IN THE HIGH COURT OF JAMMU & KASHMIR AND LADAKH AT JAMMU
RAJNESH OSWAL, J.
Monica Pathania - Petitioner
Versus
State of J&K & Ors. - Respondents
SWP No. 1062 of 2016
Decided On : 26-04-2023
Medical Reimbursement - J&K Civil Services (Medical Attendance-cum-Allowance) Rules, 1990 - Rule 6(5), Rule 8 - The court quashed the rejection of the petitioner's claim for medical reimbursement and directed the respondents to consider the claim in accordance with the spirit of the rules and judicial precedents.
Fact of the Case:
The petitioner's husband fell seriously ill during a private visit to Nagpur and underwent treatment for 'Carcinoma Rectum'. The petitioner sought reimbursement for the medical expenses but was rejected by the respondents due to lack of prior permission and treatment at non-approved hospitals.
Finding of the Court:
The court found that the rejection of the claim based on lack of prior permission and treatment at non-approved hospitals was unjustified. It emphasized the emergent nature of the situation and the need for a humane approach in such cases.
Issues: The main issues were the rejection of the claim based on lack of prior permission and treatment at non-approved hospitals, and the petitioner's entitlement to reimbursement under the J&K Civil Services (Medical Attendance-cum-Allowance) Rules, 1990.
Ratio Decidendi: The court held that the emergent nature of the situation justified the petitioner's actions and that the rules allowed for relaxation in genuine cases of undue hardship. It also cited judicial precedents to support its decision.
Final Decision: The court quashed the rejection of the petitioner's claim and directed the respondents to consider the claim for reimbursement in accordance with the spirit of the rules and judicial precedents.
JUDGMENT :
Rajnesh Oswal, J.
1. With the consent of learned counsels appearing for the parties, the present petition was considered finally.
2. The rejection of the claim of the petitioner by the respondents vide communication dated 01.06.2015, seeking reimbursement of the medical expenses incurred by the petitioner on the treatment of her husband, has prompted the petitioner to approach this Court through the medium of this writ petition for not only quashing of the communication dated 01.06.2015 (Supra), but also for directing the respondents to reimburse the medical expenses for an amount of Rs.14,99,511/- along with interest at the rate of 12 percent per annum from the date, the bills were submitted by the petitioner with the respondents.
3. The facts necessary for the disposal of this writ petition are that while the petitioner, who was a contractual employee with the respondent No. 1, was on a private visit to Nagpur along with her husband in the year 2009, her husband fell seriously ill and was admitted in Kalaptaru Hospital in Nagpur on 15.10.2009. The husband of the petitioner was operated and he was found to be suffering from 'Carcinoma Rectum'. The husband of the petitioner underwent emergent treatment i.e. chemotherapy as well as radiotherapy at Yashodha Cancer Hospital, Nagpur. Though the petitioner claims to have spent more than Rs. 25 Lakhs upon the treatment of her husband who expired on 08.09.2011, but the petitioner further claims to have retained the bills only for an amount of Rs.12,31,711/- regarding which she made a claim with her employer for reimbursement, but was paid an amount of Rs. 1.5 Lacs only in March, 2011. The petitioner after submitting the above mentioned bills submitted more bills for an amount of Rs.2,67,000/- as the treatment of her husband was continuing even after 2010. The verification regarding the nature of the treatment of the husband of the petitioner was sought by the respondents vide communication dated 21.08.2010 (Annexure H to the writ petition) from the Director, Health Services in terms of Rule 6(5) of J&K Civil Services (Medical Attendance-cum-Allowance) Rules, 1990. The Directorate of Health Services after examination of the claim of the petitioner found that the treatment received by the patient i.e. husband of the petitioner was genuine and intimated the same to the respondent Nos. 1 and 2 vide its communication dated 04.03.2011 (Annexure J to the writ petition). The petitioner further claims to have approached the respondent No. 3 for according sanction to the release of her medical reimbursement claim and even submitted the representation on 20.03.2014 and the respondent No. 2 submitted the claim of the petitioner to the respondent No. 3 vide its communication dated 25.02.2015 (Annexure L to the writ petition). The claim of the petitioner was rejected by the respondent No. 3 vide its communication dated 01.06.2015 which is the subject matter of the present writ petition.
4. The petitioner has assailed the communication dated 01.06.2015 issued by the respondent No.3 on the grounds inter alia that the petitioner had not deliberately gone outside the erstwhile State to get the treatment for her husband but while she was on a private visit to her parental house at Nagpur along with her husband, the husband of the petitioner suddenly fell seriously ill. Then and there only malignancy was deducted and the petitioner had no time to come to Jammu to seek proper sanction for the treatment and that the respondent No. 1 which is the Society, has extended the rules in to its employees and under Rule 8 of the Rules (supra), the power of relaxation is there, therefore, the society can relax any aspect of the rule in question so as to give effect to the spirit of the rules.
5. The Respondents have filed their response, wherein it has been stated that no permission was obtained by the petitioner to travel outside the State from her office and had left for Nagpur on her own. Four days leave fr
The obligation of the state to secure the welfare of its citizens, including providing adequate medical facilities, and the right to life, encompassing the right to good health, were the central lega....
Medical reimbursement denied for non-emergency treatment at private hospitals without prior permission or government referral under CS(MA) Rules; ignorance no excuse; precedents fact-specific.
In emergency medical situations, full reimbursement of medical expenses is mandated regardless of any imposed ceiling limits, emphasizing the right to timely medical treatment.
The main legal point established in the judgment is that government employees are entitled to full reimbursement of medical expenses incurred for the treatment of themselves or their dependents, and ....
Login now and unlock free premium legal research
Login to SupremeToday AI and access free legal analysis, AI highlights, and smart tools.
Login
now!
India’s Legal research and Law Firm App, Download now!
Copyright © 2023 Vikas Info Solution Pvt Ltd. All Rights Reserved.