Himachal Pradesh High Court
Ravinder Parshad Bhardwaj vs Of on 9 October, 2015
Bench: Rajiv Sharma, Sureshwar Thakur
IN THE HIGH COURT OF HIMACHAL PRADESH, SHIMLA.
CWP No.2164 of 2015.
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Reserved on: 30/09/2015.
Decided on: October 09, 2015.
_______________________________________________ Ravinder Parshad Bhardwaj ...Petitioner.
Versus
of
H.P. Gramin Bank ...Respondent.
Coram:
rt
The Hon'ble Mr.Justice Rajiv Sharma, Judge.
The Hon'ble Mr. Justice Sureshwar Thakur, Judge.
Whether approved for reporting?1Yes. ____________________________________________________________ For the petitioner: Mr.Ashish Verma, Advocate.
For the respondent: Ms.Devyani Sharma, Advocate.
------------------------------------------------------------------------------------------------------------- Sureshwar Thakur, Judge.
The petitioner had served the respondent-bank as its Manager. The respondent-bank stands sponsored by the Punjab National Bank and came into existence with the amalgamation of RRB. Since the respondent bank is performing public function for the welfare of the people of the 1 Whether the reporters of the local papers may be allowed to see the judgment?
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-2-State of Himachal Pradesh, as such, it is amenable to the writ jurisdiction of this High Court.
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2. In the year 2006 the petitioner was diagnosed for 'Choroidal Neovacular Membrane' in his right eye. The aforesaid ailment of the right eye which befell the petitioner is averred to be a critical eye ailment which can cause loss of eye of sight. For curing the aforesaid ailment in his right eye the petitioner undertook treatment at Super Specialized Institution rt i.e. Dr. Rajinder Prashad Centre for Ophthalmic Sciences, New Delhi. Annexure P-1 appended to the writ petition comprises the record of treatment undertaken by the petitioner herein at the aforesaid hospital. It also details the expenses incurred by the petitioner herein for receiving the apposite treatment from Dr. Rajinder Prashad Centre for ophthalmic sciences. The petitioner claimed from the respondent bank reimbursement of Rs.65,000/- constituting the expenses incurred by him for receiving medical treatment for curing the ailment of 'Choroidal Neovacular Membrance' which afflicted his right eye. However, under Annexure P-2, the respondent rejected his claim. Under Annexure P-3 the petitioner made a representation to the ::: Downloaded on - 15/04/2017 19:10:45 :::HCHP CWP No.2164 of 2015.
-3-respondent bank enunciating therein that the rejection of his claim by the latter for reimbursement of a sum of Rs.65,000/-
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to him comprising the expenses incurred by him for curing his ailment aforesaid by his receiving treatment from Dr. Rajinder Prashad Centre for Ophthalmic Sciences, New Delhi, was in the face of the apt rules governing the reimbursement of medical of expenses claimed by him from the respondent bank, untenable. However, under Annexure P-4 the respondent bank rt turned down the representation of the petitioner comprised in Annexure P-3 against the former rejecting his claim for reimbursement of medical expenses raised by him under Annexure P-1. The ground as meted out in Annexure P-4 for the respondent bank turning down the representation of the petitioner against the rejection of his claim for medical reimbursement preferred by him before the respondent bank arising from his having received treatment for curing disorder of Choroidal Neovacular Membrane of his right eye from Dr. Rajinder Prashad Centre for Ophthalmic Sciences, New Delhi, is constituted in the fact that PDT Therapy was not performed as part of Hospitalization, hence the same is not payable. The ::: Downloaded on - 15/04/2017 19:10:45 :::HCHP CWP No.2164 of 2015.
-4-respondent in its reply meted to the writ petition has supported the reasons meted out in Annexure P-4 for rejecting the .
representation made by the petitioner before it comprised in Annexure P-3 against the refusal on the part of the respondent-bank to reimburse to him the medical expenses incurred by him for curing disorder of Choroidal Neovacular of Membrane of his right eye. Even though there is a mandate in the relevant portion of the rules (which stand extracted rt hereinafter) governing besides regulating the reimbursement of medical expenses incurred by the officers, staff and their family members and it having been enjoined therein that hospitalization expenses incurred by staff "SCHEDULE FOR REIMBURSEMENT OF HOSPITALISATION EXPENSES FOR OFFICERS STAFF.
