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2013 DIGILAW 618 (JK)

Syed Musadiq Qadri v. State

2013-10-21

Mansoor Ahmad Mir

body2013
1. This petition involves a very short controversy. The petitioner, a Statistical Officer, borne on the cadre of Planning Department of the Government of Jammu and Kashmir State, was registered under registration No. 148382 at SMHS Hospital as a patient suffering from Primary Infertility (Oligozoospermia). He was referred to Lilavati Hospital and Research Centre, Bandra, Mumbai, India, by SMHS Hospital, Srinagar, for management of primary infertility, which facility was certificated to be not available in SMHS Hospital. This was done in terms of Referral Certificate dated 12.12.2002 issued in terms of Rule 6.1 of the Jammu and Kashmir Civil Services (Medical Attendance-cum-Allowance) Rules, duly signed by the prescribed authorities. The treatment is stated to have cost the petitioner a total expenditure of Rs. 3,03,252.00. He is stated to have preferred a medical reimbursement claim of the medical expenses thus incurred by him on his treatment. The medical reimbursement claim so preferred by the petitioner has been refused to him; hence this writ petition. 2. The case of the petitioner is that he duly applied for accord of sanction for treatment outside the State in Lilavati Hospital and Research Centre, Bandra, Mumbai, India, which application of the petitioner was forwarded to the Director, Statistics and Economics by his immediate officer vide endorsement dated 28.12.2002 who, in turn, referred the matter to the Administrative Department, respondent No. 1, vide communication No. DES/PF-105/SA(Adm) dated 30.01.2003. Communication dated 20.01.2004 written by the Assistant Director, Economics and Statistics to the Under Secretary to Government, Planning and Development Department, placed on record, reveals that the Administrative Department slept over the matter and did not respond to the request of the petitioner duly recommended by the Directorate of Economics and Statistics. Meanwhile, the petitioner states that he had to leave for his treatment. It was on 06.02.2006 that respondent No. 1 through Deputy Secretary to Government, Planning and Development Department informed the Joint Director, Economics and Statistics that Government had introduced Mediclaim Insurance Scheme with ICICI, Lomgard General Insurance Company Ltd. and that the petitioner may be asked to opt for the said policy. The petitioner states that he, in fact, was enrolled under the J&K Govt. Employees Group Medical Policy under UHID No. ICIC.465166, but ICICI refused to entertain the claim on the ground that treatment of infertility is a standard exclusion and is not covered under the policy. The petitioner states that he, in fact, was enrolled under the J&K Govt. Employees Group Medical Policy under UHID No. ICIC.465166, but ICICI refused to entertain the claim on the ground that treatment of infertility is a standard exclusion and is not covered under the policy. The petitioner vide his representation dated 10.05.2006 brought this matter to the notice of the Director, Economics and Statistics with request to obtain necessary sanction from the Administrative Department. The case seems to have been taken up with the Finance Department. The Finance Department rejected the claim of the petitioner in the following terms as contained in communication No. DES/PF- SA/2008(Adm) dated 25.02.2008 addressed by Joint Director, (C) Economics and Statistics to the Principal, Government Medical College, Srinagar, under whom the petitioner was working at the relevant point of time: "Finance Department Convey regrets to the Department proposal as there are no cogent reasons to consider it for relaxation of rules in Finance Department." 3. Respondents were put on notice. Reply was filed on behalf of respondent No. 1 which was adopted on behalf of respondent No. 2 in terms of order dated 21.10.2011. In the reply it is stated that the answering respondent did every effort under rules, but finally it is respondent No. 2 who can in relaxation of rules reimburse the medical claim of the petitioner. It is also stated that the answering respondent played his role as well as sent the proposal to the Finance Department and the Finance Department in turn rejected the proposal of the answering respondent on the ground that there is no cogent reason to relax the rules. 4. I have heard learned counsel for the parties. The writ petition is admitted to hearing and is taken up for final disposal on agreement of learned counsel for the parties. 5. I have considered the matter. In effect and in essence, the respondents have not contested the claim of the petitioner except saying that there was no cogent reason to relax the rules. Mr. Tasaduq Khwaja submitted that since the medical claim of the petitioner was not covered under the rules, he is not entitled to the reliefs claimed by him, especially so because the rules have not been relaxed. It is not understandable as to where was the requirement of relaxing the rules. Mr. Tasaduq Khwaja submitted that since the medical claim of the petitioner was not covered under the rules, he is not entitled to the reliefs claimed by him, especially so because the rules have not been relaxed. It is not understandable as to where was the requirement of relaxing the rules. Admittedly, the petitioner is governed by the Jammu and Kashmir Civil Services (Medical Attendance- cum-Allowance) Rules, 1990. Rule 6 of these Rules provides for treatment outside the State. It states that treatment outside the State may be authorized in respect of a beneficiary by the Administrative Department concerned on production of a certificate on the prescribed Proforma by the Head of Specialty not below the rank of Associate Professor. Where a Professor is not available it should be countersigned by the concerned Principal of the Medical College in the State. In terms of sub-Rule (2) of the aforesaid Rule, a beneficiary is entitled to reimbursement of actual expenses incurred on Road/Railway fare of the patient and one attendant, if any accompanying him by the class of which he is entitled for journey on tour; expenditure incurred on Pathological, Bacteriological/Radiological and other methods of examination/investigation or treatment like electric therapy etc.; charges including cost of blood transfusion, if any, levied by hospital authorities; operation charges paid to the Hospital; consultation fee, if any paid under hospital rules and cost of medicines purchased from market on the advice of hospital authorities. 6. Note (1) appended to the aforesaid Rule says that the concessions under this rule (Rule 6) shall also be applicable to such State employee who get medical facilities under any other scheme but for whom there is no provision in that scheme for treatment outside the State. 7. Rule 6-A identifies the private hospitals where treatment outside the state can be got done, but this Rule pertains to treatment for heart ailment, kidney transplantation, cancer and other life consuming diseases only. There does not seem to be any rule, and none was brought to the notice of the Court which provides that the petitioner could not get himself treated in a private hospital outside the State, especially so when he was referred to the said hospital by none other than Government Medical College/SMHS Hospital, Srinagar. 8. There does not seem to be any rule, and none was brought to the notice of the Court which provides that the petitioner could not get himself treated in a private hospital outside the State, especially so when he was referred to the said hospital by none other than Government Medical College/SMHS Hospital, Srinagar. 8. In light of the above rule position, there seems to be no reason or justification for the respondents to refuse reimbursement of the medical claim submitted by the petitioner. In fact, it is not comprehendible how the Finance Department has come in-between when the Rule makes it manifest that it is only the Administrative Department concerned which can authorize treatment outside the State on production of the requisite certificate. The petitioner seems to have been put to an avoidable harassment merely because of the unjustifiable intransigence of the Finance Department. 9. In light of the above, this petition is allowed. The impugned communication dated 25.02.2008 containing the decision of the Finance Department is quashed as being unsupported by Rules. Consequently, the respondents, especially respondent No. 1, are directed to consider and dispose of the medical reimbursement claim of the petitioner in terms of Rule 6 of the Rules referred to hereinabove. 10. No order as to costs.