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2022 DIGILAW 1039 (GUJ)

K. N. Chandran v. State Of Gujarat Thro The Secretary

2022-09-15

A.Y.KOGJE

body2022
JUDGMENT : 1. This petition under Article 226 of the Constitution of India is filed with following prayers:- “A. Your Lordships may kindly be pleased to issue a writ of Mandamus and/or any other appropriate writ, direction and/or order quashing and setting aside the orders communications of respondent dated 4/10/2010 and 25/11/2011. B. Your Lordships may kindly be pleased to issue a writ of Mandamus and/or any other appropriate writ, direction and/or order quashing and setting aside the impugned Resolution dated 12.09.1983 by holding and declaring that the same as nonest and is illegal, unjust, arbitrary, discriminatory, ultra-virus and in violation of Article 19(1)(e) of the Constitution of India. C. Your Lordships may kindly be pleased to direct the present respondents to immediately grant the benefits of Medical Reimbursement to the present petitioner, as claimed by the present petitioner.” 2. Learned Advocate for the petitioner submitted that by the impugned communications dated 25.11.2011 and 04.10.2010 claim of the present petitioner with regard to medical reimbursement has been refused on the ground that the present petitioner is staying and withdrawing his pension outside the State of Gujarat. The petition is also filed against impugned resolution dated 12.09.1983 of respondent No.1-Finance Department, whereby it has been decided not to extend the benefits of medical reimbursement to the pensioners who are withdrawing/receiving their pension outside the State of Gujarat. 2.1 It is submitted that the petitioner and his family belonged to Kerala State and therefore, after retirement, the petitioner is residing with his family in Kerala State. 2.2 It is submitted that wife of the petitioner was required to undergo medical treatment for her heart ailment, viz. Angiography, Angioplasty, TMT, ECG, X-ray, scanning, etc. at Medical Trust Hospital in the year 2010. It is submitted that she was admitted to Medical Trust Hospital, Cochin from 22.01.2010 to 27.01.2010. It is submitted that cost of first phase of treatment came to about Rs.2,21,961.65. The same was demanded by the petitioner by letter dated 30.03.2010. It is submitted that the petitioner had also requested for reimbursement of medical bill of her second phase of treatment for bypass surgery of Rs.2,07,682.94 and Rs.23,336.92 by letter dated 23.05.2011. 2.3 It is submitted that the petitioner submitted the bills with respondent No.3 claiming the medical reimbursement under the provisions of the Gujarat Civil Services (Medical Treatment) Rules, 1988 (“the Rules” for short). 2.3 It is submitted that the petitioner submitted the bills with respondent No.3 claiming the medical reimbursement under the provisions of the Gujarat Civil Services (Medical Treatment) Rules, 1988 (“the Rules” for short). It is submitted that the petitioner submitted the application for medical reimbursement to his parent Department-Gujarat Maritime Board by communications dated 30.03.2010 and 23.05.2011. It is submitted that the application of the present petitioner was rejected on the ground that the petitioner is staying and withdrawing his pension outside the State of Gujarat, considering the resolution dated 12.09.1983. 2.4 It is submitted that the impugned communication was challenged by the petitioner by filing Special Civil Application No.16018 of 2010. the said petition was disposed of by this court by order dated 01.08.2011. It is submitted that as per the said order, the petitioner made a detailed representation to the respondent authorities by communication dated 19.08.2011. 2.5 It is argued that the petitioner submitted claim for medical reimbursement under the provisions of the Rules. The State of Gujarat enacted the Rules for the purpose of extending the benefit of medical facilities to the employees those who are working as well as to the pensioners. The Rules came into force with effect from 30.12.1988. The respondent-Department issued resolution dated 12.09.1983, whereby it has been resolved for implementation of the Rules through out the State of Gujarat. The benefit of the medical reimbursement could not be extended only in the categories those which fall within the ambit of Rule 1(3) of the Rules. The case of the present petitioner does not fall within the ambit of Rule 1(3) of the Rules. Therefore, decision of respondent No.3 of not granting the benefits of medical reimbursement is contrary to the provisions of the Rules. 2.6 Learned Advocate for the petitioner placed reliance on a decisions of this Court in case of J.V.Shah, Ex Managing Director Vs. State of Gujarat, reported in 2012 (2) GCD, 1374 and in case of Harishkumar Kanchanlal Trivedi Vs. State of Gujarat, in Special Civil Application No.1998 of 2009 dated 27.04.2016. 3. As against this, learned Advocate for respondent No.3- Gujarat Maritime Board submitted that the petitioner was working with respondent No.3 as a Welfare Officer and retired upon attaining age or superannuation on 31.05.2002. State of Gujarat, in Special Civil Application No.1998 of 2009 dated 27.04.2016. 3. As against this, learned Advocate for respondent No.3- Gujarat Maritime Board submitted that the petitioner was working with respondent No.3 as a Welfare Officer and retired upon attaining age or superannuation on 31.05.2002. 3.1 It is submitted that the petitioner is residing outside the State of Gujarat and according to Government resolution dated 12.09.1983, has been receiving fixed medical allowance along with pensionary benefits. It is submitted that as per the said resolution, benefits as accruing to the petitioner have already been paid to him and the said resolution specifies that the personnel receiving pension outside the State of Gujarat shall not be entitled to reimbursement of medical bills. 