IN THE HIGH COURT OF JAMMU AND KASHMIR AT JAMMU
TASHI RABSTAN, J.
Suresh Kumar Sen - Appellant
Versus
State of J&K and Ors. - Respondents
OWP No. 286 of 2010 and MP No. 1595 of 2012
Decided On : 08-11-2017
Medical Reimbursement - Rejection of claim for medical reimbursement in lieu of treatment of petitioner's son - Jammu and Kashmir Medical Reimbursement Rules, 2008 - Rule 8 - Surjit Singh v. State of Punjab (1996) 2 SCC 336 - State of J & K v. Popinder Singh (2015) 4 JKJ 22 - Article 21 of the Constitution of India
Fact of the Case:
The petitioner's son developed a neurology problem and was initially taken to All India Institute of Medical Sciences (AIIMS) for treatment. However, due to non-availability of facilities and a long waiting period, the petitioner took his son to a private hospital in Gurgaon, where the son underwent surgery and incurred expenses. The petitioner's claim for medical reimbursement was rejected by the government on the grounds that the treatment was obtained at a non-empaneled hospital and without a recommendation from a competent authority.
Finding of the Court:
The court found that the rejection of the petitioner's claim for medical reimbursement was not justified, especially considering the genuine nature of the claim as certified by the Medical Reimbursement Verification Committee. The court emphasized the right to self-preservation and the necessity to provide medical benefits to government servants in genuine cases, even if there are technical violations of the rules.
Issues: The main issue was the rejection of the petitioner's claim for medical reimbursement based on the treatment obtained at a non-empaneled hospital and without a recommendation from a competent authority.
Ratio Decidendi: The court relied on the Jammu and Kashmir Medical Reimbursement Rules, 2008, and the legal principles established in the cases of Surjit Singh v. State of Punjab (1996) 2 SCC 336 and State of J & K v. Popinder Singh (2015) 4 JKJ 22. The court emphasized the right to self-preservation and the necessity to provide medical benefits to government servants in genuine cases, even if there are technical violations of the rules.
Final Decision: The court directed the respondents to release the medical reimbursement claim as per the rates of AIIMS along with admissible interest under the law.
JUDGMENT :
Tashi Rabstan, J.
1. Writ petition, with the consensus of learned counsel for the parties, is taken up for final disposal at admission stage.
2. Rejection of claim for medical reimbursement in lieu of treatment of petitioner's son by Director Finance PW (R & B) Department, J & K Government, conveyed vide letter/order dated 28th January, 2010, is the reason forcing petitioner to knock at portals of this Court with instant writ petition, praying following relief:
"i. Allow this writ petition of the petitioner.
ii. Issue writ of certiorari quashing communication No. PW-(R & B)/MC/2009-10/259, dated 28.01.2010, issued from the office of respondent No. 3 and addressed to respondent No. 4 as well as decision of respondent No. 2 regarding rejection of the medical reimbursement claim of the petitioner in respect of the treatment of his son, undertaken outside the State in view of seriousness of the disease.
iii. Issue writ of Mandamus commanding the official respondents to reconsider the matter on the analogy of similarly situated cases, wherein reimbursement of the claim has been allowed.
iv. Any other writ, order, command or direction as this Hon'ble Court may deem just and proper in the given facts and circumstances of the case may also be passed in favour of the petitioner."
3. Petitioner's son. It is said, had developed neurology problem. To come out of this situation, petitioner took his son to All India Institute of Medical Sciences (AIIMS), on 24.04.2008. However, name of the son of petitioner was kept in waiting list, at serial No. 2764, with proposed day of admission reflected as in the month of December 2008, i.e. after a gap of almost 8 months. Crucial circumstances faced by petitioner's son, compelled petitioner to visit another private hospital, namely, Paras Hospital Gurgaon Haryana, where his son was operated upon as per the date of admission reflected in the medical record, i.e. 28.04.2008 and was discharged from the said hospital on 12.05.2008. Further contention of petitioner is that subsequent to the surgery, petitioner expended Rs. 1,79,900/- as per the bill, issued by the said hospital. The claim projected by petitioner for medical reimbursement was placed before Medical Reimbursement Verification Committee, constituted by Director Health Services Jammu. A communication dated 27.05.2009 was issued by the Director Health Services Jammu conveying that the Committee found the treatment and bill as genuine and Director Health Services Jammu forwarded the case for reimbursement under rules as per the rates of AIIMS New Delhi. However, Director Finance PW (R & B), has rejected medical claim vide impugned letter/order dated 28.01.2010, which is the subject matter of challenge in present writ petition.
4. Justification for rejection of petitioner's claim for medical reimbursement by respondents in their Reply in opposition to writ petition, has been rested primarily on two grounds: petitioner had got treatment at private hospital without approaching the government empaneled hospital; and without getting recommendation from competent authority.
5. Respondents in pursuance to order dated 28.02.2012 have filed latest affidavit, again rejecting petitioner's claim on premise that the plea, projected in instant writ petition, has already been considered by this Court before passing order dated 28.02.2012.
6. Heard learned counsel for the parties and perused the record.
7. Petitioner's counsel has invited attention of this Court to the order dated 28.02.2012, passed by this Court, directing respondents for reconsideration of release of the amount covered by medical reimbursement bill notwithstanding earlier order of rejection dated 28.01.2010. A meticulous read-through of the order dated 28.01.2010 portrays that this Court has rejected respondents' contention qua petitioner not having approached the government empaneled hospital before undertaking his son's surgery at Paras Hospital, Gurgaon. Thus, it is apt to reproduce order d
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