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2010 DIGILAW 3373 (MAD)

S. Nizar Ahmed v. Joint Secretary to Government

2010-08-05

S.TAMILVANAN

body2010
O r d e r :-This writ petition has been filed by the petitioner under Article 226 of the Constitution of India, seeking an order in the nature of writ of certiorarified mandamus, calling for the records of the respondents relating to Proceedings No.82335/Pension/04-1, dated 11.01.2005 and the order of the second respondent made in Proceeding No. O.Mu.36751/ 04/Y2, dated 24.08.2004 and quash the same and consequently, direct the respondents to pay a sum of Rs.50,000/- from Tamil Nadu Government Pensioners, Health Fund Scheme to the petitioner. 2. It is not in dispute that the petitioner is a retired special Tahsildar drawing pension from the Government through the second respondent. The petitioner has averred that he was suffering from hypertension and diabetic problem and he was taken to a hospital in a serious condition, on account of his heart problem, since there was massive heart attack on 08.05.2004. As he became unconscious, he was immediately taken to the nearest hospital, Sri Ramakrishna Hospital, Coimbatore, by his family members and it was diagnosed that two of his heart valves were completely damaged and asked to undergo open heart surgery immediately. As the health condition was deteriorating, operation was done on 10.05.2004 in Sri Ramakrishna Hospital, Coimbatore and he was an inpatient in the said hospital from 08.05.2004 to 22.05.2004. For the said open heart surgery and for the treatment, the petitioner incurred expense, a sum of Rs.2,01,742/- and that has been meted out by getting loan from his relatives and friends and also getting loan from State Bank of India. 3. The Government of Tamil Nadu has introduced a scheme called Employment Health Fund Scheme, by order, dated 09.01.1992. The Government have issued G.O.Ms.No.562, Finance (Pension) Department, dated 11.07.1995 and that has been implemented towards Tamil Nadu Pensioner’s Health Fund scheme, in respect of state Government Pensioners with effect from 01.07.1995. As per the scheme, each pensioner shall subscribe a sum of Rs.50/- per annum towards the Tamil Nadu Government Pensioners Health Fund. An assistance of Rs.50,000/- or 75% of the actual cost of the treatment, whichever is less be given to the State Government Pensioners, in case of taking any treatment. However, the representation made by the petitioner, seeking sanction of the aforesaid amount of Rs.50,000/- was negatived by the respondents. 4. An assistance of Rs.50,000/- or 75% of the actual cost of the treatment, whichever is less be given to the State Government Pensioners, in case of taking any treatment. However, the representation made by the petitioner, seeking sanction of the aforesaid amount of Rs.50,000/- was negatived by the respondents. 4. Mr.N.Ishtiaq Ahmed, learned counsel appearing for the petitioner drew the attention of this Court to the copy of the impugned order, dated 24.08.2004, wherein, it is seen that the request of the petitioner was negatived by the said order by the Treasury Officer, Coimbatore, the second respondent herein that the petitioner underwent the heart surgery in a hospital, which was not accredited by the Government. 5. Mr.A.Edwin Prabhakar, learned Additional Government Pleader appearing for the respondents has not disputed the fact that the petitioner is a retired government servant and he had paid subscription under the Health Fund Scheme and subsequently, underwent open heart surgery, as per the documents produced by him. 6. Learned counsel appearing for the petitioner also produced copy of the supporting documents along with the writ petition to substantiate the fact that the petitioner had undergone heart surgery in Sri Ramakrishna Hospital, Coimbatore and spent an amount more than Rupees Two lakhs towards the surgery and treatment. The genuineness of the documents produced by the petitioner are not in dispute. The only reason assigned by the respondents for rejecting the claim is that the petitioner underwent surgery in a hospital, that was not accredited by the Government. 7. As per G.O.Ms.No.207, Finance (Pension) Department, dated 22.04.1997, in the Annexure-II of G.O., the name and place of 24 hospitals have been specified, accordingly, Kuppuswamy Memorial Hospital, Coimbatore, Kovai Medical Centre and Hospital Limited, Coimbatore are recognised as accredited Institutions where specialised surgeries / Treatment are given. 8. As contended by the learned counsel appearing for the petitioner, since the petitioner was in an unconscious state of mind, considering the urgency, to save his life, he was admitted in the nearby hospital and expert doctors have conducted the surgery successfully and saved the life of the petitioner herein. 9. 8. As contended by the learned counsel appearing for the petitioner, since the petitioner was in an unconscious state of mind, considering the urgency, to save his life, he was admitted in the nearby hospital and expert doctors have conducted the surgery successfully and saved the life of the petitioner herein. 9. In the aforesaid circumstances, when the petitioner has established that he had spent more than Rupees Two lakhs towards the surgery and the treatment, there is no justification to reject the claim of the petitioner, merely on the ground that the petitioner had undergone the surgery, in a hospital, that was not accredited by the Government. 10. This Court in similar cases has passed orders, whereby held that the petitioners therein were entitled to the amount claimed as per the health scheme. In support of his contention, the learned counsel cited the following decisions : 1. Balaswami, K vs. Director of Pension, 2007 (2) CTC 494 2. Ramalingam, E vs. The Director of Collegiate Education, 2006 (4) CTC 832 11. In Ramalingam, E vs. The Director of Collegiate Education, reported in 2006 (4) CTC 832 , it has been held as follows : “8. In regard to the reasons as to the non-inclusion of the Hospital in Government Order for denial, this Court cannot brush aside the advancement in modern medical treatment. Specifically Hospitals are established for treatment for specified ailments and services of Doctors specialised in a discipline are availed by patients only to ensure proper, required and sage treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive the beneficial order of the Government, solely on the ground that the said Hospital is not included in the Government Order. It cannot be so, as the Government Order should be read keeping the purpose for which the same was issued. