Exclusion of psychiatric treatment from reimbursement under CPRMS violates the Mental Healthcare Act, 2017, which mandates equal treatment for mental and physical illnesses.

ORDER :

ANANDA SEN, J.

By filing this writ petition, petitioner prays to quash the Office Note dated 26.10.2019 (Annexure 4) and letter dated 23.01.2020 (Annexure 6), by which the Medical Bill for psychiatric treatment of petitioner’s wife has been rejected on the ground that the same is not admissible as per Clause 6.3(i) of CPRMSE Rules. It has also been prayed that the respondents be directed to reimburse the amount, which has been spent by the petitioner for psychiatric treatment of his wife, which has been illegally deducted from the bills raised by the petitioner.

2. Learned counsel appearing on behalf of the petitioner submitted that the wife of the petitioner was suffering from some disorder, which needed psychiatric treatment. He argued that as a retired executive of Bharat Coking Coal Limited, he is entitled for reimbursement of the amount spent on his wife for psychiatric treatment, but the respondents, taking shelter of Clause 6.3(i) of the Contributory Post Retirement Medicare Scheme for Executives of CIL & its Subsidiaries (hereinafter referred to as CPRMS), have denied reimbursement, which is absolutely illegal. He submitted that treatment of mental health and mental healthcare cannot be differentiated with other healthcare treatments. He argued that there cannot be any distinction so far as it relates to mental illness and other type of physical illness. He argued that this artificial differentiation by the respondents is not based on any intelligible differentia. The embargo created by class / differentia is illegal, discriminatory and without any basis.

3. Learned counsel appearing for the respondents-BCCL submitted that reimbursement of medical bills for retired executives are guided and governed by the CPRMS. As per Clause 6.3(i) of the said CPRMS instructions, the petitioner is not entitled for reimbursement of the expenses incurred by the petitioner which relates to psychiatric treatment. Since there is an embargo as per the said CPRMS instructions, petitioner is not entitled to any relief as claimed by him.

4. I find that the facts are admitted in this case. Petitioner is a retired executive of Bharat Coking Coal Limited, a subsidiary of Coal India Limited. He got his wife treated by psychiatrist, as she was suffering from mental illness. The bills were raised and he claimed reimbursement, but the respondents deducted the amount, which was spend for psychiatric treatment on the ground that as per the CPRMS, petitioner is not entitled for reimbursement of the amount spent for psychiatric treatment of his wife.

5. Reimbursement of medical expenses in Coal India Limited and its subsidiaries, so far as superannuated executives are concerned, is governed by CPRMS. As per Clause 1.1 of the CPRMS, medicare is provided to retired executives including Board Level appointees of Coal India Limited and its subsidiaries and also to their spouses. There is no dispute that the petitioner is governed by the CPRMS. The entitlement and the benefits are provided in Clause 3 of the CPRMS. Though the maximum limit of reimbursement is provided, but in terms of Clause 3.2.1.d, there is no fiscal limit in case of treatment of the deceases mentioned in the said clause, i.e., heart and vascular diseases involving surgical or interventional therapy, cancer, renal disease, paralysis, AIDS and Addison’s disease & Adrenal Histoplasmosis. It suggests that there is an unlimited reimbursement though in respect of limited number of diseases. So far as Outpatient/Domiciliary Treatment is concerned, the amount payable is Rs.36,000/- per year.

6. The procedure for claim has been provided in Clause 6 of the CPRMS. Clause 6.3 is the exclusion clause, which provides for the conditions and the diseases for which if expenses is incurred, will not be reimbursed. As per Clause 6.3.(i) of the CPRMS, any psychiatric treatment is excluded from reimbursement. It is necessary to quote Clause 6.3.(i) of the CPRMS for better appreciation: -

6.3 Other conditions

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