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Judgment
Om Prakash VII, Member (J)
The present O.A has been filed by the applicant under section 19 of Administrative Tribunal Act, 1985 seeking following reliefs:-
i) To quash and set aside the impugned rejection order bearing letter No. A-1/M-Bill-Indoor/J.N. Singh/7 dated 19.03.19/02.04.19 passed by respondent No. 4 annexed as (Annexure No. A-1) to this original application.
ii) To direct the respondents to release the medical claim amount to the tune of Rs. 8, 01,647/- along with interest within a stipulated period.
iii) To pass any other or further orders as this Hon’ble Court may deem fit and proper under the circumstances of the case.
iv) Award cost of application/petition9”.
The brief facts of the case are that husband of the applicant retired from the post of T.D.M. Jaunpur on 31.07.2014. At the time of retirement, the basic pay of husband of the applicant was Rs. 52,430/-. The husband of the applicant while residing at Vaishali Ghaziabad, all of sudden he was fallen sick and admitted to Max Super Specialty Hospital, Patpadganj, New Delhi. After the examination of the husband of the applicant, the hospital diagnosed that he had suffered brain hemorrhage and immediately admitted him to the ICU for further treatment. Applicant through Fax dated 04.12.2017 informed TDM, BSNL, Jaunpur, and requested to kindly depute some officer to enquire into the fact about her husband's sickness so that on claiming the medical expenses, the same may be reimbursed from the department. Husband of the applicant expired on 18.1.2.2017 for which the applicant informed the department vide letter dated 4.01.2018. Thereafter applicant vide letter dated 06.03.2018 submitted all medical bills to the department for reimbursement. Accounts Officer vide letter dated 14.05.2018 pointing out certain deficiencies in reimbursement of medical claim bill of Max Hospital to the tune of Rs. 8,01,647/- did pay the bill amount. Thereafter applicant submitted reply on 21.05.2018 to the Accounts officer. When nothing has been done on behalf of respondents, then the applicant again submitted an application dated 12.12.2018 regarding reimbursement of the medical bill of her late husband. Vide letter dated 19.03.2019/02.04.2019, the respondent No. 4 informed the applicant that her claim for medical reimbursement bill was rejected. Hence, aggrieved against the letter dated 19.03.2019/02.04.2019, applicant filed the present original application.
I have heard Shri A.K. Dave, learned counsel for the applicant and Shri D.S. Shukla, learned counsel for the respondents and perused the records.
Learned counsel for the applicant argued that the applicant was hospitalized in emergency condition and received treatment in Max Super Specialty Hospital, Patpadganj, New Delhi, therefore, applicant is entitled to get her medical bills of Rs. 8,01,647/- reimbursed. Learned counsel further argued that Max Super Specialty Hospital, Patpadganj, New Delhi where treatment of the applicant’s husband took place is the empanelled hospital, as per own admission of respondents, hence his claim for medical reimbursement has been illegally and arbitrarily denied by the respondents. During the course of hearing, learned counsel for the applicant relied upon the judgment of Hon’ble Supreme Court in the case of Shiv Kant Jha Vs. Union of India reported in (2018 (2) ESC 332 (SC).
Learned counsel for the applicant lastly argued that the right to life and health is a fundamental right enshrined in Article 21 of the Constitution of India, therefore, the applicant had a right to avail of the best medical facilities which were available in the country for saving the life of her husband.
Learned counsel for the respondents argued that although Max Super Specialty Hospital, Patpadganj, New Delhi is an empanelled Hospital with the Department but no permission has been sought by the applicant before admitting in the hospital. It is also submitted that no certificate of emergency, which was issued by the hospital has been produced by the applicant, therefore, applicant is not entitled to get his medical bills reimbursed from the Department. Only intimation has been given by the son of applicant. Hence the visiting officer could not be appointed by the department.
I have considered the rival submissions advanced by the learned counsel for the parties.
In the case of Shiva Kant Jha (supra), Hon’ble Apex Court in para Nos. 13 and 14 has observed as under:-
“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 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. Specialty 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 Specialty 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 not included 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 is supported 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 of the CGHS have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court.
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 facts 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 CRT-D 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 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”.
From the perusal of letter dated 14.08.2018 issued by Accounts officer, BSNL Jaunpur, it is evident that respondents have demanded (i) Produce a certificate regarding empanelment of Max Hospital, New Delhi (ii) Produce a permission letter issued by the General Manager (East), Circle Lucknow regarding the treatment of her husband and (iii) produce site inspection certificate.
So far as the empanelment certificate of Max Hospital is concerned, the department is very well competent to investigate whether Max Hospital, New Delhi is an empanelled hospital or not. The second point regarding permission letter to be produced before the department are concerned, applicant has informed the department through fax dated 4.12.2017 regarding sickness of her husband and further she had wrote a letter dated 4.12.2017 to the department and it was admitted by the respondents that the said letter dated 4..12.2017 has been reached to the department and third point regarding site inspection certificate is concerned, it is the responsibility of the respondents to depute officer for inspection of the site, which respondents has not done so. Hence, all the objections raised by the Accounts Officer, BSNL, Jaunpur are baseless and cannot be sustainable.
Considering the entire facts and circumstances of the present case and comparing the same with the ratio laid down in the aforesaid judgment, I am of the opinion that applicant is entitled for medical reimbursement as incurred by her during the treatment of her husband. Accordingly, OA is allowed. Impugned order dated 19.03.2019/02.04.2019 is quashed. Respondents are directed to reimburse the amount permissible under Rule to the applicant within a period of three months from the date of receipt of a certified copy of this order. No order as to costs.