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Himachal Pradesh High Court · body

2007 DIGILAW 478 (HP)

AMRIK SINGH v. STATE OF H. P.

2007-11-26

M.R.VERMA

body2007
JUDGEMENT M.R. Verma, J (Retd.) Chairman:- The applicant herein has claimed the relief that the respondents may be directed to pay a sum of Rs. 28,000/- to him as medical reimbursement which is due for payment to him with interest on the delayed payment at the rate of 18% per annum. 2. The case of the applicant, in brief, is that he retired as Divisional Magistrate, H.P. State Forest Corporation, on 31.7.2003. On 14.4.1989, he had undergone heart surgery from All India Institute of Medical Sciences, New Delhi and when he again suffered from some heart problem in the year, 1998, he was advised heart surgery for which the Health Department of the Government of Himachal Pradesh permitted him to take treatment in Batra Hospital, New Delhi. The applicant was operated on 18.12.1998 at Batra Hospital and thereafter, he applied for medical reimbursement to the respondents-Department, in February/March, 1999. Respondent No.3 asked for sanction for payment for Rs. 1,45,000/- to the applicant by respondent No.1 vide Annexure A-2. However, respondent No.1 vide Annexure A-3 sanctioned a sum of Rs. 1,15,000/- only. Vide Annexure A-4 the applicant represented to respondent No.1 against sanction of lesser amount. The respondents however, took up the matter with General Manager, Batra Hospital, to refund the excess amount to the applicant and the applicant was also asked to take up the matter with the said Hospital authorities. The applicant, vide Annexure A-7, wrote to the General Manager of the said Hospital for reimbursement of Rs.30,000/- charged in and also made a further request in this regard vide Annexure A-8. On communication Annexure A-9, the applicant sent required papers to Batra Hospital vide Annexure A-10. Finally, the said Hospital refunded a sum of Rs.2,000/- to the applicant stating that it was charged extra but refused to refund any other amount on the plea that in fact a sum of Rs.30,000/- is charged for Redo Bypass Surgery. In these circumstances, the applicant vide Annexures A-12 wrote to respondent No.1 for sanctioning the balance amount of Rs. 28,000/-. However, he was informed vide Annexure A-13 that the reimbursement to the maximum limit had already been made to him. The applicant then made a representation to the Chief Minister which was rejected by respondent No.1 vide Annexure A-15. In these circumstances, the applicant vide Annexures A-12 wrote to respondent No.1 for sanctioning the balance amount of Rs. 28,000/-. However, he was informed vide Annexure A-13 that the reimbursement to the maximum limit had already been made to him. The applicant then made a representation to the Chief Minister which was rejected by respondent No.1 vide Annexure A-15. Hence, this original application by the applicant on the ground that denial to pay the due amount to him is arbitrary, mala-fide and against the Principles of Natural Justice. 3. The respondents contested the claim of the applicant. While admitting the grant of sanction to get himself treated in Batra Hospital by the applicant, submission of bill by him but payment of only Rs.1,15,000/- and non-payment of Rs.30,000/- charged for Re-do surgery, the claim for the remaining amount has been denied on the ground that the reimbursement of medical claim as in hand is done with the prior approval of the Health and Finance Department of the Government which sanctioned only the amount which has already been paid to the applicant and the release of balance amount of Rs.30,000/- as taken by the Department with the Health Department for approval was not approved on the ground that as per the instructions maximum limit for medical reimbursement was Rs.1,15,000/-. It is also claimed that the Hospital authorities have not adhered to the terms of the package deal entered into with them which has put the applicant in financial hardship, therefore, it was requested to refund the excess amount to the individual and that it be ensured that the charges are restricted as per package deal. The applicant was also directed to claim the amount from the Hospital authorities. The further representation of the applicant was examined by the Department and his case was once again sent to the Health Department for approval which was again rejected because of absence of any provisions to allow medical claim over and above the package deal as fixed by the Government with the concerned Hospital. In these circumstances, the claim of the applicant has been denied by the respondents. 4. I have heard the learned counsel for the applicant and the Learned Deputy Advocate General for respondents No.1 & 2. 5. In these circumstances, the claim of the applicant has been denied by the respondents. 4. I have heard the learned counsel for the applicant and the Learned Deputy Advocate General for respondents No.1 & 2. 