3.2 It is submitted that the petitioner has been claiming for medical expenses incurred for heart ailment of his wife of approximately sum of Rs.4,52,982.51. The said treatment has been received by the wife of the petitioner at Medical Trust Hospital, Cochin and not in the State of Gujarat. It is submitted that as per Rule 8(3) of the Rules, for receiving treatment in any other State, prior permission from appropriate authorities is required. In the instant case, the petitioner had not applied for any such prior permission, rather after the treatment, had raised the issue of reimbursement and therefore, the claim of the petitioner is contrary to the Rules. 3.3 It is submitted that wife of the petitioner has not received treatment in the notified hospitals nor had applied for prior permission before undertaking the treatment. It is afterwards that the petitioner claimed reimbursement. It is submitted that the Government of Gujarat vide resolution dated 09.09.2005 has specifically approved certain private hospitals located in the State of Gujarat which are covered for reimbursement or for common package. It is submitted that the hospital in which treatment was taken is not covered in the said resolution and therefore, question of reimbursement for the expenses being incurred does not arise. 4. Having heard learned Advocates for the parties and having perused documents on record, it appears that the petitioner was working as Welfare Officer with respondent No.3-Gujarat Maritime Board, which is Government of Gujarat undertaking. The petitioner joined service in 1963 and retired on 31.05.2002 on attaining age of superannuation after 39 years of service. 5. 4. Having heard learned Advocates for the parties and having perused documents on record, it appears that the petitioner was working as Welfare Officer with respondent No.3-Gujarat Maritime Board, which is Government of Gujarat undertaking. The petitioner joined service in 1963 and retired on 31.05.2002 on attaining age of superannuation after 39 years of service. 5. The wife of the petitioner was required to undergo medical treatment for her heart ailment, like Angiography, Angioplasty, TMT, ECG, X-ray, Scanning, etc. at Medical Trust Hospital in the year 2010. She was admitted in Medical Trust Hospital, Cochin between 22.01.2010 to 27.01.2010. The cost for first phase of treatment came to Rs.21,21,961.65. The same was demanded by the petitioner by letter dated 30.03.2010. The petitioner also requested for reimbursement of medical bill of her wife for the second phase of treatment for Rs.2,07,682.94 by letter dated 23.05.2011. The petitioner submitted bills with respondent No.3 claiming medical reimbursement under the provisions of the Rules by communications dated 30.03.2010 and 23.05.2011. The application of the petitioner was rejected on the ground that the present petitioner is staying and withdrawing his pension outside the State of Gujarat, considering resolution dated 12.09.1983. The said communication was challenged by the petitioner by filing Special Civil Application No.16018 of 2010. The said petition was disposed of by this Court by order dated 01.08.2011. As per the said order, the petitioner made a detailed representation to the respondent authorities on 19.08.2011. However, the said representation was rejected by the respondent authorities by communication dated 25.11.2011. 6. In case of J.V.Shah, Ex Managing Director (supra), this Court in paras-17 and 18 has observed as under:- “17. The grievance of the petitioner in this petition is that even though he was required to take emergency treatment for heart ailment in the private hospital, his medical claim is not sanctioned by the Department. The facts as I have reproduced in the judgment are undisputed. It is required to be noted that, whenever there is emergency for taking medical treatment, one is not expected to find out where the Government or Civil Hospital is situated. In such cases an attempt would be made by the concerned person or his relative first to approach the nearest hospital so that one can save his life. It is required to be noted that, whenever there is emergency for taking medical treatment, one is not expected to find out where the Government or Civil Hospital is situated. In such cases an attempt would be made by the concerned person or his relative first to approach the nearest hospital so that one can save his life. All other things are subsequent and under the circumstances, the first priority which is required to be given by a person is to save his life. It is not expected, therefore, from an ailing person to run from pillar to post seeking permission or prior approval to go and get himself operated at other hospital outside the State of Gujarat as in the present case at Apollo Hospital, Chennai having regard to the nature of the ailment. I am of the view, considering the peculiar facts of the case, that the respondents should have gracefully sanctioned the medical bill in favour of the petitioner. In spite of knowing fully well that in the angiography report 7 blockages were detected in three main arteries, the respondents, considered the application of the petitioner as if he was to travel outside the State of Gujarat for medical treatment for an ailment like common Cold or Fever. The Rules, 1988 itself provides that a person can be admitted in the private hospital in case of emergency and even the medical bill for the same emergency treatment can be reimbursed in turn with the rates of the Government hospital or any other private hospital. 