Central Administrative Tribunal - Mumbai
Dated This Tuesday The 24Th Day Of April vs Union Of India on 24 April, 2012
1 OA.420/2011 CENTRAL ADMINISTRATIVE TRIBUNAL, BOMBAY BENCH, MUMBAI. O.A.No.420/2011 Dated this Tuesday the 24th Day of April, 2012. Coram : Hon'ble Shri R.C. Joshi, Member (A). Shri Karl D'Souza, working as Supdt. Of Police, Police Wireless Headquarters, Pashan Road, Pune. R/at: Bungalow No.17, Himmat St. Patrick Town, Sholapur Road, Pune 411 013. ..Applicant. ( By Advocate Shri K.K. Waghmare ). Versus 1. Union of India, through the Secretary, Home Department, D.O.P.T., Ministry of Home Affairs, North Block, Central Secretariat, New Delhi 110 001. 2. State of Maharashtra, through the Addl. Chief Secretary, Home Department, Mantralaya, Mumbai 400 032. 3. Add. Chief Secretary, Department of Health, Ministry of Health & Family Welfare, Mantralaya, Mumbai 400 032. 4. Director General of Police, Head Quarter, M.S. Mumbai Shahid Bhagat Singh Marg, Mumbai 400 023. 5. Addl. Director General of Police & Director, Police Wireless, Maharashtra State, Chavan Nagar, Pashan Road, Pune 411 008. .. Respondents. 2 OA.420/2011 ( By Advocates Shri V.S. Masurkar with Shri Vinod Joshi ). Reserved on 9th April, 2012 O R D E R
In this Original Application the Applicant has impugned order dated 06.11.2009 passed by Respondent No.1 rejecting the reimbursement claim of the Applicant amounting to Rs.10,46,000/-.
2. Briefly, the Applicant who is an IPS Officer of 1974 Batch had lost his power of hearing while serving as a Sub Divisional Police Officer, Akola. He was advised by an ENT Specialist at Pune in 2005 to undergo Cochlear Implant Surgery as this was the only option available for the treatment of hearing problem. The Applicant, therefore, had obtained the required permission and medical advance was sanctioned amounting to Rs.10,08,000/-vide dated 26.09.2005. The Applicant after undergoing the treatment submitted a claim of reimbursement of medical expenses vide dated 02.07.2007, but despite constant follow up through personal efforts and correrspondence, he has not been able to receive the required sanction for reminbursement. Hence this Original Application.
3. The learned counsel on behalf of the Applicant in the pleadings has stated that the Applicant belongs to Indian Police Service (IPS) 3 OA.420/2011 and was appointed and posted at Akola as a Sub Divisional Police Officer and while on duty, he suffered from high fever while camping in the remote area and lost his power of hearing in both the ears. His hearing disability was not acquired by birth but while performing the duties assigned to him. He consulted an ENT Specialist at Pune who advised Cochlear Implant Surgery, which is an advanced medical treatment for hearing disability. He was informed by the Advanced Auditory Research Private Limited, Cochlear Implant Centre, Pune vide their medical opinion dated 09.09.2005 that the Cochlear Implant was the only option available to the Applicant. He was informed that the expenses of the surgery and treatment were estimated at Rs.9,48,000/-excluding Hospital Room charges etc. As it was difficult for the Applicant to raise such heavy amount, he submitted an application dated 26.09.2005 for medical advance to the Government through proper channel. A Committee headed by the then Addl. Chief Secretary of the Home Department which was constituted as per the notification issued by the Public Health Department, recommended that the expenses for the said operation be reimbursed after obtaining the treatment. The Committee recommended to the Finance Department to pay the medical advance to the Applicant. However, 4 OA.420/2011 as per directions of the Health Department, the Home Department vide their order dated 19.03.2005 and letter dated 04.12.2006 (Exhibit A-4 and A-5) directed the Applicant to submit the claim for reimbursement of medical expenses after taking the treatment of Cochlear Implant Surgery. As the Respondents did not sanction the advance on the basis of order dated 04.12.2006, the Applicant requested the Office of Director