the Aster Medicity to get the surgery performed. The Supreme Court in the case of the Shiva Kant Jha v. Union of India [2018 (16) SCC 187] in such situation has held as under;
8. Union of India, by filing an affidavit before this Court, submitted that most of the claims are reimbursed only through the CGHS sources as per the package rates of CGHS. However, there are few such cases received occasionally where reimbursement is done from two sources i.e. from CGHS and from the insurance companies. Such claims are first processed by insurance companies and then by the CGHS. The claim of CGHS is reimbursed as per the Office Memorandum dated 19.02.2009. It is further submitted that no such cases involving reimbursement from two sources is pending in CGHS.
9. Further, the writ petitioner was admitted in emergency condition with complaint of breathlessness on 11/11/2013 in Fortis Escorts Health Institute, which was a non-empanelled hospital at the relevant time. He underwent angiography on 12/11/2013 which revealed diffused disease in left anterior descending coronary artery 50-60%. He had been implanted the CRT - D device (Combo) as part of cardiac resynchronization therapy (CRT) on 12/11/2013. The hospital charged an amount of Rs. 11,56,293/- for the said treatment, out of which, an amount of Rs. 10,70,000/- was for the cost of the unlisted cardiac implant (CRT - D) and an amount of Rs. 3,19,950/- was paid by the Insurance company directly to the hospital.
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13. It is a settled legal position that the Government employee during his lifetime or after his retirement is entitled to WP(C) NO. 21622 OF 2024 6 2025:KER:13202 get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds. Clearly, in the present case, by taking a very inhuman approach, the officials of the CGHS have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court.
9. The Clause 6.6 and 6.7 are not applicable in respect of the life threatening diseases mentioned in Clause 6.8. Clauses 6.6 and 6.7 would be applicable in respect of the diseases which are not mentioned in Clause 6.8.
10. In view thereof, I am of the opinion that the petitioner is entitled for reimbursement up to Rs. 4,00,000/- as per Clause 6.8 of WP(C) NO. 21622 OF 2024 7 2025:KER:13202 the PRMS. The petitioner has been paid Rs. 1,08,050/- and the balance amount as per Clause 6.8 has to be paid within a period of two months from today.
With the aforesaid direction, the present writ petition is hereby disposed of.
Sd/-
D. K. SINGH JUDGE Svn WP(C) NO. 21622 OF 2024 8 2025:KER:13202 APPENDIX OF WP(C) 21622/2024 PETITIONER'S EXHIBITS Exhibit-P1 TRUE PHOTOCOPY OF FCI POST-RETIREMENT MEDICAL SCHEME.
Exhibit-P2 TRUE PHOTOCOPY OF CERTIFICATE OF DR.
KISHORE T.A. Exhibit-P3 TRUE PHOTOCOPY OF REPRESENTATION DATED 01/12/2023 OF THE PETITIONER.
Exhibit-P4 TRUE PHOTOCOPY OF REPRESENTATION DATED 13/01/2024 OF THE PETITIONER.
Exhibit-P5 TRUE PHOTOCOPY OF LETTER DATED 09/04/2024 OF THE DIVISIONAL MANAGER, FCI.
Exhibit-P6 True photocopy of Patient Registration Card issued by KIMS Hospital.
RESPONDENTS' EXHIBITS
Exhibit R1(a) The true copy of the representation dated
01-12-2023 submitted by the petitioner
received on 06-12-2023 addressed to the
2nd respondent.
Exhibit R1(b) The true copy of the representation
submitted by the petitioner dated 07-12- 2023 addressed to the 2nd respondent.
Exhibit R1(c) The true copy of the Circular No.EP-12- 2023-22 dated 23-05-2023.