18. At this stage, reference is also required to be made to the decision of the Apex Court in the case of Surjit Singh v/s. State of Punjab, reported in AIR 1996 SC 1388 . In paragraph 11, the Apex Court has observed as under: “The appellant, 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 meetings difficult to happen. The appellant also did not have to stand in queue in the Government hospital of AIIMS and could go elsewhere to an alternate hospital as per policy. He did not have to stand in queue before the Medical Board, the manning and assembling of which, barefacedly, makes its meetings difficult to happen. The appellant also did not have to stand in queue in the Government hospital of AIIMS and could go elsewhere to an alternate hospital as per policy. When the State itself has brought the Escorts on the recognized list, it is futile for it to contend that the appellant could in no event have gone to the Escorts and his claim cannot on that basis be allowed, on suppositions. We think to the contrary. In the facts and circumstances, had the appellant remained in India, he could have gone to the Escorts like many others did, to 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 that the respondents pay to the appellant, the rates admissible as per Escorts. The claim of the appellant having been found valid, the question posed at the outset is answered in the affirmative. Of course the sum of Rs.40,000/- already paid to the appellant would have to be adjusted in computation. Since the appellant did not have his claim dealt with in the High Court in the manner it has been projected now in this Court, we do not grant him any interest for the intervening period, even though prayed for. Let the difference be paid to the appellant within two months positively. The appeal is accordingly allowed. There need be no order as to costs.” 6.1 In the decision of this Court in case of Hasmukhbhai N.Shah Vs. Commissioner of Health and Welfare Deptt., in Special Civil Application No.1636 of 2000 dated 30.04.2012, in para-5, this Court has relied upon decision of the Apex Court in case of Surjitsingh Vs. State of Punjab, reported in AIR 1996 SC, 1388 and observed as under:- “5.4 The requirement of taking prior permission in Rule 8(i) (c) of the Rules as they pertain to medical treatment of ailing employee and his health concerns cannot be applied as a cast iron rule. It has to permit sufficient elasticity in its applicability. By very nature, it relates to something which would not permit brooking of delay in a given set of urgent circumstances. It has to permit sufficient elasticity in its applicability. By very nature, it relates to something which would not permit brooking of delay in a given set of urgent circumstances. It could not be insisted in every situation that a prior permission or approval of the Director in advance is a must before the employee goes to a hospital outside the State for his treatment. In an urgent and emergent situation where delay in treatment would endanger the health, life and safety, it was to be a natural conduct of any person to rush to a hospital for being treated immediately. 5.5 A pedantic and wooden approach would negate the very purpose of the welfare measure. An interpretation that in all circumstances prior permission as required in Rule 8(i)(c) of the Rules is indispensable would be self defeating. In fact, it would be contradictory in a given set of facts, such as obtained in the present, in as much as if rule is read properly, it takes care by excepting such permission where delay would jeopardize the health and life of the patient. Having regard to the undisputed facts of the present case, it could be seen that the petitioner had to rush to be admitted in Hinduja Hospital at Mumbai and had to underwent surgery after having been diognized for 95% blockage in the heart artery. The petitioner could not have been expected to wait and seek a prior permission by staking and endangering his life. The facts amply demonstrated that it was a situation where claim of the petitioner for reimbursement could not have been refused on the ground of non, taking of prior permission.” 6.1 In the same decision, in para-7, this Court has held as under:- “7. In light of the above principles of law relating to policy for reimbursement of medical claim as applied to the facts of the case, the contention of the respondent State that the petitioner’s claim was not reimbursable in full on the ground of his not taking prior permission under Rule 8 of the Rules and without such permission having treated himself at the hospital outside the State, cannot be countenanced. As seen above, it was clear from the facts of the case that the petitioner had to negotiate an emergent situation, in which he rushed to a hospital outside the State. As seen above, it was clear from the facts of the case that the petitioner had to negotiate an emergent situation, in which he rushed to a hospital outside the State. The conduct of the petitioner in getting expert treatment outside the State was a permissible exercise of his right of self preservation. It was neither legitimate nor legal for the authority concerned to disallow the medical expenses claimed by the petitioner. Prior permission could not have been insisted and could not be raised as ground for not reimbursing the actual expenses in full. Ex-postfacto sanction to the expenses could have been a good compliance of Rule 8 of the Rules, and that ought to have been done.” 7. In view of the aforesaid, the Court has no hesitation in holding that the petitioner would be entitled to the benefit of reimbursement. The impugned decisions are therefore set aside. The respondents are directed to undertake the necessary proceedings on the application of the petitioner in accordance with law and grant the reimbursement as admissible as per the rates fixed by the State Government by treating the petitioner being entitled to the benefit of reimbursement for the treatment received by wife of the petitioner. The petition stands partly allowed. Rule is made absolute to the aforesaid extent. No order as to costs.