General of Police to pay the advance of Rs.10,46,000/-from the Central Police Welfare Fund. The Applicant gave an undertaking to refund and deposit the amount into the said Welfare Fund in one instalment immediately after his claim for reimbursement was sanctioned. The Applicant was sanctioned the amount of advance on 16.03.2007 by the Director General of Police, Maharashtra State with a condition either to refund said advance from the medical reimbursement amount or any other dues payable to the Applicant within a period of nine months (Exhibit A-6). The Applicant thereafter, received the treatment of 'Cochlear Implant' from KEM Hospital at Pune during the period from 25.03.2007 to 28.03.2007. Thereafter, a claim for reimbursement of medical expenses of Rs.10,13,423/-for emergency medical treatment of the Applicant was processed vide letter dated 19.05.2007 of Addl. DGP and DPW, Maharashtra State 5 OA.420/2011 and was technically sanctioned by the Superintendent Sassoon General Hospital, Pune (Exhibit A-7). The Superintendent, Sassoon Hospital has also mentioned in his recommendation that the said treatment of Cochlear Implant was not available in their hospital. As the amount of claim was more than Rs.40,000/-the claim was submitted to the Government for sanction as a special case. It was pointed out that the Applicant had also submitted a representation dated 18.1.2008 (Exhibit A-9) stating that in two similarly situated cases, the claim of State Government employees were sanctioned by the State Government (Exhibit A-10 and A-11).
4. It was further stated that the Government Resolution dated 19.03.2005 (Exhibit A-5) provides at para 3(3) that a Committee is constituted to consider the exceptional cases, which do not fulfill the conditions prescribed in the said Government Resolution as special cases.
5. The Applicant accordingly requested the Addl. Chief Secretary, Public Health Department, Maharashra State to sanction his claim as a special case and followed it by a reminder. The Addl. Chief Secretary, Public Health Department vide letter dated 06.11.2009 informed the Addl. Director General of Police, Mumbai and Director of Police, Wireless Pune that a meeting of the Committee constituted 6 OA.420/2011 vide Government Resolution dated 19.03.2005 was held on 20.09.2009 to consider the claim of reimbursement of medical expenses in respect of the Applicant and the same was rejected on the ground that the Committee had no jurisdiction in the matter (Exhibit A-13).
6. The Addl. Director General of Police and the Director of Police Wireless vide their letter dated 20.11.2009 once again reqeusted that the Applicant's case be reconsidered vide letter dated 20.11.2009 which was recommended to the Addl. Chief Secretary, Home Department vide letter dated 17.05.2010 by the Director General of Police, Maharashtra State, Mumbai. Since there was a considerable time lag in sanctioning the amount already incurred by the Applicant in his medical treatment, the Applicant received a notice/order for recovery of the amount of advance at Rs.10,56,000/from the monthly salary of the Applicant @ Rs.38,740/-per month vide dated 19.10.2010. The Applicant thereafter again requested for reconsideration of his claim vide application dated 01.10.2010, but the decision is still awaited. The Applicant has retired and there is likelihood of substantial recovery being made / adjusted against his retirement benefits due to the Applicant which would cause great financial hardship to the 7 OA.420/2011 Applicant.
7. The Areliefs:pplicant has sought the following a) To allow this Original Application.
(b) To direct the Respondents to consider the quash and set aside the order dated 06.11.2009 passed by the Respondent No.1.
bb) To quash & set aside the order dated 19.10.2010 passed by Spl. IGP, HQ, Mumbai.
c) To direct the Respondents to issue sanction for reimbursement of medical expenses amounting to Rs.10,46,000/-as a Special Case and make the payment to the Applicant with interest @ 12% p.a.
d) To pass any other order in the interest of justice.
e) To award cost.