Hospitalisation expenses will be reimbursed to officers staff in the bank to the extent of 100 percent in case of self and 75 percent in case of members of family subject to the procedure for reimbursement of hospitalization expenses as enumerated hereunder:
a) Hospitalisation charges to the extent stated above will be reimbursed in case of all ailments and major accidents which require hospitsalisation.
b) An officer or his family members will be considered to have been hospitalized only if they are admitted as indoor patient(s) in the hospital in respect of diseases/accidents as mentioned above in sub-para (a) Medical expenses incurred for the hospitalization will be reimbursed on the strength of bills/vouchers to the extent of 100% in case of himself and 75% in case of family members subject to limits prescribed hereunder"::: Downloaded on - 15/04/2017 19:10:45 :::HCHP
CWP No.2164 of 2015.-5-
and officers of the bank will be fully reimbursable to them only if they have remained admitted as indoor patient in the .
hospital concerned. The petitioner herein having received photodynamic therapy from Dr. Rajinder Prashad Centre for Ophthalmic Sciences, New Delhi for alleviating disorder of Choroidal Neovacular Membrance which afflicted his right eye of while his not having remained admitted therein as an indoor patient constrained the respondent to, in consonance with the rt hereinabove extracted mandate of the apposite rules, reject his claim for reimbursement of medical expenses comprised in a sum of Rs.65,000/-. The construction as placed upon the aforesaid apposite rules of it necessitating the claimant/patient to portray his having remained admitted as an indoor patient in the hospital concerned for receiving the treatment/therapy, for alleviating his ailment is a rigid besides a grossly pedantic literal construction qua its amplitude, which hence defeats the purpose for which the said rule stood enacted. The therapy which the claimant/petitioner herein received from Dr. Rajinder Prashad Centre for Ophthalmic Sciences, New Delhi for ::: Downloaded on - 15/04/2017 19:10:45 :::HCHP CWP No.2164 of 2015.-6-
alleviating or correcting the disorder of Choroidal Neovacular Membrance which afflicted his right eye was purveyed to him .
as portrayed in Annexure P-3 while his having remained admitted in the hospital concerned in the morning and his having come to be discharged therefrom in the evening. The disclosure in annexure P-3 of his having obtained from Dr. of Rajinder Prashad Centre for Ophthalmic Sciences, New Delhi, photodynamic therapy therefrom besides his having come to rt be admitted therein in the morning and his having come to be discharged in the evening has not been controverted by the respondent in its reply. Necessarily then the ailment which beset the right eye of the patient/petitioner herein necessitated the purveying to him the therapy/treatment for its alleviation or correction only in the hospital, even if only during the course of the day, sequels an apt inference that it was meted to him as an indoor patient in the hospital concerned and was not required to be on the instructions of the doctor concerned carried into effect by the petitioner at home. Consequently, the discarding of by the respondent the medical reimbursement bill raised by the petitioner for reimbursing to ::: Downloaded on - 15/04/2017 19:10:45 :::HCHP CWP No.2164 of 2015.-7-
him the medical expenses incurred by him for correcting the disorder of Choroidal Neovacular Membrance of his right eye .
on the mere ground that in the opinion of the medical consultant of the respondent, the therapy was not received by the petitioner herein as part of hospitalization, infracts the innate spirit and import of the relevant apposite rule governing of the reimbursement of medical expenses to the officers and staff of the respondent bank. The opinion of the medical rt consultant of the respondent concerned which led the respondent to reject the claim for reimbursement of the medical expenses incurred by the petitioner herein for correcting Choroidal Neovacular Membrance (CNVM) which afflicted his right eye erodes besides subverts the intrinsic spirit of the apt rules which on its closest and keenest reading with a discerning eye does not mandate therein that a patient who incurs medical expenses for correcting or alleviating any ailment which befalls upon him, is required to remain admitted as an indoor patient at the hospital concerned overnight nor it enjoins that when the therapy which he receives for correcting his ailment or disease at the hospital concerned and which ::: Downloaded on - 15/04/2017 19:10:45 :::HCHP CWP No.2164 of 2015.-8-
stands meted to him at the hospital itself, while hence rendering him to be construable to be an indoor patient even if .
purveyed to him during the course of the day would oust his claim for reimbursement of medical expenses incurred by him for receiving the therapy at the hospital concerned.
