Krishan Lal Gera vs State of Haryana and Others

Augustine George Masih, J

The petitioner has approached this Court praying for issuance of a writ of certiorari for quashing the order dated 9.12.2009 (Annexure-P-7) vide which his claim for reimbursement of the medical bills submitted by the petitioner stands rejected on the ground that there was no emergency which would have forced the petitioner to undergo immediate surgery. It is contention of the counsel for the petitioner that the petitioner was admitted in Fords Hospital, Noida on 13.9.2007 with serious spine problem. Keeping in view his seriousness he was operated upon in the said hospital on 14.9.2007. On discharge from the hospital, petitioner submitted his medical reimbursement claim along with the certificate issued by the Doctor of the Fortis Hospital showing that the emergency was there because of which operation was conducted. The claim of the petitioner was considered by the respondents and the same has been rejected only on the ground that Civil Surgeon, Rewari has given a finding that the treatment availed of by the petitioner was not in emergent situation which would entitle him for reimbursement claim as has been made by him. Counsel contends that this finding of the Civil Surgeon, Rewari is not sustainable in the light of the certificate issued by the operating Doctor of the petitioner from the Fortis Hospital. Prayer has, thus, been made for directing the respondents for reimbursing the medical bills which have been submitted by the petitioner. In support of this contention counsel for the petitioner has placed reliance upon the judgment passed by this Court in Naunihal Singh v. Union of India and others; 2011 (1) SCT 811, Ram Singh v. State of Haryana and others; 2008 (2) SLR 78 Vasu Dev Bhanot Vs. Union of India (UOI) and Others, , Mahipal Singh Vs. State of Haryana and Others, Shakuntla Vs. State of Haryana and Others, and Gurnam Singh Vs. Punjab Agricultural University and Others,

Counsel for the respondents, on the other hand, has submitted that as per the policy of the Government of Haryana in case of an emergency an employee can claim medical reimbursement for treatment taken from a non-approved hospital/source, in case the said treatment is taken for an emergency where he was not in a position to get a reference for the said treatment from the competent authority i.e. Chief Medical Officer/Civil Surgeon. Since the petitioner had taken treatment and got himself operated from a source which was unapproved the consideration had to be as to whether the said treatment has been taken in an emergent situation. As per the policy the competent authority, who assess the emergent situation which would entitle the claim under the policy is the Chief Medical Officer/Civil Surgeon. The reimbursement bill along with the case history was sent to the competent authority i.e. Civil Surgeon, Rewari, who on consideration of the discharge slip has come to a conclusion that the treatment which has been taken by the petitioner would not fall in a situation which could be termed as emergent. Under these circumstances, the claim of the petitioner has rightly been rejected. She accordingly contends that the writ petition deserves to be dismissed.

I have considered the submissions made by the counsel for the parties and with their assistance have gone through the records of the case.

As is apparent from the rejection order of the claim of the petitioner as also the certificate issued by the Civil Surgeon, Rewari dated 8.7.2008 (Annexure R-2) petitioner had been taking treatment from the Fortis Hospital, Noida for the last 15-20 days prior to the surgery. Under those circumstances, it has been concluded by the Civil Surgeon that it was not an emergent situation where the petitioner was operated upon. The reasons assigned by the Civil Surgeon are quite justified in facts and circumstances as the petitioners was taking treatment for the last 15-20 days and thus could have approached the appropriate authorities for reference for treatment/operation. Although, the policy of reimbursement of the Government of Haryana of medical claims is to be liberally construed and given effect to but that does not mean that the policy has to be given a go-bye altogether. Present is a case where the petitioner despite having reasonable time to get the matter referred from the competent authority for proper treatment, has instead chosen to undergo Surgery which has been certified to be not of an emergent nature which would not fall within the definition of emergent situation as provided under the policy instructions issued by the Government of Haryana dated 6.5.2005. The rejection of the claim of the petitioner is fully justified and is in consonance with the policy of the State of Haryana. The judgments referred to in support of the contention raised by the counsel for the petitioner cannot be doubted with so far as emergent situation under which the treatment was taken by the petitioners in those cases is concerned. The facts in the present case do not justify holding the situation in which the petitioner had to be operated upon to be one which would fall within the policy of the Government of Haryana dated 6.5.2005. In view of the above, the present writ petition being devoid of any merit is dismissed.