Meena Sarin vs Chairman-Cum-Managing Director And Ors

The brief factual matrix of the case is that the applicant is working as Chief Section Supervisor (CSS) with the respondents since 28.09.1981. It is the contention of the learned  counsel  for  the  applicant  that  as  per  the MTNL Medical Rules 2001, the applicant is entitled for indoor medical treatment of her spouse. She is also having a Medical Identity Card No. 2382 issued by the respondents showing her husband late Shri Rahul Sarin as dependent on her for indoor medical treatment as well as her son and daughter. The medial I-Card was valid upto 31.12.2010.

It is stated by the learned counsel for the applicant that suddenly the husband of the applicant late Shri Rahul Sarin, one of the beneficiaries of the medical scheme of the applicant, had to be admitted in emergency in Gitanjali Hospital, Malviya Nagar, New Delhi on 9.09.2010 with high fever. The condition of the husband of the applicant deteriorated and accordingly he had to be shifted to Max Hospital, Saket, New Delhi on 11.09.2010. The husband of the applicant remained admitted throughout in ICU and later expired on 19.10.2010. After the death of her husband, the applicant submitted the medical reimbursement claim on 20.11.2010 with relevant documents in the prescribed format. On receiving the medical claim for reimbursement, MTNL vide their letter dated 20.01.2011 sought certain clarifications from the applicant with a copy to the Medical Superintendent, Max Hospital, Saket, New Delhi. Clarifications sought read as under:

"(a) Drugs for Rs.9,00,010/- and medical courses for Rs.2,15,746.68 paisa used in the treatment.

(b) In the Head of "Employment Charges" the hospital has charged for Alpha Bed Excel charges @ Rs.234/- per day, whether it relates to the equipments used or not.

(c) In general Misc, Bplant well provided AFO Brace for Rs.4400/- this item is not clear.

(d) Affidavit submitted by you is signed by "public notary" but it should be signed by First Class Magistrate."

In regard to the clarifications sought by the respondents, the applicant as well as the Max Hospital gave their reply dated 1.03.2011 to the MTNL. It was informed by the applicant to the department that her husband was employed in a private firm namely Travel Ace (India) Pvt. Limited, New Delhi as Marketing Manager and she also produced a certificate duly issued by the firm that the husband of the applicant was not entitled to reimbursement of the bills for indoor treatment in a hospital as per the terms of their service rules. As no decision was taken by the respondents, the applicant made repeated requests for settlement of her medical claim through various representations dated 3.03.2011, 18.11.2011, 7.03.2013,18. 06.2013 and 25.03.2014. Irrespective of reminders and repeated requests, as no reply was received from the respondents, the applicant sought information under RTI to know the status of her medical claim. In response to the same, the applicant was informed that reimbursement of medical bill has not been approved by the MTNL Corporate Office due to non-submission of original receipts. The applicant again submitted a representation for reconsideration of her claim and the respondents again informed her vide letter dated 4.04.2014 that the MTNL Corporate Office has not approved the payment of medical reimbursement. Challenging that order of the respondents, the applicant filed OA No.1845/2014 which was disposed of on 5.01.2017 with the following directions:

"14...... In the circumstances and for the aforesaid reasons, the OA is allowed and the respondents are directed to consider the medical reimbursement claim of the applicant, without insisting for original bills/receipts, however, after satisfying themselves about the genuineness of the claim and entitlement and quantum of amount, etc., as observed above, as per Rules and to pass an appropriate order, within a period of 90 days from the date of receipt of a copy of this order. The applicant shall co-operate with the respondents, by submitting duplicate bills/receipts or any other information, as directed by the respondents. No order as to costs."

Even after the order passed in OA 1845/2014, since there was no compliance of the Tribunal's directions by MTNL, a Contempt Petition No.319/2017 was filed by the applicant.

The said C.P. was closed on 20.07.2017 with liberty to re-agitate the matter if any grievance still remained.

