A person who has undergone surgery at a Government Hospital cannot be denied actual medical costs, and there has to be reimbursement of the actual medical expenses incurred.

HARSIMRAN SINGH SETHI, J.

CM No.2625-CWP-2020

1. Application is for placing on record Annexure P.10.

2. Application is allowed. Annexure P.10 is taken on record.

CWP No.24498 of 2016

3. Present petition has been filed raising grievance that total reimbursement of the medical bill for the treatment with regard to Surgery qua total Hip replacement incurred by the petitioner as indoor patient from 09.05.2015 to 27.05.2015 undertaken at Government Medical College Hospital, Sector 32, Chandigarh (hereinafter to be referred as “Medical College”) has not been made to the petitioner.

4. Learned counsel for the petitioner argues that it is a matter of fact that the petitioner had undertaken Hip Replacement Surgery, which was advised to him by the Doctor to be necessary after taking into account medical condition of the petitioner and the petitioner remained admitted at the Medical College and underwent total Hip Replacement Surgery and incurred a total medical bill of Rs.4,17,004/-, which bill was duly verified by the Medical Superintendent of the Medical College. Learned counsel for the petitioner further submits that the petitioner claimed for reimbursement of said medical expenses incurred by him but out of total medical bill of Rs.4,17,004/-, sanction has only been accorded to the reimbursement of medical charges amounting to Rs.1,00,304/- vide Annexure P/5. Thus, the action of the respondent for not reimbursing the total medical bill amount has been challenged in the present petition.

5. Upon notice, respondents have filed reply, wherein it has been mentioned that for certain surgeries, the maximum ceiling rate has been fixed by the Government qua the implants and a sum of Rs.45,000/- plus Rs.5000/- in all totalling Rs.50,000/- has been prescribed in respect of Hip Implant, as per Government policy dated 06.08.2013, which has only been reimbursed to the petitioner.

6. As per the reply, though it is conceded to the effect that as per the medical bills submitted, cost of implant has been mentioned as Rs.2,75,000/- plus Rs.82,400/- being spent on medicines and other equipments, but the same cannot be reimbursed, in view of maximum ceiling fixed, which is Rs.45,000/- plus Rs.5000/- qua the implants, hence claim of the petitioner is liable to be rejected.

7. I have heard learned counsel for the parties and gone through the record with their able assistance.

8. It may be noticed that the medical treatment, which the petitioner had undertaken is from a Government Hospital. It is also not a disputed fact that as per the medical bills, which have been verified by the Medical Superintendent of the Medical College, total expenditure incurred on the treatment of petitioner is Rs.4,17,004/-. That being so, the respondent-Department cannot restrict the reimbursement to Rs.1,10,044/-. Once, it is a conceded position that actually the implant which was used was as per the recommendations of the Doctors concerned, who conducted the surgery and the said implant cost Rs.2,75,000/-, the said amount incurred by the petitioner cannot be deducted to mean that only Rs.45,000/- will be reimbursed for the said implant despite the fact that implant actually costed Rs.2,75,000/- to the petitioner.

9. It is not a case that the petitioner had undertaken the surgery/treatment in a private hospital and then claimed the benefit of total reimbursement. In the present case, the expenditure incurred at a Government Hospital is being claimed for medical reimbursement which also is not being extended to the petitioner. It is settled principles of law in CWP No.22833 of 2015 titled as Ayoudhia Prasad Duggal vs. CAT, Chandigarh and others, decided on 20.02.2017 wherein Division Bench of this Court has held that merely because Government does not revise package deal amount under Medical Attendance Rules from time to time, a person who has undergone surgery cannot be denied actual medical costs and there has to be reimbursement of actual medical expenses incurred. Relevant paragraph