Ramjibhai Punjabhai Parmar v. Ahmedabad Municipal Corporation
2019-09-05
A.S.SUPEHIA
body2019
DigiLaw.ai
JUDGMENT : 1. Since the issue involved in both the petitions is common, the writ petitions are heard and decided analogously by this court vide common judgment and order. 2. The facts are incorporated from Special Civil Application No. 28921 of 2007. 2.1 Since the petitioner had suffered massive heart attack, he was required to undergo Coronary Artery bypass Grafting and hence, he was admitted in the Sterling Hospital on 04.08.2006 and was operated on 15.08.2006 and was discharged from the hospital on 27.08.2006. He had incurred medical expenses to the tune of Rs.1,37,976/-. Thereafter, the petitioner had applied for medical reimbursement as per the policy of respondent No.1 – Ahmedabad Municipal Corporation however, the same has been denied to him vide impugned communication dated 04.05.2007. 3. Learned advocate Mr.Prabhakar Upadhyay appearing for the petitioner has submitted that the impugned action of denying the medical reimbursement to the petitioner is contrary to the circular and policies of the respondent Corporation. He has submitted that the petitioner is entitled to the medical reimbursement as per the policy dated 15.05.2006, wherein the respondent No.1 has laid down various parameters of the medical reimbursement and also specified names of the private hospitals, in which the employees if have undergone treatments would be entitled to the medical reimbursement equivalent to the medical expenses incurred in Sheth V.S. General Hospital. He has submitted that the petitioner has been denied the medical reimbursement only on the technical ground that the respondent No.2Ahmedabad Municipal Transport Service has adopted the policy of the respondent No.1 vide resolution dated 29.11.2006. He has also submitted that by the impugned order, the medical reimbursement is denied to the petitioner on the basis of the date, on which the respondent No.2 has adopted the said resolution i.e. 29.11.2006. Thus, he has submitted that the impugned communication may be quashed and set aside. 4. Learned advocate Mr.H.S.Munshaw for the respondents has submitted that the petitioner would not be entitled to the medical reimbursement since he was the employee of the respondent No.2 and it has adopted policy of reimbursement of the respondent No.1 on 29.11.2006 and since the petitioner has undergone the medical treatment on 13.08.2006, prior to the adoption of the policy of the respondent No.1 promulgated on 15.05.2006, the petitioner would not be entitled to any medical reimbursement.
Thus, he has submitted that the petitioner is not eligible and entitled for the medical reimbursement or any other monetary benefit as his case would be covered by the resolution dated 25.05.2006 and not by the resolution dated 15.05.2006 of the respondent No.1. 5. Heard the learned advocates for the respective parties. 6. The facts, which are not in dispute are that the petitioner had undertaken the medical treatment in emergency condition. He has to undergo the bypass surgery on 15.08.2006 in the Sterling Hospital. 7. The petitioner was serving as an Assistant Traffic Inspector in the respondent No.2. The petitioner, after taking the medical treatment in the Sterling Hospital requested the respondent No.2 to reimburse the medical expenses incurred by him however, by the communication dated 04.05.2007, he has been denied the same on the ground that since the respondent No.2 had adopted the policy for medical reimbursement of the respondent No.1 vide circular dated 29.11.2006, he would not be entitled to any medical reimbursement as he has undertaken treatment on 13.08.2006 i.e. prior to three (3) months from the adoption of such policy of reimbursement. 8. In the considered opinion of this Court, the stand taken by the respondent authorities is too technical and also against the welfare policy of providing medical reimbursement to the employees of the respondents. It appears from the circular dated 15.05.2006 issued by the respondent No.1AMC that there was already a policy in existence in the year 2004 and the same was revised by the aforesaid circular granting the medical reimbursement to their employees. The circular specifically states that the employees working in the respondent No.1 would be entitled to the medical reimbursement equivalent to the medical expenses incurred at Sheth V.S. General Hospital. The list of the private hospitals is also provided in the aforesaid circular. The name of the Sterling Hospital figures at Sr. No. 9 of the list of circular, wherein the petitioner had undertaken his treatment. The aforesaid policy of the respondent No.1 was adopted by the respondent No.2AMTS vide resolution dated 29.11.2006, wherein it is specifically referred that the circular dated 15.05.2006 granting the medical reimbursement to the employees, who had taken the treatment of heart ailment would be entitled to the medical reimbursement as per the provision of the said circular i.e. equivalent to the expenses suggested by Sheth V.S. General Hospital.