The learned counsel for the applicant stated that late husband of the applicant was wholly dependent on her and, therefore, the amount spent by the applicant on treatment of her late husband should be reimbursed to her. The learned counsel further stated that Medical Claim Rules 2001 have undergone amendment vide Medical Rules 2010 wherein the limit of income for the dependents of MTNL employee has been fixed as Rs.3500/- for dependency. However, the wording of the Rule does not indicate that it applies to the spouse of the MTNL employee. The learned counsel for the applicant also vehemently stated that the respondents are contemplating to initiate disciplinary proceeding against the applicant which is nothing but colorable exercise and blatant misuse of power. He stated that the applicant lost her husband and she incurred a hefty amount on his treatment by taking loans from various relations. Thus, non-reimbursement of medical bills has put her in enormous hardship. The learned counsel contended that instead of reimbursing the money incurred on treatment, the respondents are arbitrarily contemplating to initiate disciplinary proceeding against the applicant and prays that respondents be restrained from initiating disciplinary action against the applicant in the interest of justice, subject to outcome of this OA.

Learned counsel for the respondents vehemently opposed the contentions of the learned counsel for the applicant and stated that the deceased husband of the applicant was never dependent on the applicant as has been certified by the employer of the late husband of the applicant. It was also stated that the husband of the applicant was an income tax assessee and used to draw salary much more than Rs.3500/-, which is the prescribed limit for the dependant of an employee to prove dependency on the employee of MTNL. Learned counsel stated that MTNL Medical Rules 2001 have undergone a change in the year 2010 and in an express way, the definition of family has been described as under in MTNL Medical Rules 2010:

"(c) For the purpose of these rules "Family" shall include only wife/husband, parents whose monthly income is less than Rs.3500/- p.m. wholly dependent on the employee; children upto two only including step children and adopted children (Third child born as a twin along with the second child will be extended with the facility as that of children upto two). Permanently disabled child irrespective of age will be included in the definition, "family". In respect of children more than two existing as on 31.12.2009, the benefit will be extended subject to the condition that 25% of the total expenses are borne by the employee. For this purpose, the employee shall give a declaration in the prescribed form. Furnishing of false information shall attract proceedings under relevant disciplinary rules applicable.

Exclusion:

Spouse profitably employed including "self employed" who is an Income Tax assesse AND Married daughters including divorced/separated, Son/ Daughter unmarried and of more than 25 years age and Son/Daughter earning, irrespective of age, WILL NOT BE INCLUDED in the definition of "family".

Relying on the definition of "family" as described in MTNL Medical Rules 2010, the learned counsel for the respondents stated that by no stretch of the imagination, it can be said that the husband of the applicant was dependent on her.

As regards contemplation to initiate disciplinary proceedings against the applicant, the learned counsel for the respondents argued that charge sheet was issued for filing false declaration and false affidavit by the applicant, which amounted to gross misconduct having no relation with the present issue. In this regard, my attention was drawn to the judgment of the Hon'ble Apex Court in Union of India and another Vs. Kunisetty Satyanarayana where it was observed as follows:

"14........  A  mere  charge-sheet  or  show-cause notice does not give rise to any cause of action, because it does not amount to an adverse order which affects the rights of any party unless the same has been issued by a person having no jurisdiction to do so. It is quite possible that after considering the reply to the show-cause notice or after holding an enquiry the authority concerned may drop the proceedings and/or hold that the charges are not established.........A mere show-cause notice or charge-sheet does not infringe the right of any one. It is only when a final order imposing some punishment or otherwise adversely affecting a party is passed, that the said party can be said to have any grievance."

Heard the learned counsel for the parties and perused the pleadings available on record.