Even otherwise, the respondent does not controvert the of relevant factum as reflected in Paragraph-6 which stands extracted herein-after:
rt"DAY CARE SURGERY TREATMENT:
The bank has been considering reimbursement of hospitalization expenses only when the officer or his family members are admitted as indoor patient in a hospital in respect of disease/accidents. The matter pertaining to reimbursement of hospitalization expenses in respect of 'day care surgery treatment' and also reimbursement of cost of intra ocular lens implanted during cataract operation has been considered and it has been decided as under:-
1. In the case of laser operation of the diseases of eye, operation like cataract lithotripsy operation for removal of gallstones, which do not require patient to stay in the hospital for more than few hours, keeping in view present day technological developments and superior micro surgery available in several medical institutions, the officer may be reimbursed hospitalization expenses subject to the limits specified under schedule through they are not admitted as 'indoor' patients; and ::: Downloaded on - 15/04/2017 19:10:45 :::HCHP CWP No.2164 of 2015.-9-
2. The officer be reimbursed the cost of lens to the extent of 100% or 75% of the actual cost of lens or Rs.2500/- whichever is less, where the .
government hospitals do not have provision for supply of intra ocular lens to the patients undergoing cataract operations and lens are purchased from outside by the patient and supplied to the surgeon before the operation."
of theirs while being abreast of the rapid growth in of technological developments for correcting eye disorders like Cataract, had thought it fit to permit reimbursement of hospitalization expenses incurred by a patient for correcting rt Cataract. Even though the afore referred portion of the relevant rules governing the reimbursement of medical expenses for a patient receiving therapy for correcting a Cataract disorder or removal of gall stones by deployment of the latest state of art in vogue techniques, is not exhaustive so as to encompass the photodynamic treatment received by the petitioner herein during the course of the day from Dr.Rajinder Prashad Centre for Ophthalmic Sciences, New Delhi for correcting the disorder of Choroidal Neovacular Membrane which afflicted his right eye. Nonetheless, the omission of its incorporation in the aforesaid referred apt rules permitting the ::: Downloaded on - 15/04/2017 19:10:45 :::HCHP CWP No.2164 of 2015.
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reimbursement of medical expenses to the patients receiving day care therapy for alleviation of diseases/ailments referred .
therein even when they are not admitted overnight in the hospital concerned, would not oust the claim of the petitioner herein for his being entitled to the reimbursement of medical expenses incurred towards his receiving photodynamic therapy of as day care surgery/therapy from Dr.Rajinder Prashad Centre for Ophthalmic Sciences, New Delhi for correcting the disorder of rt Choroidal Neovacular Membrane which afflicted his right eye especially when the reasons meted out hereinabove dehors the afore referred extracted relevant rules applicable for permitting reimbursement of medical expenses to patients receiving day care surgery/treatment qua diseases enumerated therein, constitute him to be an indoor patient moreso when the therapy was imparted besides receivable only on his having come to be admitted as a patient in the hospital concerned even for a day during the course whereof it was purveyed to him. Since no part of the therapy was imparted to him nor received by him while his having departed from the hospital nor was necessitated to be on the instructions of the doctor concerned volitionally undertaken at home by him, reinforcingly renders him to be ::: Downloaded on - 15/04/2017 19:10:45 :::HCHP CWP No.2164 of 2015.
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an indoor patient in the hospital concerned, especially when the photodynamic therapy which he received from the doctor .
at the hospital concerned for correction of disorder of Choroidal Neovacular Membrane which afflicted his right eye, is an advanced state of art therapy/technique which does not necessitate for its being purveyed to him his being kept of overnight in the hospital. Necessarily then given the advancement in the technology of the therapy meted to the rt petitioner, the relevant rules have to be kept abreast of the latest technological developments, also when the innate spirit of the apt rules encompasses "within" the domain of indoor patients, even a patient receiving therapy only within the precincts of the hospital and not outside it, conjunctively any contrary interpretation as afforded by the medical consultant of the respondent on which opinion the respondent ousted the medical expenses raised by the petitioner herein would not give life or spirit to the intrinsic worth of the apposite rules.
The respondent has contended that the delay of seven years at the instance of the petitioner herein to institute the writ petition before this Court renders his claim to be stale ::: Downloaded on - 15/04/2017 19:10:45 :::HCHP CWP No.2164 of 2015.
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hence deprives him to raise the said unclaimed medical expenses through the instant writ petition. However, the said .
argument cannot be accepted by this Court as the petitioner herein had raised the claim not qua seniority or promotion rather has raised a claim for his tenable entitlement of reimbursement of medical expenses which claim having been of unjustifiably denied to him by gross misreading by the respondent of the relevant rules, which claim in case not rt vindicated by this Court even if some delay has been occasioned, would disentitle him to receive from the respondent his legitimate dues. The argument of the learned counsel for the respondent that the writ petition is vitiated by the stench of staleness deserves to be rejected, hence stands discountenanced.
With the aforesaid observations, the writ petition is allowed. Pending application(s), if any, shall also stand disposed of. No costs.
( Rajiv Sharma ) Judge.
October 09, 2015. (Sureshwar Thakur), (TM) Judge.
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of rt ::: Downloaded on - 15/04/2017 19:10:45 :::HCHP