IN THE HIGH COURT OF DELHI AT NEW DELHI
V. Kameswar Rao, Saurabh Banerjee, JJ.
Manish Kumar - Appellant
Versus
Union of India & Anr. - Respondents
W.P.(C) 686 of 2018
Decided On : 09-02-2024
SSB - Medical Treatment Reimbursement - CS(MA) Rule, 1944, CWF - 24th Governing Body Meeting of the SSB CWF - Central Service Medical Attendance Rules, State of Punjab and Others vs Mohinder Singh Chawala, AIR (1997) SC 1225, W.P.(C) No.694/2015 titled Shiva Kant Jha vs Union of India
Fact of the Case:
The petitioner, a constable in SSB, sought reimbursement of medical expenses for kidney ailment treatment. The SSB sanctioned a loan for the treatment and later decided to recover it from the petitioner's salary. The petitioner challenged this action under Article 226 of The Constitution of India.
Finding of the Court:
The court found that the petitioner was duly cared for and attended properly by the Medical teams provided by the respondents. The court also noted that the petitioner defaulted in repaying the loan and ordered recovery from his salary.
Issues: Reimbursement of medical expenses, recovery of loan amount, disciplinary actions against officers causing harassment, legality of recovery from salary
Ratio Decidendi: The petitioner was provided with medical care and financial assistance by the respondents. The recovery of the loan amount from the petitioner's salary was justified due to his default in repayment.
Final Decision: The writ petition was dismissed, and the parties were left to bear their respective costs.
JUDGMENT
Saurabh Banerjee, J.
1. As per facts involved, the petitioner after having joined Sashastra Seema Bal (hereinafter referred to as `SSB') as a Constable on 01.02.2006, remained posted to 11 Bn until 07.04.2012, whereafter he was posted to 42 Bn at Coy Hqr, Gandoh, J&K on 18.04.2012.
2. On 01.10.2013, the petitioner, vide an application to the Commandant 42 Bn, requested for self-treatment from any of the SSB empanelled Hospital for his kidney ailment. In response, the Director (Medical) FHQ SSB, New Delhi accorded the permission on 04.10.2013. Based thereon, the petitioner reported at 25 Bn, SSB Ghitorni, New Delhi on 06.10.2013, where he was accommodated at the unit Hospital for dialysis. The petitioner was further kept on dialysis at an SSB empanelled Hospital being the Asian Institute of Medical Science, Faridabad, Haryana on credit basis through 25 Bn, SSB Ghitorni, New Delhi from 07.10.2013 to 17.03.2015.
3. In the meantime, the petitioner, vide an application dated 06.02.2014, made a request to the Commandant 42 Bn seeking permission to proceed for kidney transplant at Sir Ganga Ram Hospital, New Delhi (hereinafter referred to as `SGRH'). In response, 25 Bn, SSB Ghitorni, New Delhi on 27.02.2014 categorically informed the petitioner that SGRH was neither recognized under Central Government Health Scheme (hereinafter referred to as `CGHS') nor is it an empanelled Hospital with the SSB. Despite thereto, the petitioner, nevertheless, proceeded for his medical treatment from SGRH and in fact vide an application dated 16.06.2014, applied for a medical advance of Rs.11,00,000/-. Needless to say, the said application was returned to him vide memorandum dated 13.10.2004 alongwith the following remarks of the Ministry of Home Affairs (hereinafter referred to as `MHA'):
"a. As per Central Service Medical Attendance Rules, treatment in a private Hospital can only be obtained in an emergency cases involving accidents, serious nature of disease etc, in case no Government or recognized Hospital is available nearer than the private Hospital. Whereas, in the instant case it appears that the petitioner was taking treatment from a long time back. Moreover, no emergency certificate has been issued by Sir Ganga Ram Hospital.
b. The petitioner in his application has stated that ABO Incompatibility facilities are not Renal Transplantation available in Apollo Hospitals and AIIMS, New Delhi Whereas, neither these Hospitals furnished any certificate regarding non availability Transplantation of ABO Incompatibility Renal facilities nor patient to Sir Ganga Ram Hospital for management referred the further management."
4. Thereafter, on the petitioner applying for a loan amount of Rs.6,00,000/- to the Central Welfare Fund (hereinafter referred to as `CWF') of the SSB for his kidney transplant, the CWF sanctioned an interest free loan of Rs.6,00,000/- to the petitioner, vide order No.35/SSB/Wel/Medi Loan/13/517-19 dated 27.01.2015.
5. After that, the petitioner submitted a medical reimbursement bill of Rs.11,21,716/- which was forwarded by the department to the Joint Director (R&H), CGHS (HQ), New Delhi for consideration, who vide letter No.S-9827/2015/R&H/CGHS(HQ)/1918 dated 10.08.2015 advised reimbursement of the medical expenses as per CGHS rates approved vide Serial No. 809 of the CGHS Rate List OM dated 01.10.2014. Accordingly, the claim of the petitioner was processed and admitted for Rs.6,35,827/- and payment qua the same was made in October, 2015.
6. As per respondents, as it was categorically decided in the 24th Governing Body Meeting of the SSB CWF dated 21.12.2014 that upon the reimbursement of his medical bill, the petitioner had to repay the loan amount sanctioned by the CWF and as he was wilfully not paying, it was decided by the respondents that a monthly recovery of Rs.30,000/- should be made from his salary.
7. Aggrieved thereby, the petitioner filed the present petition under Article 226 of The Constitution of India, seeking the foll
The recovery of a loan amount from an employee's salary can be justified if the employee defaults in repayment, despite receiving medical care and financial assistance.
The judgment establishes the importance of meeting specific criteria for emergency medical treatment under the Central Government Health Scheme, and the significance of the petitioner's admission reg....
Essentiality certificate not required for medical reimbursement per 2009 OM; authorities must verify treatment genuineness from records/hospital, not reject claims technically when factum undisputed,....
The main legal point established in the judgment is the obligation of the state to ensure timely medical treatment and the need for a compassionate and sympathetic consideration of medical reimbursem....
Full medical reimbursement mandatory for genuine emergency treatment in empanelled hospitals, regardless of CGHS rates.
In emergency medical situations, full reimbursement of medical expenses is mandated regardless of any imposed ceiling limits, emphasizing the right to timely medical treatment.
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