Punjab-Haryana High Court
Union Of India (Uoi) And Ors. vs S.K. Rampal on 5 April, 1999
Equivalent citations: (1999)122PLR373
Author: N.C. Khichi
Bench: N.C. Khichi
ORDER G.C. Garg, J.
1. Dispute in this petition is regarding reimbursement of medical claim. Respondent is working as Junior Scientific Officer (Physics) in the Central Forensic Science Laboratory at Chandigarh (for short "CFSL") and thus, is a Central Government employee. Respondent developed heart ailment and remained under treatment in General Hospital, Sector 16, Chandigarh. Respondent was advised to undergo angiography and if need be, to undergo by-pass surgery. Respondent approached the Escorts Heart Institute and Research Centre, New Delhi (for short "Escort Hospital") for advance treatment. Respondent made a request to the office for making payment of Rs. 1,74,000/- as advance money for his treatment i.e. the amount as indicated in the estimate, Annexure P-2 issued by the Escort Hospital. Director, Central Forensic Science Laboratory sanctioned a sum of Rs. 1,39,0007- i.e., 80% of the amount demanded, and sent the payment directly to the Escort Hospital by bank draft on 13.11.1996. The Director CFSL later on examined the case of the respondent for reimbursement of medical claim and it was found that in terms of circular dated 31.10.1994, Annexure P-1 issued by the Ministry of Health and Family Welfare he was only entitled to reimbursement of Rs. 72,480/-. Respondent after undergoing angiography and coronary by-pass surgery, submitted his medical reimbursement bill in the sum of Rs. 1,76,694.60 as per the certificate Annexure P-4 given by the Escorts Hospital and prayed that after adjusting the advance of Rs. 1,39,000/-, the balance amount of Rs. 37,694.60 may be reimbursed, The Director CFSL, however, came to the conclusion that in terms of the circular dated 31.10.1994, Annexure P-1, the respondent was entitled to reimbursement of Rs. 72,480/- only. He accordingly deducted the balance amount of Rs. 66,520/- from the sanctioned amount of Rs. 69,000/- against General Provident Fund advance of the respondent and paid the balance amount of Rs. 2,480/- to him.
2. Aggrieved by this action of the petitioners, respondent approached the Central Administrative Tribunal, Chandigarh Bench, Chandigarh by filing a petition for seeking a direction to the petitioners to reimburse the entire medical claim as indicated in Annexure P4. The petitioners took a stand before the Tribunal that the respondent was entitled to reimbursement to the extent of Rs. 72,480/- only as admissible in terms of circular dated 31.10.1994. Annexure P1, applicable to the Central Government employees who choose to get themselves treated from a private hospital recognised by the Central Government Health Services when the said facility is available in a number of government hospitals such as All India Institute of Medical Sciences, New Delhi, G.B. Pant Hospital, New Delhi and P.G.I., Chandigarh etc. in view of Rule 6 of the Central Services (Medical Attendance) Rules for short "the Rules".
3. The Central Administrative Tribunal, Chandigarh Bench, Chandigarh on a consideration of the matter and after relying upon its two earlier judgments in D.P. Puri v. Union of India and Ors., in O.A. No. 94/PB of 1996 decided on 8.11.1996, J.D. Verma v. Union of India, O.A. No. 646/CH of 1995 decided on 27.3.1997 and two judgments of the Supreme Court in State of Punjab and Ors. v Mohinder Singh, 1997 S.C.C. (L&S) 294 and Surjit Singh v. State of Punjab, 1996(1) R.S.J. 845 came to the conclusion as under:-
"The government employee is entitled to reimbursement of total actual expenditure incurred by him on his medical treatment. In case of present applicant who was found suffering from Heart trouble for which he could not wait for due reference by the Competent Authority or permission for getting treatment from one of the recognised hospital. It has been a practice accepted that the Court will deem such sanction having been given as a patient in emergent cases, cannot be expected to wait for such reference to the hospital or sanction of the competent authority. In view of the ratio of the above mentioned judgments, the objection raised by the respondents has to be rejected."
4. The Tribunal thus, by its order dated 12.9.1997, Annexure P-5 allowed the petition filed by the respondent with a direction to the petitioner herein to reimburse the total amount as mentioned in Annexure P-4. It was further directed that the remaining amount against the total reimbursement claim be released to the respondent herein, within a period of three months from the receipt of a copy of the order. This is how the Union of India and others have challenged the order, Annexure P-5 of the Tribunal by filing this petition under Articles 226/227 of the Constitution of India.
5. Petition was resisted by filing a reply. It was stated that the petition is not maintainable as the circular dated 31.10.1994, Annexure P-1, was valid only for a period of two years and it had become non-operative in the case of the respondent. On merits it was stated that the Escorts Hospital is also a recognised Institute of the Central Government Health Services as per the list appended with the circular Annexure P-1. It was also stated that the circular Annexure P-1 was also considered by the Tribunal, and that there is no justification to curtail the reimbursement claim and he is entitled to full reimbursement as claimed vide bill Annexure P-4.
6. As per the case set up by the petitioners, though the facility of angiography and by-pass surgery is available in Government Hospitals, but the respondent, without seeking any reference from the Government Hospital for undergoing angiography and by-pass surgery, of his own decided to undergo the treatment for coronary by-pass surgery from Escorts Hospital, which is a private recognised hospital by the Central Government Health Service and, therefore, under the rule the respondent is entitled to medical reimbursement of Rs. 72,480/- only, on the basis of rates fixed by the Ministry of Health and Family Welfare as indicated in Annexure P-1. It is also the case of the petitioners that the Tribunal dealt with the policy issued by the Punjab Government and it did not deals with the provisions of Rule 6 of the Rules and the rate fixed by the Government of India as reflected in Annexure P-1.
