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IN THE HIGH COURT OF JAMMU AND KASHMIR AND LADAKH AT JAMMU
WASIM SADIQ NARGAL, J.
Bimla Ji Bhat & Ors. - Petitioners
Versus
Union of India & Ors. - Respondents
OWP No. 1726 of 2015
Decided On : 28-09-2022
MEDICAL REIMBURSEMENT - EMPLOYEE BENEFITS - BSNL Employees Medical Reimbursement Policy, Article 21 of the Constitution of India - The court discussed the BSNL Employees Medical Reimbursement Policy, particularly clauses regarding eligibility for reimbursement, treatment in recognized and non-recognized hospitals, and the procedure for claims. The court emphasized that the technicalities of the rules should not frustrate the purpose of the scheme, and that the right to medical reimbursement is a constitutional obligation under Article 21, which ensures the right to health and medical aid. The court's decision was influenced by the need to interpret the policy liberally in favor of the employees, ensuring that the petitioners' claims were processed and reimbursed.
Fact of the Case:
The petitioners, legal representatives of Sh. Maharaj Krishan Bhat, sought a writ for medical reimbursement for treatment received by the deceased, who was an employee of BSNL and suffered from blood cancer. They also requested compassionate employment for a family member. The respondents denied the claims citing insufficient points for compassionate appointment and lack of submitted medical bills.
Finding of the Court:
The court found that the petitioners were entitled to medical reimbursement under the BSNL Employees Medical Reimbursement Policy. It noted that the respondents had a legal obligation to process the claims and could not deny them based on technical grounds. The court emphasized the importance of considering the actual treatment received rather than the technicalities of the policy.
Issues: Whether the petitioners are entitled to medical reimbursement for the treatment of the deceased under the BSNL Employees Medical Reimbursement Policy, and whether the respondents' denial of the claim was justified.
Ratio Decidendi: The court held that the right to medical reimbursement is a constitutional obligation under Article 21 of the Constitution of India. It ruled that the respondents must process the medical claims of the petitioners expeditiously, emphasizing that the technicalities of the policy should not prevent the rightful claims of employees from being honored.
Final Decision: The writ petition was allowed, directing the respondents to process and release the medical reimbursement claims of the petitioners within two months.
JUDGMENT :
Wasim Sadiq Nargal, J.
1. The present writ petition has been filed by the petitioners seeking a writ in the nature of mandamus commanding upon the respondents to settle down their medical claims (medical reimbursement) in respect of the treatment provided to the deceased-husband of Petitioner No. 1 and father of Petitioner Nos. 2 to 4. Besides this, they are also seeking relief of compassionate employment to any of the legal heirs of the deceased-Shri Maharaj Krishan Bhat.
2. The present writ petition has been preferred by the legal representatives of Sh. Maharaj Krishan Bhat, who was working as a Telephone Mechanic in the Bharat Sanchar Nigam Limited (BSNL) at Kupwara, Kashmir.
3. It has been averred in the writ petition that Sh. Maharaj Krishan Bhat was the husband of the Petitioner No. 1 and the father of Petitioner Nos. 2 to 4. The case of the petitioner is that in the month of October, 2009 when the deceased was performing his duties in Kupwara, Kashmir he got seriously ill and was shifted to Government Medical College Hospital, Jammu. Since his health condition continued to deteriorate, he was shifted to Apollo Hospital, New Delhi in the Emergency Wing where doctors attended him and he was advised certain tests to be carried out. Further stand of the petitioners is that on the basis of all those tests conducted on him, the deceased was diagnosed as suffering from blood cancer. It is stated by the petitioners that since the family of the deceased did not have enough resources to get him treated in the Apollo Hospital at New Delhi, he came to be shifted to the All India Institute of Medical Sciences, New Delhi (AIIMS) in a serious condition where he came to be admitted in the Emergency Wing. Later on, the deceased came to be referred to the Oncology Department of the Institute where the response of the doctors towards the deceased was not good, as such, finding no alternative the deceased was shifted back to Apollo Hospital, New Delhi for Chemotherapy.
4. It is averred in the petition that the petitioners have filed various representations before the respondent Department from time to time for providing them the medical claims (medical reimbursement) of the deceased with all the details i.e. medical diagnosis, medical bills, etc and also prayed for compassionate appointment of any of the family members of the deceased. Further stand of the petitioners is that they have also filed representation before the Minister for Communication and Information Technology and also to the General Manager, Bharat Sanchar Nigam Limited (BSNL), J&K Circle, Jammu, which were not accorded consideration and as such, the petitioners were left with no other option but to file the present writ petition.
5. Per contra, response has been filed by Respondent Nos. 2 to 4 in which respondents have taken a stand that as per the Policy guidelines regarding Compassionate Appointment, there should be 55 or more net points for consideration by the Corporate Office High Power Committee for compassionate grounds but the petitioners scored 31 points only, as such, they are to be treated as non-indigent and their case needs no consideration and rejected.
6. The respondents have further submitted that as per the communication received from DE NTR, Srinagar Vide No. E-4/Staff/DE/SKC/2017-18, dated 04.12.2017, no medical bills have been received in the said office from the petitioners. It is the specific stand of the respondents that no receipt of medical bills having submitted has been even found enclosed with writ petition also, as such, no action could have been taken by the respondents.
7. Further stand of the respondents is that on receipt of representation, which has been annexed as Annexure-D with the writ petition, their case for compassionate appointment was processed but none of them were found suitable/entitled for compassionate appointment in view of the fact that as per the Policy guidelines regarding Compassionate Ground Appointments, there shoul
AI
The right to medical reimbursement for employees is a constitutional obligation, and claims should be processed liberally without undue reliance on technicalities.
CGHS-recognised hospitals deemed recognised under BSNL MRS for cancer treatment; no separate indoor/outdoor bills required for chronic diseases.
A widow is entitled to claim medical reimbursement for her deceased husband's treatment under BSNL rules if proper documentation is presented.
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 right to medical claim cannot be denied solely because the hospital is not included in the government order. The factum of treatment and supporting records certified by doctors/hospitals are cruc....
Full medical reimbursement mandatory for genuine emergency treatment in empanelled hospitals, regardless of CGHS rates.
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....
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