Punjab-Haryana High Court
Ramesh Kumar Butta vs State Of Haryana And Others on 30 April, 2019
Author: Harsimran Singh Sethi
Bench: Harsimran Singh Sethi
CWP-8743-2016 -1-
IN THE HIGH COURT OF PUNJAB AND HARYANA AT
CHANDIGARH
CWP-8743-2016
Date of decision: - 30.04.2019
Ramesh Kumar Butta
....Petitioner
Versus
State of Haryana and others
.....Respondents
CORAM : HON'BLE MR. JUSTICE HARSIMRAN SINGH SETHI
Present:- Mr. Praveen Gupta, Advocate
for the petitioner.
Mr. Charanjit Singh Bakhshi, Addl. A.G., Haryana.
****
HARSIMRAN SINGH SETHI, J. (ORAL)
In the present writ petition, the challenge is to the order dated 25.06.2015 (Annexure P-7) by which the petitioner has only been reimbursed an amount of `2,52,044 instead of the claimed amount of `3,32,044/-
As per the facts narrated in the writ petition, petitioner who was working as a Circle Superintendent with the respondent department, retired on 31.03.2012 after rendering 42 years of service. After the retirement, he underwent Bilateral Total Knee Replacement operation from Fortis Hospital, Mohali. The said Fortis Hospital, Mohali is on the panel of the approved hospital for undergoing the treatment of the knee replacement. Petitioner remained hospitalized for the knee replacement 1 of 5 ::: Downloaded on - 12-05-2019 00:43:06 ::: CWP-8743-2016 -2- operation from 24.11.2014 till 01.12.2014. On the said treatment, according to the petitioner, he spent a sum of `3,33,742/. After getting discharged, the petitioner made a request on 18.12.2014 for the reimbursement of the amount which he spent on the medical treatment. After considering all the claims of the petitioner, vide order dated 25.06.2015 (P-7), out of the total reimbursed claim, claim amounting to `2,52,044/- was allowed and the rest claim was declined by the respondents. This action of the respondents is under challenge in the present writ petition.
Counsel for the petitioner contends that the reimbursement policy dated 06.08.2013 (Annexure P-1) makes the petitioner entitled for the benefit of total reimbursement as claimed by him.
Counsel for the petitioner argues that as per the package rates for the knee replacement, an employee is entitled for `1,05,000/- for the knee replacement and apart from the said amount, under the instructions dated 06.08.2013, the petitioner was entitled for the cost of implant plus bone cement and therefore, keeping in view the said package, the petitioner was entitled for full reimbursement of the amount of `3,33,742/-.
Counsel for the petitioner argues that denial of the total amount is contrary to the instructions dated 06.08.2013 (Annexure P-1) and therefore, the respondents are liable to be directed to reimburse the full amount as incurred by the petitioner while undergoing the treatment as narrated above.
Upon notice of motion, the respondents have filed the reply.
2 of 5 ::: Downloaded on - 12-05-2019 00:43:06 ::: CWP-8743-2016 -3- In the reply, the respondents have stated that the petitioner has been paid the full amount for which he was entitled for the treatment which he has undertaken from the Fortis Hospital, Mohali. In the reply, counsel for the respondents have admitted that petitioner was entitled for `1,05,000/- + cost of implant + bone cement and therefore, by calculating `1,05,000/- for the knee replacement and `60,000/ for the implant and `5,000/- for the bone cement, petitioner has been paid the full amount for which he has entitled for. As the petitioner had undergone the knee replacement for both the legs, so the amount was doubled and the petitioner was given the same vide impugned order dated 25.06.2015 (Annexure P-7).
Counsel for the petitioner in rebuttal states that once for the medical implant, the petitioner had spent a sum of `1,90,000/-, which is clear from the bills raised by the Fortis Hospital, which is a listed hospital from where an employee can take treatment, the reduction of the same by the respondents is arbitrary as the petitioner has only been reimbursed a sum of `1,20,000/- instead of `1,90,000/- which the petitioner had actual spent while undertaking the treatment of replacement of both his knees.
I have heard counsel for the parties and have gone through the record with their able assistance.
On 06.08.2013, respondents-State issued instructions and alongwith these instructions a list of 21 packages rates for different ailments/treatments was also given. An employee was entitled for `1,05,000/- + cost of implant + cost of bone cement in case an employee undertakes the treatment of knee replacement. The cost of implant was 3 of 5 ::: Downloaded on - 12-05-2019 00:43:06 ::: CWP-8743-2016 -4- not defined under the said instructions, but the respondent department vide instructions of the same date, fixed the rates of the implant by a separate notification. In the said notification also dated 06.08.2013 (P-6), the reimbursement cost of knee replacement (knee implant) has been fixed as `60,000/- + costs of bone cement, which is `5,000/-. The relevant instructions in this regard are as under: -
"Reimbursement of Cost of Knee and Hip Implants S.No. Item Maximum ceiling rate 1 Knee Implant 1. Knee implant cemented (unilateral) -
Rs.60,000/- + the cost of Bone Cement Rs.5,000/-
2 Hip Implant 2. Hip implant cemented (unilateral) = Rs.35,000/- + the cost of Bone Cement Rs.5,000/-
3. Hybrid Hip implant one component cemented and other uncemented (unilateral) = Rs.45,000/- + cost bone cement i.e. Rs.5,000/-
4. Hip implant uncemented (unilateral) - Rs.60,000/-
5. Surface replacement Hip Implant (unilateral) Rs.1,20,000/- "
No doubt, the instructions dated 06.08.2013 (Annexure P-1) wherein the details of the package was given, the amount of the implant was not fixed, but the government has fixed the same on the same date by a separate notification. Said fact has been admitted by the petitioner as the said notification has been attached by the petitioner as Annexure P-6.
Once, the cost of the implant has been fixed by the respondents and the said action of the respondents is not under challenge, the reimbursement has to be given to the petitioner under the instructions dated 06.08.2013 (P-6) which was applicable on the date when he undertook the treatment. Petitioner undertook the treatment from 4 of 5 ::: Downloaded on - 12-05-2019 00:43:06 ::: CWP-8743-2016 -5- November, 2014 till December, 2014 and on the said date, the instructions dated 06.08.2013 (P-6) fixing the costs of the implant was very much available and were in operation and therefore, the petitioner was only entitled for the same as cost of implant and not the actual costs which he paid to the concerned hospital.
In the absence of any challenge to the instructions dated 06.08.2013 (Annexure P-6), fixing the rate of implant by the petitioner, this Court cannot go into the veracity of the same and has to decide on the basis of instructions applicable at the time when the petitioner undertook the treatment, From the above pleadings and the factual position narrated above, it is clear that the petitioner has been reimbursed the amount which he was entitled for under the instructions prevalent and therefore, no grievance can be made by the petitioner and order dated 25.06.0215 (Annexure P-7) needs no interference by this Court.
In view of the above, present writ petition stands dismissed.
( HARSIMRAN SINGH SETHI )
April 30, 2019 JUDGE
naresh.k
Whether reasoned/speaking? Yes
Whether reportable? No
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