The petitioner, who has undergone the treatment on 13.08.2006 could not have been denied the medical reimbursement since the respondent No.1AMC was already having the policy of reimbursement. 9. The respondents have also placed reliance on the circular dated 25.05.2006 denying the medical reimbursement to the petitioner on the ground that if any employee has undertaken the treatment in the hospital other than the hospitals run by the respondent No.1, then he would not be entitled to medical reimbursement. 10. At this stage, it would be apposite to refer to the observations made by the Apex Court in case of Shiv Kant Jha Vs. Union of India, (2018) 3 SLR 328 (S.C.). "10. The Apex Court, in the recent decision, in the case of Shiv Kant Jha versus Union of India, reported in 2018(3) SLR 328 (S.C.) has observed thus:" “13. It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests 11 only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is notincluded 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 issupported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds.
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 issupported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds. Clearly, in the present case, by taking a very inhuman approach, the officials 12 of the CGHS have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court.” 11. In the case before the Apex Court the employee had taken treatment in a hospital, which was not at all recognized or approved by the State Government or it was not included in the Government Order. The Apex Court has observed thus:“ “14. This is hardly a satisfactory state of affairs. The relevant authorities are required to be more responsive and cannot in a mechanical manner deprive an employee of his legitimate reimbursement. The Central Government Health Scheme (CGHS) was propounded with a purpose of providing health facility scheme to the central government employees so that they are not left without medical care after retirement. It was in furtherance of the object of a welfare State, which must provide for such medical care that the scheme was brought in force. In the The brief facts of the case are as under: of the present case, it cannot be denied that the writ petitioner was admitted in the above said hospitals in emergency conditions. Moreover, the law does not require that prior permission has to be taken in such situation where the survival of the person is the prime consideration. The doctors did his operation and had implanted CRTD device and have done so as one essential and timely. Though it is the claim of the respondent-State that the rates were exorbitant whereas the rates charged for such facility shall be only at the CGHS 13 rates and that too after following a proper procedure given in the Circulars issued on time to time by the concerned Ministry, it also cannot be denied that the petitioner was taken to hospital under emergency conditions for survival of his life which requirement was above the sanctions and treatment in empanelled hospitals.” 12.
The Apex Court has noted the submissions advanced by the respondent-State that “the rates were exorbitant whereas the rates charged for such facility shall be only at the CGHS 13 rates and that too after following a proper procedure given in the Circulars issued on time to time by the concerned Ministry”. The Apex Court has observed that the petitioner was taken to hospital under emergency conditions for survival of his life, which requirement was above the sanctions and treatment in empanelled hospitals. The Apex Court directed the respondent-State to pay balance amount to the writ petitioner towards his medical reimbursement.” 13. Thus, in view of the observations made by the Apex Court, the petitioner could not have been denied the medical reimbursement only on the ground that the respondent No.2 had the policy dated 25.05.2006, which barred medical reimbursement from any other hospital except the hospitals run by the respondent No.1AMC. An employee in an emergency condition would not search for empanelled hospitals of the respondent No.1AMC. An employee for the survival of his life would opt for the best medical treatment available for him in any speciality hospital. Thus, the medical reimbursement cannot be denied on such hyper technical reason to an employee, who in order to survive, has undertaken the best medical treatment available to him. Furthermore, the Sterling Hospital already figures in the list of the respondent No.1AMC annexed with the circular dated 15.05.2006. The said circular is subsequently adopted by the respondent No.2AMTS on 29.11.2006. 14. In light of the aforegoing observations, the writ petition succeeds. The impugned communication dated 04.05.2007 is hereby quashed and set aside. Rule is made absolute. 15. The respondents are hereby directed to pay the medical reimbursement to the petitioner within a period of eight (8) weeks from the date of receipt of the writ of this order. However, it is clarified that he will be paid the same at the rates equivalent to Sheth V.S. Hospital, Ahmedabad prevalent at the relevant time. 16. Registry to place a copy of this order in the connected matter.