5. It is not in dispute that the applicant had undergone the treatment in question and the expense claimed by him were in fact incurred by him for his treatment. It is also not in dispute that at the relevant time Batra Hospital, Delhi, was approval Hospital for treatment of heart problem like surgery and the applicant was referred for treatment to said Hospital The defence of the respondents in fact appears that said Hospital did not adhere to the package deal, therefore, the respondents are not bound to pay the amount over and above the package amount. The defence does not seem to be reasonable and legal. The Hospital is approved for treatment by the State Government. The package has been entered into with it by the State Government if an employee or retiree of the State Government after due permission of the concerned authority takes treatment in such Institution charges more money from the person than permissible under the package, it is the entire responsibility of the State Government to settle the dispute with the Hospital in the manner it deems fit and proper but it cannot punish the employee by refusing to pay him/her such dues as has been paid by him/her to so authorised/approved Hospital for his/her treatment for self preservation which is the necessary concomitant of the right to life enshrined in Article 21 of the Constitution. 6. In Surjit Singh Vrs. State of Punjab and others (1996 (2) SCC 336), the Honble Apex Court held as under: "9. The policy, providing recognition for treatment of open heart surgery in the Escorts specifically came to be examined by a Division Bench of the Punjab and Haryana High Court at Chandigarh titled as Sadhu R. Pall v. State of Punjab, wherein the claim of the then writ petitioner to medical reimbursement was accepted when in order to save his life he had got himself operated upon in the Escorts, and the plea of the State that he could be paid rates as prevalent in the AIIMS was rejected. Special Leave Petition No.22024 of 1995 against the said decision was dismissed by this Court on 2-2-1994. Special Leave Petition No.22024 of 1995 against the said decision was dismissed by this Court on 2-2-1994. The other judgments of the High Court following the decision in Sadhu R. Pali case are: (i) K.L.Kohli V. State of Punjab; (ii) Mohan Duggal v. State of Punjab; (iii) Prem Singh Gill v. State of Punjab; (iv) Tarlok Chander v. State of Punjab and (v) Surya Pandit v. State of Punjab 10. All the aforementioned judgments of the High Court have a common factual basis, i.e. each recipient of the relief from the High Court had in fact been treated in the Escorts and born expenses. The other common factor is that the High Court believed each writ petitioner, pleading emergency to got Escorts in the given fact situation. But this factor by itself is not the core of the views of the High Court, Hypothetical, the appellant says, he too may be considered to have been treated in the Escort more so, when he is being treated to have been operated upon the AIIMS without actually having been so, and had a choice to go either to the. AIIMS or Escorts or Christian Medical College, Ludhiana or Apollo Hospital, Madras. The appellant in these circumstances cannot be said to be far too wrong in choosing Escorts amongst the three recognized hospitals for open heart surgery available in the North, the AIIMS being governmental and the other two being private hospitals. The Division Bench in Sadhu R. Pall easel observed as follows: "The respondents appear to have patently used excusals in refusing full reimbursement, when the factum of treatment and the urgency for the same has been accepted by the respondents by reimbursing the petitioner the expenses incurred by him, which he would have incurred in the AIIMS, New Delhi, we cannot lose sight of factual situation in the AIIMS, New Delhi, i.e. with respect to the number of patients received there for heart problems. In such an urgency, one cannot sit at home and think in a cool and calm atmosphere for getting medical treatment at a particular hospital or want for admission in some government medical institute. In such a situation, decision has to be taken forthwith by the person, or his attendants if precious life has to be saved." 11. In such an urgency, one cannot sit at home and think in a cool and calm atmosphere for getting medical treatment at a particular hospital or want for admission in some government medical institute. In such a situation, decision has to be taken forthwith by the person, or his attendants if precious life has to be saved." 11. It is otherwise important to bear in mind that self-preservation of ones life is the necessary concomitant of the right of life enshrined in Article 21 of the Constitution of India, fundamental in nature, scared precious and inviolable." 7. In "State of Punjab & others vs. Mohinder Singh Chawla (1997) 2 SCC 83) the Honble Apex Court has held as under: - " It is now settled law that right to health is integrat to the right to life. Government has a constitutional obligation to provide health facility if the government servant has suffered and ailment which requires treatment as a specialised approved hospital and on reference whereat the government servant had undergone such treatment therein, it is but the duty of the State to bear the expenditure by the Government servant. Expenditure, thus, incurred requires to be reimbursed by the state to the employee". 8. In view of the above settled position in law and the due sanction for the treatment having been accorded by the competent authority, the respondents cannot deny the reimbursement of full medical expenses incurred by the applicant. 9. As result this original application is allowed in his ... that respondents are directed to pay to the applicant an amount of Rs.28,000/- on account of reimbursement of his remaining medical claim within two weeks with costs quantified in the sum of Rs.15007-. In case the amount is not paid within the stipulated period, the respondents shall be liable to pay this amount with interest at the rate of 12% per annum form the date it was payable till It is paid. This original application is accordingly disposed of.