JUDGMENT :

SANDEEP MOUDGIL, J.

Prayer

1. Claim in the present petition is in the nature of writ under Articles 226/227 of the Constitution of India seeking quashing of the order/letter dated 19.09.2018 (Annexure P-4) and 07.01.2019 (Annexure P-5) whereby the respondents have sought to reject the claim of the petitioner for reimbursement of his medical bills in terms of the Post Retirement Medical Scheme (PRMS) (Annexure P-2), with a further direction to respondents to reimburse medical bills of the petitioner in terms of the PRMS.

The Conspectus of Facts

2. The petitioner is a retired employee of the Food Corporation of India who superannuated as Manager (Quality Control) after rendering long and unblemished service. The FCI had introduced the Post-Retirement Medical Scheme (PRMS) notified in December 2016 which was framed as a welfare measure for employees of the respondent department for a minimum service period of 15 years and envisages reimbursement of medical expenses subject to prescribed conditions, including treatment at Government hospitals, FCI empanelled hospitals, or such other hospitals of national repute as may be notified.

3. The petitioner underwent treatment of right total knee replacement in December 2016, and availed treatment at Amandeep Hospital, Amritsar during the periods 11.09.2019 to 21.08.2017 and 05.12.2017 to 20.12.2017 pursuant to the knee surgery, and thereafter submitted his claim for reimbursement along with requisite medical bills to the competent authority. The matter was processed internally, and an opinion was sought from the Chief Medical Officer, who opined that the treatment having been taken in a private hospital not empanelled with FCI and not notified as a hospital of national repute at the relevant time, the claim would not fall within the ambit of Clause 6.8 of the PRMS.

4. Acting upon the said opinion, the respondents returned the original medical bills and rejected the claim vide communications dated 19.09.2018 and 07.01.2019, holding that the petitioner had undertaken treatment from a non- empanelled private hospital and thus was not entitled to reimbursement beyond the permissible limits under the scheme.

5. Aggrieved by the said rejection, the petitioner has approached this Court by way of this petition.

Contentions On behalf of the petitioners

6. Learned counsel for the petitioner submits that the rejection of medical reimbursement is arbitrary and contrary to the object of the PRMS, which is a beneficial scheme intended to provide post-retirement medical security. It is contended that Clause 6.8 of the scheme ought to be interpreted purposively, and the expression “hospital of national repute” cannot be confined to formal notification alone, particularly when the hospital in question is NABH-accredited and subsequently empanelled by the respondents.

7. It is urged that the insistence on technical conditions such as prior empanelment, defeats substantive entitlement where the treatment is undisputedly genuine and necessary. It is further argued that no discrepancy in the medical bills has been pointed out and, therefore, denial of reimbursement on procedural grounds is violative of Article 14.

On behalf of respondent/State

8. Per contra, learned counsel for the respondents contends that the claim is governed strictly by the terms of the PRMS, which clearly restricts reimbursement under Clause 6.8 to treatment taken in Government hospitals, empanelled hospitals, or hospitals specifically notified by the competent authority. It is submitted that at the relevant time, the hospital was neither empanelled nor notified, and thus the petitioner does not satisfy the eligibility conditions. The subsequent empanelment has no retrospective effect.

9. It is further contended that no prior approval or medical emergency has been shown so as to justify deviation from the scheme, and the petitioner having already been granted reimbursement up to the permissible limit for non-empanelled treatment, no further