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2008 Supreme(Del) 724
IN THE HIGH COURT OF DELHI
A.K. Sikri and J.R. Midha, JJ.
Sh. Balram Sharma - Appellants
Vs.
Union of India (UOI) and Anr. - Respondent
WP(C) No. 13740/2005
Decided On: 04.07.2008
For Appellant/Petitioner/Plaintiff: J.P. Sengh, Sr. Adv. and Iram Majid, Adv.
For Respondents/Defendant: Divya Chaturvedi, Adv.
In cases of emergent medical treatment at approved private hospitals, government employees are entitled to full reimbursement of medical expenses under the CGHS Rules and relevant legal provisions.
Headnote:
Medical Expenses Reimbursement - Government Employee - CGHS Rules, AIIMS, Escorts Heart Institute - [CGHS Rules, AIIMS Act, State of Punjab and Ors. v. Mohinder Singh Chawla AIR 1997 SC 1225, State of Punjab and Ors. v. Ram Lubhaya Bagga [1998] 1 SCR 1120, Commander Randeep Kumar Rana v. Union of India, CWP No. 2464/2003] - The court discussed the reimbursement of medical expenses for a government employee who underwent treatment at Escorts Heart Institute. The court analyzed the CGHS Rules, AIIMS Act, and various judgments to determine the entitlement of the employee to full reimbursement of medical expenses.
Fact of the Case:
The petitioner, a government employee, sought full reimbursement of medical expenses incurred for treatment at Escorts Heart Institute. The Tribunal had dismissed the petitioner's claim, leading to the present writ petition.
Finding of the Court:
The court found that the petitioner's treatment at Escorts Heart Institute was necessitated by emergent circumstances and the seriousness of his illness, justifying full reimbursement of medical expenses.
Issues: The main issue was whether the petitioner was entitled to full reimbursement of medical expenses under the CGHS Rules and relevant legal provisions.
Ratio Decidendi: The court held that in cases where treatment at a private hospital is necessitated by emergent circumstances and the hospital is on the approved list of the government, the employee is entitled to full reimbursement of medical expenses.
Final Decision: The court allowed the writ petition, set aside the Tribunal's judgment, and directed the government to pay the balance amount of medical expenses to the petitioner.
A.K. Sikri, J.
1. The petitioner seeks full reimbursement of the medical expenses incurred by him while undertaking the treatment at Escorts Heart Institute and Research Centre, New Delhi (hereinafter referred to as the Escorts Heart Institute) from his employer Department of Tele-communication, Government of India. He had sought this relief by filing OA before the Central Administrative Tribunal, which has been dismissed by the Tribunal vide its judgment dated 23.12.2004. Not satisfied with the said judgment and maintaining hope to recover the expenses incurred by him from his pocket, from the Government, he has challenged the order of the Tribunal and wants that his prayer made in the OA before allowed. This is the second round of litigation which has come to this Court by means of the present writ petition. His OA No. 2175/2002 was earlier dismissed vide judgment dated 8.5.2003. He had filed writ petition challenging that judgment. The said writ petition was dismissed of vide order dated 14.7.2004.
2. The circumstances in which the petitioner was to undergo the said operation at Escorts Heart Institute, on the basis of which he claims that he is entitled to full reimbursement of the expenses and not the partial contribution from the employer, may first be recapitulated.
.3. The facts unfolded in the petition are that the petitioner suffered a heart attack in January 2000 while he was on official tour to Bhopal. He was admitted to Ayushman Hospital in Bhopal for some time. Thereafter, he came to Delhi and was examined by the doctors at the All-India Institute of Medical Sciences (AIIMS) on 25.2.2000. After the preliminary tests, AIIMS decided to take TMT test of the petitioner. It took about one month when this test was conducted on 23.3.2000 on the basis of which he was advised to undergo cardiology assessment of his heart ailment. After receiving this advise, the petitioner wrote a letter to his Department/respondent No. 2 on 17.4.2000 explaining that at AIIMS even the TMT test took one month due to heavy rush of patients and his health was such that it was not possible for him to wait for a long time. In these circumstances, he took permission to take treatment from Escorts Heart Institute. By communication dated 28.4.2000 the respondent No. 2 gave permission for treatment at the Escorts Heart Institute. He may point out at this stage that the Escorts Heart Institute is one of the recognized private hospitals as per Memorandum dated 18.9.1996.
4. The petitioner, in these circumstances, got himself examined at the Escorts Heart Institute where he was diagnosed a case of Triple Vessel Disease with mild left ventricular disfunction. On this diagnosis, he was advised to undergo open heart surgery and also the Carotid surgery, which is a high risk surgery. The petitioner underwent the said surgery and treatment at Escorts Heart Institute for which purpose the respondent No. 2 paid a sum of Rs. 89,000/- to the said hospital as advance on 4.6.2000. The surgery took place on 12.6.2000 and the total medical expenses incurred by the petitioner on the said treatment, as per the bills given by Escorts Heart Institute and other medical bills for medicines etc. came to Rs. 2,30,306/-. The petitioner submitted all these bills along with the requisite certificates to the respondent No. 2 for reimbursement of the balance sum incurred by him on his treatment. He was given another sum of Rs. 41,612/-. Thus, a total amount of Rs. 1,30,612/- was reimbursed to the petitioner as against Rs. 2,30,306/-. As per the respondents, that was the only amount which could be reimbursed as per the rules and therefore, the respondents refused to make further payments. This led the petitioner enter into protected communicated, which, however, did not yield any results. Failing to get relief administratively, the petitioner approached the Tribunal and filed the aforesaid OA, which has met the result already indicated above.