This is second round of litigation. It is seen that while disposing of OA No.1845/2014 (supra), this Tribunal gave liberty to the applicant for submission of duplicate bills as it was claimed by her that original bills were misplaced and the main cause for not acceding to the medical reimbursement claim was that she failed to submit original receipts and bills. It is also seen that the respondents themselves have sought certain clarifications in regard to medical reimbursement of bills from the applicant as well as Max Hospital and nowhere have they taken any plea of dependency of the husband of the applicant on her. It is further noticed that while deciding OA No.1845/2014 (supra) and giving liberty to the applicant for submission of duplicate bills, this Tribunal also directed the respondents to consider medical reimbursement claim of the applicant without insisting on original bills/ receipts but they shall satisfy themselves about genuineness of the claim and entitlement and quantum of amount etc. as per rules and pass an appropriate order within a period of 90 days from the receipt of a copy of the order. In reference to that, the respondents have accepted the medical bills of the applicant and passed a detailed order dated 19.07.2017 (Annexure A-1).

It is seen from the impugned order dated 19.07.2017 at Annexure A-1 that the respondents have gone into details in regard to entitlement and dependency of the husband of the applicant and after a detailed discussion, rejected the claim of the applicant for medical reimbursement and also come to the conclusion that the applicant herein made a false claim intentionally to gain wrongfully and contemplated disciplinary action against her. Though the learned counsel for the applicant argued that the deceased husband of the applicant used to get only an allowance to the tune of Rs.1200/- for the year 2009 and Rs.1250/- from the year 2010 towards medical allowance along with salary from his employer but the claim here of the applicant is not of medical allowance but of medical reimbursement. The learned counsel for the applicant tried to distinguish between medical allowance and medical reimbursement and stated that even though the husband of the applicant used to get medical allowance from his office but the applicant is entitled for medical reimbursement as at the time of his death, the husband of the applicant was completely dependent on her. To the contrary, the learned counsel for the respondents stated that the husband of the applicant was getting a salary much more than the limit prescribed of Rs.3500/- as amended in the Medical Rules of 2010 and also was an income tax assessee, as evident from the documents provided by the applicant herein. As per copy of income tax returns of the deceased husband of the applicant, it is evident that he was an income tax assessee for the year 2007-08 and 2008-09. However, the applicant did not provide income tax returns for the subsequent years. It is also seen from the impugned order that a cheque amounting to Rs.1,16,083/- was received by the applicant herein on account of final settlement including salaries of September and October 2010 and also an ex-gratia payment of Rs.26,583/-. It is further noticed from the impugned order that no termination letter was issued by the employer of late husband of the applicant during his course of hospitalization, meaning thereby that till his death he was in employment and not dependent on his spouse i.e. the applicant herein.

It is further seen that in the entire pleadings of the OA, the applicant has never taken any plea that her husband was not employed or not getting salary as stated in the impugned order dated 19.07.2017. The applicant has also not denied that her late husband was an income tax assessee or that she received money on account of final settlement of dues and also an ex-gratia payment of Rs.26,583/-. In the entire pleadings, the applicant has only stated that as her late husband was an employee of a private firm and as there was no provision in the rules of that firm for reimbursement of bills for indoor medical treatment in a hospital, she was entitled for reimbursement of money incurred on the treatment of her late husband. Nowhere in the OA has it been stated that the applicant used to get less salary than the limit prescribed of Rs.3500/-. It is seen that the respondent-MTNL have categorically clarified in the amended Medical Rules of 2010 that where spouse is profitably employed including "self employed" and is an Income Tax assessee, will not be included in the definition of "family" and thus would not be covered under MTNL Medical Rules, 2010. The entitlement of medical reimbursement shall accrue only to those who come under the definition of "family". In view of above clarification, the late husband of the applicant cannot be included in the definition of "family" and also cannot be benefitted by MTNL Medical Rules 2010.

Thus, in my considered view as the late husband of the applicant was in employment and getting salary more than the limit prescribed of Rs.3500/- and also was an income tax assessee, would not come within the ambit of definition of "family" and hence the applicant will not be entitled for medical reimbursement. The OA being devoid of merit, is dismissed. No costs.