8. The learned counsel on behalf of the Respondents in the pleadings stated that the Applicant during his field tenure in Akola District of Maharashtra suffered a paralytic attack and lost his power of hearing in both the ears while on duty. Although the Applicant recovered but could not regain hearing in both the ears. The applicant consulted Dr. Hemant Dabake of Advanceed Auditory Research Private Limited, Cochlear Implant Centre, Pune Centre and was operated upon. The operation cost was Rs.10,08,000/-and in order to meet the heavy expenses the Applicant made an application on 8 OA.420/2011 26.09.2005 to get the medical advance from the Government. The technical sub committee headed by the Addl. Chief Secretary, Home Department recommended that the expenses for the said operation be reimbursed after obtaining the treatment. The Applicant was advised vide letter dated 04.12.2006 to get the operation done and submit the proposal for reimbursement in accordance with the guidelines given in the order dated 19.03.2005 from the Public Health Department. However, as the Committee did not recommend the advance, the Finance Department also refused to pay the advance to the Applicant. The Applicant thereafter requested for medical advance of Rs.10,46,000/-from the Central Police Welfare Fund. After his treatment the Applicant submitted the claim of Rs.10,13,423/for reimbursement. In accordance with the Government Resolution dated 19.03.2005, the claim being more than Rs.40,000/-was to be sanctioned by the State Government after considering the recommendations given by a Committee headed by the Addl. Chief Secretary, Public Health Department, Mantralaya and the Secretary (Expenditure), Finance Department; Secretary of the concerned Departments; Director General, Health Service, Mumbai, Director, Medical Education and Research, Mumbai was constituted in accordance with the Government Policy. This 9 OA.420/2011 Committee was constituted to consider the claims submitted by Government servants which are more than Rs.40,000/-and in respect of cases which do not conform to the prescribed provisions contained in the Government Resolution dated 19.03.2005. The claim was, however, not approved by the Committee as the same was considered to be beyond the jurisdiction of the Committee. The Applicant made several applications to get the medical claim which were duly recommended by the Home Department which was reconsidered and rejected by the Committee citing the same reason of the claim being 'beyond jurisdiction of the Committee'. The Applicant had taken an advance from the Central Police Welfare Fund to meet the expenses involved in the operation for which an undertaking was given to refund the same within the time stipulated. As the Applicant failed to deposit the instalment of advance taken from the Central Police Welfare Fund, the Director General of Police directed that the instalments be recovered from the Applicant vide their letter dated 19.11.2010. The Applicant again submitted request for reimbursement of the claim vide dated 22.03.2011 which is still under consideration of the Government and no decision as yet has been taken.
9. I have gone through the pleadings, documents enclosed and have extensively heard Shri 10 OA.420/2011 K.K. Waghmare, learned counsel on behalf of the Applicant, Shri V.S. Masurkar and Shri V.B. Joshi, learned counsel on behalf of the Respondents.
10. A perusal of the case papers reveal that the Applicant, an Officer of Indian Police Service belonging to 1974 batch suffered from high fever in the interior area of Akola where he has gone for investigating a murder case and while on duty, suffered a paralytic attack and lost his power of hearing in both the ears. As the use of hearing aids did not help the Applicant, he consulted an ENT Specialist at Pune who advised the Applicant to undergo Cochlear Implant surgery which was recommended as the only remedy available to the Applicant. The expenditure involved in the surgery was estimated at Rs.9,58,000/-. The Applicant sought an advance of Rs.10,08,000/-for meeting the expenses which was duly recommended by the Home Department to the Public Health Department for consideration.
