2009 Supreme(Gau) 228
IN THE HIGH COURT OF GAUHATI (AGARTALA BENCH)
Utpalendu Bikas Saha, J.
Nimai Chandra Sarkar – Appellants
Vs.
State of Tripura and Ors. – Respondent
Decided On: 31.03.2009
Entitlement to medical reimbursement as per the bill submitted by the petitioner in accordance with the scheme of the Government.
Headnote:
Medical Reimbursement - Recognition of Hospital - SSKM Hospital, Kolkata - [T.A. Rules, 2006, Memorandum of Finance Department dated 9.8.2005] - The court discussed the entitlement of the petitioner to medical reimbursement as per the bill submitted by him in accordance with the scheme of the Government. The court referred to previous decisions and observed that the petitioner is entitled to reimbursement of his medical expenses at the rate of the referral Hospital, i.e., the SSKM Hospital, Kolkata prevalent at the relevant time.
Fact of the Case:
The petitioner, a Fireman, sought medical reimbursement for his treatment at Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata. The Director of Health Services, Government of Tripura, informed the Director of Fire Service that the medical reimbursement claim is not admissible as the said institution is not recognized by the Govt. of Tripura.
Finding of the Court:
The court found that the petitioner is entitled to reimbursement of his medical expenses at the rate of the referral Hospital, i.e., the SSKM Hospital, Kolkata prevalent at the relevant time.
Issues: The main issue was the entitlement of the petitioner to medical reimbursement as per the bill submitted by him in accordance with the scheme of the Government.
Ratio Decidendi: The court held that the petitioner is entitled to reimbursement of his medical expenses at the rate of the referral Hospital, i.e., the SSKM Hospital, Kolkata prevalent at the relevant time, based on previous decisions and the memorandum of the Finance Department.
Final Decision: The impugned order of the Director of Health Services, Government of Tripura, informing that the medical reimbursement claim is not admissible, stands quashed. The petitioner is directed to re-submit the bills, and the respondents authorities are directed to re-examine the same and allow reimbursement of the amount which is admissible to the petitioner as per the rate of SSKM Hospital, Kolkata prevalent at the relevant time within two months from the date of resubmission of the bill by the petitioner.
U.B. Saha, J.
1. By filing this writ petition under Article 226 of the Constitution of India, the petitioner has sought for quashing the impugned order dated 17.8.2006 (Annexure-P/6) whereby and whereunder, the Director of Health Services, Government of Tripura, Agartala, the respondent No. 4 herein, informed the Director of Fire Service, Government of Tripura, Agartala, the respondent No. 3 herein, that the medical reimbursement claim submitted by the petitioner for his treatment at Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata (herein after referred to as 'the RTI Institute') is not admissible as the said institution is not recognized by the Govt. of Tripura, and also for a direction to the respondents to make medical reimbursement of Rs.1,10,119, on account of his treatment and Rs.50,000, on account of traveling and other incidental expenses incurred in connection with his treatment.
2. Heard Mr. Somik Deb, Learned Counsel for the petitioner and Ms. A.S. Lodh, Learned Counsel appearing for the state respondents.
3. Considering the nature of the controversy involved in the matter and as agreed to by the Learned Counsel of both, sides, this matter is taken up for final disposal at the order stage itself.
4. The brief facts needed to be discussed for disposal of this case are as follows:
The petitioner is a Fireman under the Directorate of Fire Services, Government of Tripura. Having suffered from acute chest pain on 4.4.2006, he went to the GBP Hospital and attended in the Out Patient Deportment for treatment. But ultimately considering that the petitioner is a cardiac patient and severity of his illness, the Medical Board of the GBP Hospital referred him to SSKM Hospital, Kolkata on 10.4.2006, for further investigation and treatment. Accordingly, as advised by the Medical Board of GBP Hospital, on 3.5.2006, the petitioner reported to the Out Patient Department of the SSKM Hospital, Kolkata, but the hospital authorities regretted the admission of the petitioner at the relevant time, as no bed was available for admission in the said Hospital. Thereafter, as the question of death and life of the petitioner is involved, the petitioner could not wait for treatment in the SSKM Hospital, and in order to get the immediate treatment of his illness, he rushed to the RTI Institute, Kolkata on 3.5.2006 and got admitted there. A major operation, namely, CAG + PTCA, was performed on the petitioner and he remained hospitalized up to 7.5.2006. In the said process of treatment, the petitioner incurred a Puget expenses amounting to Rs.1,10,119, and in addition, he had also to incur expenses towards his attendant, escort etc., amounting to Rs.50,000. Accordingly, on return, the petitioner prepared his medical bill and submitted the same to the respondent No. 3 for reimbursement. The respondent No. 3 referred the said medical bill to the respondent No. 4 for necessary action. But unfortunately, by the impugned order, the respondent No. 4 informed the respondent No. 3 that the medical bill submitted by the petitioner is not admissible, as the RTI Institute is not recognized by the Government of Tripura.
5. It is contended by the petitioner that though he is entitled to get medical reimbursement limited to the cost of treatment and expenses thereunder as per the existing T.A. Rules, he has beers denied the same by the respondents authorities. Hence the present writ petition.
6. The respondents filed their counter-affidavit denying the claim or the petitioner.
7. Mr. Deb, Learned Counsel for the petitioner submits; that though the petitioner is entitled to reimbursement of his medical expenses according to the scheme of the Government, the respondent authorities are denying the claim of the petitioner. His further submission is that the petitioner may not be entitled to the medical reimbursement as per the rate of the RTI Institute where he was treated, but he is entitled to. reimbursement of his medical expenses as per