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1995 Supreme(P&H) 695
PUNJAB & HARYANA HIGH COURT
G.S.Singhvi and M.L.Koul JJ.
Ravi Mohan Duggal
Versus
State Of Punjab
Civil Writ Petition No. 260 of 1995,
Decided On : MAY 30, 1995
Government employees are entitled to reimbursement of medical expenses incurred at recognized hospitals for specialized treatment of heart ailments.
Headnote:
MEDICAL REIMBURSEMENT - PUNJAB GOVERNMENT EMPLOYEES - RECOGNIZED HOSPITALS - REIMBURSEMENT OF MEDICAL EXPENSES INCURRED AT RECOGNIZED HOSPITALS - RIGHT OF GOVERNMENT EMPLOYEES - INTERPRETATION OF GOVERNMENT INSTRUCTIONS - DELAY IN REIMBURSEMENT - INTEREST AWARDED.
Fact of the Case:
The petitioner, a regular employee of the Punjab Roadways, underwent cardiac surgery and angioplasty at Escort Heart Institute, New Delhi, and Apollo Hospital, Madras, respectively. Both hospitals were recognized by the Punjab Government for specialized treatment of heart ailments. The petitioner incurred medical expenses amounting to Rs. 79,440/-. Despite submitting the bills and essentiality certificates, the respondents failed to reimburse the petitioner's medical expenses for over two years.
Finding of the Court:
The court held that the petitioner was entitled to reimbursement of medical expenses incurred at recognized hospitals for specialized treatment of heart ailments. The court found that the respondents' refusal to reimburse the petitioner's medical expenses was arbitrary, unjust, and unreasonable. The court also held that the respondents' delay in reimbursing the petitioner's medical expenses was deplorable.
Issues: 1. Whether a government employee is entitled to reimbursement of medical expenses incurred at recognized hospitals for specialized treatment of heart ailments? 2. Whether the respondents' refusal to reimburse the petitioner's medical expenses was arbitrary, unjust, and unreasonable? 3. Whether the respondents' delay in reimbursing the petitioner's medical expenses was deplorable?
Ratio Decidendi: 1. The court interpreted the Punjab Government's instructions on reimbursement of medical expenses incurred at recognized hospitals and held that government employees are entitled to reimbursement of medical expenses incurred at such hospitals for specialized treatment of heart ailments. 2. The court found that the respondents' refusal to reimburse the petitioner's medical expenses was arbitrary, unjust, and unreasonable because the petitioner had submitted genuine bills and essentiality certificates from recognized hospitals and there was no impediment in the way of the respondents to reimburse the petitioner's bills as per rules. 3. The court held that the respondents' delay in reimbursing the petitioner's medical expenses was deplorable because the petitioner had suffered unnecessary hardship and financial burden due to the delay.
Final Decision: The court allowed the writ petition and directed the respondents to make payment of the medical expenses incurred by the petitioner within a period of three months of the submission of the certified copy of the order. The court also awarded 18% interest on the amount of medical expenses from the expiry of three months from the date of application for medical reimbursement till the date of actual payment.
M.L.Koul, J.
1. The petitioner is a regular employee of the Punjab Roadways and at present is working as Conductor in the Ferozepur Depot. In the month of September, 1992 he suffered some cardiac problem. As the same was found serious, on the advice of doctors, he went to Escort Heart Institute, New Delhi, where angeography of the petitioner was done. He took treatment there with effect from 27.9.1992 to 29.9.1992 at a total cost of Rs. 12,650/-. The essentiality certificate was issued by the Institute contained in Anaexure P-1. The receipts of payment of admission fee and deposit on account of Angeography are mentioned in Annexures P-2 and P-3. On the Angeography report it was opined by the doctors that the petitioner required immediate by-pass Heart-surgery. The petitioner being a poor man collected money from his friends and near relations, he inquired as to which was the better Institute for such treatment and his family members found it appropriate to take him to Apollo Hospital, Madras, where he remained admitted from 6.11.1992 to 8.12.1992 and was operated upon for his bypass heart surgery by Dr. M.R. Girinath, The Chief Cardio-Thoracic Surgeon of the said Hospital. In this behalf the petitioner had again incurred an expenditure amounting to Rs. 66,764/- with regard to which essentiality certificate was issued by the concerned doctor of Apollo Hospital, Madras contained in Annexure P-4. The receipts of the payments are given in Annexures P-5 to P-9.
2. The General Manager of the Punjab Roadways vide letter No. 28066 ACC dated 20.8.1993 requested respondent No. 3 i.e. the Director Health and Family Welfare, Punjab, to sanction the bill of the petitioner with regard to his by-pass heart surgery. All the medical bills were sent to him. Again the said General Manager vide his letter No. 336/Sec. II dated 7.3.1994 wrote to respondent No. 4 i.e. the Director, State Transport, Punjab, Chandigarh seeking permission for putting up the medical reimbursement case of the petitioner before the Medical Board as established by the Health Department. The petitioner had incurred all medical expenditure in the last quarter of 1992 and despite the fact that a long period of two years had elapsed, the medical expenditure incurred by him has not been reimbursed to him. After having undergone such a serious operation, a patient is expected to take due rest and avoid unnecessary strain or frustration in life but the petitioner has been continuously suffering all this. The petitioner has not been able to pay back to his well-wishes who helped him financially at the time of crisis. The petitioner has referred to the instructions of the Punjab Government dated October 08,1991, whereby both Escort Heart Institute, New Delhi and Apollo Hospital, Madras have been recognized by the State of Punjab where-from the treatment can be taken by the government employees in case of heart ailment. As the respondents did not reimburse the medical bills to the petitioner, therefore, he came with this writ petition for issuance of a writ of Mandamus directing the respondents to reimburse Rs. 79,440/- with compound interest to him, which he has spent for undergoing the by-pass surgery and Angeography at Apollo Hospital, Madras and Escort Heart Institute, New Delhi, respectively.
3. In their written statement filed by respondent Nos. 1 and 2 i.e. the State of Punjab and Director, Treasury and Accounts, Punjab have admitted the fact that the petitioner incurred all medical expenditure in the last quarter of 1992 as per the bills submitted by him. Respondent No. 3 is the competent authority to make the payment. It is admitted by respondent No.4 that he has already referred the matter to respondent No.3, who informed that it would take three months to complete all the requirement needed for making the payment to the petitioner as per the rates accepted by the P.G.I.
4. Respondent No.2 in its written statement has stated that the petitioner is an employee of t
