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1997 DIGILAW 507 (RAJ)

Bhanwar Singh v. Central Cooperative Bank, Bhilwara

1997-04-11

J.C.VERMA

body1997
JUDGMENT 1. - The petitioner suffering from various serious ailments of heart was referred to by the Principal Medical Officer, Bhilwara on 5.4.1995 for advise and diagnosis/treatment at S.M.S. Hospital, Jaipur. He was examined at the S.M.S. Hospital, Jaipur, which is a Government Hospital, on 18.4.1995. It was diagnosed that the petitioner was suffering from severe cardiac ailment and needs further ovalution by coronary cardiac by-pass surgery. It was further verified that this by-pass surgery was not available in the State of Rajasthan and, therefore, the case of the petitioner was referred to Escort Heart Institute and Research Centre, New Delhi (referred to hereinafter as `Escort Hospital') vide reference letter Annex.-3. A Medical Board was also constituted consisting of 3 members including Dr. K. S. Yadav, Dr. R. N. Mathur and Dr. S. K. Chutani. The Board recommended to the Principal and Controller, S.M.S. Medical College after thorough examination that the petitioner needs management by Stress the tune studies and cardiac by-pass surgery (CABG) at Escort Hospital, New Delhi. Further the expenditure estimates were also made by the Board to the tune of Rs. 1,60,000/- for the treatment/ investigation vide their recommendations Annex. 4. 2. The petitioner being an employee of the respondent Bank submitted an application to the Managing Director of the respondent Bank requesting him to make payment of Rupees 1,60,000/- for the treatment as has been recommended by the Principal and Controller, S.M.S. Medical College and Hospitals attached thereto at Jaipur. His application dated 27.4.1995 is attached as Annex. 6. The petitioner was also corresponding with the Escort Hospital, New Delhi and a date for petitioner's operation was fixed as 10.5.1995. He was admitted in the Escort Hospital, New Delhi on 4.5.1995. The respondent Bank did not make any payment towards the expenses to be incurred by the petitioner. The petitioner was discharged after a by-pass surgery on 18.5.1995. He had undergone the by-pass surgery on 10.5.1995 at the Escort Hospital, New Delhi and up to that time no payment was being made by the Bank. After the petitioner was discharged, the respondent Bank had made a payment of Rs. 1,00,000/- on 6.6.1995 when the petitioner had submitted all the medical bills and expenses incurred by him. The total medical bills and expenses incurred by the petitioner as submitted by him came to Rs. 1,98,479.61. The list of expenditure is attached as Annex. 7. After the petitioner was discharged, the respondent Bank had made a payment of Rs. 1,00,000/- on 6.6.1995 when the petitioner had submitted all the medical bills and expenses incurred by him. The total medical bills and expenses incurred by the petitioner as submitted by him came to Rs. 1,98,479.61. The list of expenditure is attached as Annex. 7. The petitioner made representations I for payment of the balance amount which were required to be paid to him as per the service conditions. His representations are attached as Annexs. 8, 9, 10, 11 and 12. He has been approaching the respondent Bank right up to March, 1996. It is submitted by the petitioner that he has paid more than Rs. 2 lacs to the Escort Hospital, New Delhi and the other bill of Rs. 7720/- dated 24.2.1996 was also submitted by the petitioner which he had to pay to the Escort Hospital, New Delhi. The petitioner submits that he is holding a post of Clerk-cum-Cashier in the respondent Bank and he had incurred the expenses by borrowing money from his friends and relatives. According to him, as per the agreement dated 7.2.1985 the respondent Bank is not discharging its obligation in reimbursing the amount of medical expenditure. 3. A reply has been filed on behalf of the respondent No. 2 Managing Director, Central Co. operative Bank, Bhilwara. It is stated by the respondent Bank that according to the settlement of 1991, the petitioner is not entitled to any reimbursement. The respondent Bank has reproduced the agreement under the heading of Medical Allowance wherein it has been mentioned that the medical allowance and rates and facilities shall remain unchanged. It is further mentioned that in addition to the Government hospitals situated at Jaipur i.e. Santokaba Durlabhji Memorial Hospital, Amar Jain Hospital and Charitable Institutions situated at the Block Levels shall be the hospitals where if treatment is taken by the employees or admitted therein for treatment and after being discharged from the hospital the employee shall be entitled to medical reimbursement. It is stated that despite the fact that the treatment was not taken from the institutions mentioned above, a reimbursement of Rs. 1 lac was made towards the medical expenses as a special case. It is stated that despite the fact that the treatment was not taken from the institutions mentioned above, a reimbursement of Rs. 1 lac was made towards the medical expenses as a special case. It is submitted that the petitioner is not entitled to any other amount except the amount which has already been paid to him, as the petitioner does not fall within the ambit of the instructions issued on 22.6.1991 as mentioned above. The correctness of the amount and the fact of treatment as such have not been disputed. 