11. The Government of Maharashtra vide Resolution dated 19.03.2005, had prescribed a revised policy of reimbursement of medical expenses incurred by a Government employee. Under this policy, a Committee was set up headed by the Addl. Chief Secretary, Public Health Department to consider cases of medical reimbursement which do not 11 OA.420/2011 conform to the prescribed provisions. In this context, the provisions contained in Para 3(3) of the said Government Resolution have been reproduced herein below for convenience:
3. If the sanction to the medical reimbursement is to be given in cases which are not in confirmity with the prescribed provisions in few exceptional cases as a special case, a committee is constituted as below to take the decision. Such a cases are to be submitted to the committee.
A) Addl. Chief Secretary, Public Health Department - President B) Secretary (Expenditure), Finance Department - Member C) Secretary of the concernedAdministrative Dept. - Member D) Director General, HealthServices, Mumbai - Member E) Director, Medical Education& Research Mumbai - Member F) Dy. Director (Patient Service) Public Health Dept. - Member Secretary. Therefore, looking at the facts and circumstances of the present case, it is apparent that the case of the Applicant for reimbursement of medical expenses towards meeting the cost of Cochlear Implant Surgery was not contained amongst the cases listed in Appendix 'A' to the said Government Resolution and, therefore, come within the ambit of the special cases to be considered by the Committee headed by the Addl. Chief Secretary, Public Health Department. The present case, therefore, come within the 12 OA.420/2011 'jurisdiction of the Committee' and a decision, therefore, had to be necessarily taken by this Committee to consider the case of the Applicant. There is no justification provided by the Respondents for rejection of the Applicant's case on the ground that it was beyond the jurisdiction of the said Committee
12. It is also observed from the case papers that in two similarly situated cases placed at Annexure A-10 and A-11, the case of employee Shri K.B. Indrekar, Accounts Officer in the office of Commissioner and Project Co-ordinator, State Project Management Cell, World Bank, Child Development Scheme, Navi Mumbai was sanctioned vide dated 02.07.2005 and that of Shri S.V. Birajdar, Dist. Planning Officer, Dist. Planning Committee, Collector Office, Solapur was sanctioned vide order dated 11.03.2005 as special cases. No reason has been given as to why the Applicant's case was not considered on similar lines though in Applicant's representation dated 18.01.2008, this aspect has been brought to the notice of the State Government in Home Department.
13. The State Government's scheme for reimbursement of medical expenditure is a welfare scheme under which concessions and facilities have been extended to the State Government employees 13 OA.420/2011 under the said Scheme. In this case, the action of the Respondents in rejecting the request of the Applicant has not been justified. It is needless to emphasize here that it is important that the Government's policy and instructions on the reimbursement of medical expenses are implemented in a manner which does not lead to harassment of the beneficiaries. There should also not be any arbitrariness in interpreting the various provisions which are modified / reviewed from time to time.
14. A careful consideration of the papers available on record do not justify the grounds for rejecting the Applicant's case by the Committee constituted under Government Resolution dated 19.03.2005. The ground cited on the letter dated 06.11.2009 that the Applicant's case does not come within the purview of the Secretaries Committee is not in consonance with the provisions contained in Government Resolution dated 19.03.2005 especially when similarly situated cases were granted reimbursement of medical claim vide dated 11.03.2005 and 02.07.2007.
15. In view of the above, therefore, the Original Application is allowed. The Respondents are directed to sanction the claim of reimbursement ofmedical expenses preferred by the Applicant amounting to Rs.10,46,000/-as early as possible and 14 OA.420/2011 at any rate within a period of three months from the date of receipt of a copy of this order. No order as to costs.
( R.C. Joshi ) Member (A).
H. 15 OA.420/2011 To be added The State Government's scheme for reimbursement of medical expenditure is a welfare scheme under which concessions and facilities have been extended to the State Government employees under the said Scheme. In this case, the action of the Respondents in rejecting the request of the Applicant has not been justified. It is needless to emphasize here that it is important that the Government's policy and instructions on the reimbursement of medical expenses are implemented in a manner which does not lead to harassment of the beneficiaries. There should also not be any arbitrariness in interpreting the various provisions which are modified / reviewed from time to time.