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors / Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds as found in the impugned order. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors / Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds as found in the impugned order. Having regard to the above lacunae in the earlier Government Order and issuance of subsequent Government Order including not only the treatment but also the hospital. I am of the view that the petitioner is entitled to claim reimbursement.” 12. In Surjit Singh vs. State of Punjab, reported in 1996 (2) SCC 336 , the Hon’ble Apex Court has held that the petitioner who underwent treatment in a hospital, which is not in the list under the Government Order is entitled to claim amount under the Scheme, since the factum of the surgery and the amount spend towards the medical treatment is established. 13. In Balaswami, K vs. Director of Pension, reported in 2007 (2) CTC 494 , relying on the decisions reported in 2006 (4) CTC 832 and 2006 (2) MLJ 747 (cited supra), this Court has dealt with similar issues and passed orders, holding that the petitioner therein was entitled to claim the amount under the Health Scheme. 14. In the instant case, it is an admitted fact that the petitioner is a retired Government servant and he subscribed under the Tamil Nadu Government Pensioners Health Fund Scheme and it is not in dispute that he underwent heart surgery in Sri Ramakrishna Hospital, Coimbatore and spent more than Rs.2 lakhs and receipts produced herein for a sum of Rs.1,38,000/-, even as per the supporting documents produced by the petitioner. 15. Considering the Scheme and the arguments advanced by both the learned counsel, in the light of various decisions of the Hon’ble Apex Court and this Court, I am of the view to hold the following aspects, necessary to make a claim under the Tamil Nadu Government Pensioners Health Fund Scheme : (i) The person making the claim should be a retired Government servant or his dependents. (ii) The subscription could have been paid under the Scheme to claim the amount spent towards the expense for having underwent surgery or medical treatment. (ii) The subscription could have been paid under the Scheme to claim the amount spent towards the expense for having underwent surgery or medical treatment. (iii) The claimant or the dependents must have produced the supporting documents to show that the retired Government servant had underwent surcharge or treatment and spent money towards the expenses, however, the claim is subject to the maximum limit under the Scheme to get reimbursement. 16. The point for consideration in the writ petition is with regard to the legality of the alleged bar in making the claim, in view of the condition imposed in the Government Order that the retired Government servant should have taken treatment only in an accredited hospital by the Government for getting the benefit under the Scheme. 17. It cannot be disputed that the object of the Scheme is only to help the retired Government servants on getting minimum subscription under the scheme. While the person is in an unconscious condition, due to his heart ailment, saving his life is paramount to his kith and kin and well wishers. Accordingly, the petitioner was admitted in a nearby hospital and expert Doctors did the open heart surgery successfully and also saved the life of the petitioner. The aforesaid factum is proved, by way of supporting documents, which is not disputed by the respondents in the writ petition. 18. In the aforesaid circumstances, imposing an unreasonable condition to get treatment only from few accredited hospital cannot be justified. In fact, the aforesaid condition may help few hospitals having accredited and would not help the Government servants, who are in need of immediate treatment to save their life. Merely to get reimbursement of a portion of the amount spent towards the surgery and treatment, an ailing patient in a serious condition cannot search for an accredited hospital, as saving his life is more important than any other aspect. 19. In the aforesaid circumstances, the authorities could see only the genuineness of the claim made by the claimant and therefore, rejecting the claim of the petitioner that he was not provided treatment by an accredited hospital by the Government cannot be justified and that cannot be a bar in getting the benefit under the Scheme, as the retired Government servant had actually underwent open heart surgery successfully by expert Doctors and spent more than Rs.2 lakhs and claiming only Rs.50,000/-, under the scheme. 20. 20. Relying on the decisions of the Hon’ble Apex Court and the decisions of this Court, I am of the view that the petitioner is entitled to claim the amount, Rs.50,000/- under the Scheme, as he is a retired Government servant and subscribed under the Tamil Nadu Government Pensioners Health Fund Scheme and also underwent surgery and spent more than Rupees Two lakhs, through the receipts produced is only for Rs.1,38,000/-, which is more than the amount claimed by the petitioner. Hence, the writ petition has to be allowed, to meet the ends of justice, as it is a genuine claim and the petitioner has established the relevant facts, which are needed, as per law, before the authorities as well as this Court. 21. In the result, this writ petition is allowed. The respondents are directed to pay an amount of Rs.50,000/- under the Tamil Nadu Government Pensioners Health Fund Scheme, within a period of eight weeks from the date of receipt of a copy of this order. The petitioner is also entitled to claim interest at 9% p.a for the said amount from the date of filing of the writ petition till the date of realisation. Consequently, connected miscellaneous petitions are closed. No order as to costs.