4. The only question, which arises for determination, is whether in the facts and circumstances of the present case, the petitioner is entitled to the reimbursement of the amount not. 5. A rejoinder has been filed to the written-statement. It is stated that the settlement of 1991 nowhere denies the petitioner to claim the expenditure incurred by him on his treatment. It is stated that the settlement of 1991, relied upon by the respondents, is extension of the benefits granted to the employees by the settlement of 1985. It was further submitted that Rule 7 of the Rajasthan Medical Expenditure Reimbursement Rules clearly provides for grant of medical expenditure to the employees of the Bank, who proceed for their treatment in the hospital outside the State of Rajasthan. 6. It is admitted fact that the settlement of 1991 was an extension of the earlier settlement of 1985 as the settlement of 1991 itself says that the facilities and rates of medical allowance shall remain as before and 1985 settlement prescribes that every clerk shall be entitled to Rs. 19/- per month as medical allowance and in addition to the above he shall also be entitled for himself and his family the expenditure of hospitalisation for the diseases such as Cancer, T.B., Major accidents and any other ailments where operation is required. However, it is mentioned in the service conditions that full hospitalisation expenditures are to be borne out by the Bank if the employee is admitted in the State hospitals etc. etc. 7. In the present case, it is admitted fact that the Principal Medical Officer, Bhilwara had recommended his treatment at Jaipur and the Government Hospital and College at Jaipur had recommended his operation to he done at Escort Hospital, New Delhi for the reason that no such facility was available at Jaipur. etc. 7. In the present case, it is admitted fact that the Principal Medical Officer, Bhilwara had recommended his treatment at Jaipur and the Government Hospital and College at Jaipur had recommended his operation to he done at Escort Hospital, New Delhi for the reason that no such facility was available at Jaipur. The necessary documents have been attached with the writ petition which are not denied; The defence of the respondents is untenable and far from being realistic. The aim of incorporating in the service conditions for reimbursing the medical expenditure incurred for any accident or surgery in the hospital is to provide the immediate relief to the employee. It is admitted that the Escort Heart Institute and Research Centre, New Delhi is one of the best known institute so far as bypass surgery etc. is concerned and because of the reason that the petitioner was recommended by the Government College and Hospital attached with it at Jaipur to be operated upon at the Escort Hospital, New Delhi, there was no option left with the petitioner but to approach the Escort Hospital, New Delhi to save his life. The petitioner had duly informed the respondent Bank even before proceeding to New Delhi for the said purpose. If the treatment is not available at a specific place, which is urgently required, it is implied in the service conditions if reimbursement of medical bills are permissible that the employee shall also be paid the medical bills by way of reimbursement if he takes the surgery treatment or is operated upon or is admitted in the case of sudden emergency even in a private hospital without reference, he shall be entitled to the expenses incurred by him. For example if an employee who is entitled to reimbursement of medical bills under the service conditions unfortunately meets with an accident and is removed for immediate medical attention to the nearest possible private hospital, it cannot be said that he shall not be entitled to the medical reimbursement for the reason that he was admitted in a private hospital, it cannot be imagined that for the purpose of claiming reimbursement his treatment should wait till he is removed to some Government hospital irrespective of the fact whether the Government hospital is situated near about or not. In emergency situation or if no treatment is available at such Government hospital, in that situation, the employee shall be entitled to the full reimbursement if allowed under the rules wherever he is operated upon or got treatment. 8. It has been authoritatively held by the Supreme Court in Surjit Singh v. State of Punjab, (1996) 2 SCC 336 : ( AIR 1996 SC 1388 ) as under: "The appellant employee therefore had the right to take steps in self preservation. He did not have to stand in queue before the Medical Board, the manning and assembling of which, barefacedly, makes its meeting difficult to happen. The appellant also did not have to stand in queue in the Government hospital of AIIMS and could so elsewhere to an alternative hospital as per policy. When the Slate itself has brought Escorts on the recognised list, it is futile for it to contend that the appellant could in no event have gone to Escorts and his claim cannot on that basis be allowed, on suppositions. In the facts and circumstances, had the appellant remained in India, he could have gone to Escorts like many others did, so save his life. But instead he has done that in London incurring considerable expense. The doctors causing his operation there are presumed to have done so as one essential and timely. On that hypothesis, it is fair and just the respondents pay to the appellant employee (berates admissible as per Escorts Heart Institute, New Delhi." 9. For the reasons mentioned above, the writ petition is allowed. The respondents are directed to make payment of the balance amount by way of reimbursement within 15 days from the date of receipt of a certified copy of this order. The petitioner shall also be entitled to interest @ 12% per annum. In case the payment is delayed after the stipulated period as mentioned above, the petitioner shall also be entitled to costs of the writ petition which is assessed at Rs. 2000/-.Petition allowed. *******