7. Learned counsel for the respondent, on the other hand, submitted that Escorts Heart Institute New Delhi is also a hospital duly recognised by the Government and for the treatment therefrom, the respondent is entitled to reimbursement of the full amount spent by him.
8. The facts are not much in dispute. According to the petitioners, a Central Government employee, like the applicant is entitled to full medical reimbursement in view of Rule 6 of the Rules in case he undergoes treatment from a Government Hospital. Such employee is also entitled to full reimbursement in case there is no Government Hospital or the facility is not available in the Government Hospital and the employee undergoes treatment in a hospital other than a Government hospital at or near the place as can provide the necessary and suitable treatment. In that eventuality, the government employee would be entitled to reimbursement of full amount at the rates indicated in the policy decision of the Government Annexure P-1. Contention in other words is that in case a Central Government Employee seeks treatment in a private hospital recognised by the Central Government Health Services of his own choice without any reference by the Government hospital to the effect that such treatment is not available in the Government hospital, the Central Government employee will only be entitled to reimbursement to the extent and at such rates as has been provided by the Ministry of Health and Family Welfare.
9. We have heard learned counsel for the respondent and perused the order of the Tribunal. We have gone through the judgments of the Tribunal and of the apex court relied upon by the learned Tribunal for granting the relief to the respondent-applicant in respect of reimbursement of medical claim. On an examination, we find that all the four judgments relied upon by the Central Administrative Tribunal and referred to in the earlier part of this judgment relate to the cases of reimbursement of medical claim in respect of the employees of the Punjab Government. Claims were considered in terms of the policy framed by the State of Punjab. None of these judgments relate to the policy of reimbursement of medical claim in respect of an employee of the Central Government. In the present case, the claimant is an employee of the Central Government and not of the Punjab Government.
10. Policy framed by the State of Punjab in respect of reimbursement of medical claim at the relevant time was different than the policy framed by the Government of India in respect of reimbursement of medical claim to its employees. The claim of the respondent-applicant was thus, required to be considered in the light of the policy relating to reimbursement of medical claim i.e. under the policy framed by the Government of India and not under the policy framed by the State of Punjab. This aspect seems to have been overlooked by the Tribunal while deciding the Original Application filed by the respondent-applicant.
11. The policy relating to reimbursement of expenditure, framed by the Government of India provides that medical claim for specialised treatment for heart diseases and kidney transplantation be settled as per the schedule of rates approved for the treatment of C.G.H.S. beneficiaries from time to time at private recognised hospitals under that scheme or the actual charges, which ever is less and all other cases be settled as per the item wise cealings prescribed in the annexures attached to the policy. It is indeed true that Escort Hospital where the respondent-applicant got treatment is one of the recognised hospitals by the Government of India for getting specialised treatment. It is also the conceded case that the applicant did not seek prior approval of the concerned authority for getting treatment in the recognised private hospital. In any case, the applicant is entitled to reimbursement of medical claim as per the policy of the Government of India. The applicant submitted a tentative bill of the Escorts Hospital for getting treatment. An amount of Rs. 1,39,000/- was sanctioned being 80% of the amount demanded. However, before the applicant actually underwent treatment, he was informed that he was entitled to reimbursement of Rs. 72,480/- under the policy decision and not Rs. 1,74,000/- or Rs. 1,39,000/- for which sanction had been conveyed. The applicant was thus paid the amount as admissible under the policy of 1994. According to the applicant, he was entitled to full reimbursement. He thus filed an application before the Central Administrative Tribunal claiming reimbursement of the entire amount spent on the treatment in a private recognised hospital. As already noticed, the Tribunal granted the relief as prayed. It is in this situation to be seen, whether the applicant was entitled to full reimbursement as claimed by him and granted by the Tribunal. After going through the policy, we find that the applicant certainly got treatment from a recognised private hospital but he is not entitled to reimbursement of full medical claim. He is entitled to reimbursement as per the policy framed by the Government of India and in vogue at the relevant time. Learned Tribunal has granted relief only by placing reliance on the judgments referred to above and has not given any other reason in support of the relief granted to the applicant. In that view of the matter, the order of the Tribunal, Annexure P-5 cannot be allowed to stand and the same deserves to be quashed.
12. There is, however, another aspect of the matter as well, which was brought to our notice during the course of hearing of this writ petition. The applicant was entitled to reimbursement of medical claim perhaps for a higher amount than Rs. 72,480/- under the policy decision of the Government of India relating to reimbursement of medical claim. The applicant underwent surgery in the Escorts Hospital on 27.11.1996 and at that time the policy relating to reimbursement of medical claim and the amounts payable thereunder had been revised. The applicant had been paid under the old policy but his claim for reimbursement of medical expenditure has not been considered under the revised policy dated 18.9.1996. Perhaps at that time such policy was not in the knowledge of the office ordering reimbursement of medical claim to the applicant. It was submitted on behalf of the respondent-applicant during the course of hearing that the applicant is entitled to a higher amount on account of reimbursement of his medical claim than the one sanctioned and paid by the authorities. After going through the policy of the Government of India dated 18.9.1996, we find that the rates seems to have been revised and the applicant may perhaps be entitled to a higher amount than the one sanctioned to him for getting treatment from a private recognised hospital. In the situation, we allow this writ petition and quash the order, Annexure P-5 of the Tribunal and direct the authorities to re-consider the case of the respondent-applicant for reimbursement of medical claim in terms of the policy that was in force on the date he underwent surgery. In case, he is found entitled to a higher amount than the one already paid to him, the same shall be paid to him at the earliest, preferably within three months from the date of receipt by the authorities a copy of this order. Since learned counsel for the Union of India has not put in appearance, there will be no order as to costs.