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2024 Supreme(All) 163

IN THE HIGH COURT OF ALLAHABAD
J.J. MUNIR, J.
Ram Prasad Dwivedi – Petitioner
Versus
State of U.P. and Others – Respondents
Writ (A) No. 7942 of 2023
Decided On : 09-01-2024

Advocates:
Advocate Appeared:
For the Petitioner: Girish Chandra Yadav.
For the Respondent: Vimlesh Kumar Rai.

The central legal point established in the judgment is the need for a liberal construction of the reimbursement scheme to advance its purpose and the consideration of genuine claims, especially for serious ailments like cancer, despite technical lapses.

Headnote:

Medical Reimbursement - Government Servants - The Uttar Pradesh Government Servants (Medical Attendance) Rules, 2011 - Rule 3.3.1, 3.3.2, 3.3.3, 3.3.4 - The court discussed the petitioner's claim for medical reimbursement under the Rules of 2011 and the Scheme framed by the Managing Director, U.P. Jal Nigam. The court highlighted the relaxation of restrictions on reimbursement for treatment availed at private hospitals and the requirement of prior permission for treatment at a private hospital. The court emphasized the need for a liberal construction of the Scheme to advance its purpose and the consideration of genuine claims, especially for serious ailments like cancer.

Fact of the Case:

The petitioner, a retired Assistant Engineer, sought medical reimbursement for cancer treatment at a grant-in-aid institute, which was denied by the respondents based on the classification of the hospital as private. The court examined the petitioner's claim and the respondents' objections, including technical lapses in adherence to the reimbursement scheme.

Finding of the Court:

The court found that the petitioner's claim for medical reimbursement should not be rejected solely based on technicalities and that the Scheme should receive a liberal construction to advance its purpose. The court appreciated the candid stand taken by the Principal Secretary and directed the petitioner to submit his claim afresh for consideration.

Issues: The issues involved the classification of the hospital, adherence to the reimbursement scheme, and the consideration of genuine claims for medical reimbursement.

Ratio Decidendi: The court emphasized the need for a liberal construction of the reimbursement scheme to advance its purpose and considered the genuineness of the petitioner's claim, especially for serious ailments like cancer, despite technical lapses.

Final Decision: The writ petition was allowed in part, and the petitioner was directed to submit his claim afresh for consideration, bearing in mind the guidance provided by the court and the stand taken by the Principal Secretary. The petitioner's claim was to be disposed of within a specified period.

JUDGMENT :

J.J. MUNIR, J.

1. Heard Mr. Girish Chandra Yadav, learned Counsel for the petitioner, Mr. Vimlesh Kumar Rai, learned Counsel appearing on behalf of respondent Nos. 2, 3 and 4 and Ms. Monika Arya, learned Additional Chief Standing Counsel appearing for respondent No. 1.

2. The petitioner, Ram Prasad Dwivedi is a retired Assistant Engineer. He was employed with the Uttar Pradesh Jal Nigam, and after its division, is regarded a part of the Uttar Pradesh Jal Nigam (Urban). He retired from service on 30.09.2008, when the Nigam was still a unified entity. The petitioner is now a 70 year old man, and as he says, lost vision in both his eyes to Glaucoma. The petitioner consulted an E.N.T. Doctor for a problem with his throat, who, after a clinical evaluation and consideration of pathological reports, referred him to the Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi (for short ‘the MPMMCC’) on 07.11.2021. The petitioner went to the MPMMCC, where after a thorough check-up from 13.11.2021 to 11.01.2022, he was diagnosed with Lymphoepithelial Carcinoma, a cancer. He underwent surgery followed by radio and chemotherapy, that was necessary to treat the deadly disease. The petitioner says that his treatment is still continuing. It is averred in Paragraph No. 11 of the writ petition that the petitioner informed the Personal assistant/ Executive Engineer in the office of the Chief Engineer, U.P. Jal Nigam (Urban), Prayagraj Zone, Prayagraj through an application dated 13.01.2022 that he was undergoing treatment for his cancer at the MPMMCC and Homi Bhabha Cancer Hospital, Varanasi. The petitioner then submitted his treatment plan and record of admission for the purpose of surgery at the MPMMCC to the Personal Assistant to the Chief Engineer aforesaid, whereupon the Personal Assistant is said to have written a letter to the petitioner on 31.01.2022 that the MPMMCC is not a government hospital. A copy of this letter is not on record.

3. Nevertheless, it is the petitioner’s case that he posted the office of the Chief Engineer with details of his treatment, that includes his treatment file, card etc. on 22.02.2022, that were duly received by the office of the Chief Engineer, U.P. Jal Nigam (Urban), Prayagraj on 23.02.2022. The petitioner indicated that the MPMMCC is a government hospital, being a grant-in-aid institute of the Department of Atomic Energy, Government of India. Upon receipt of the said letter dated 23.02.2022, the Personal Assistant to the Chief Engineer, U.P. Jal Nigam (Urban), Prayagraj Zone, Prayagraj responded vide memo dated 24.02.2022, bearing No. 550@fpfdRlk ÁfriwfrZ@18 declining the petitioner’s claim on the ground that the MPMMCC is a private hospital and a Branch of the Tata Memorial Centre, Mumbai. It was indicated that the petitioner’s claim for medical reimbursement cannot be paid in accordance with the office Memo No. 966@,lh&ys[kk lkekU;@fpŒ ÁfrŒ@309@20 fnukad 13-07-2020 issued by the Managing Director, U.P. Jal Nigam, Lucknow, which prohibits reimbursement of medical claims for treatment availed in private hospitals. The material part of the office memo aforesaid reads:

4. It is the petitioner’s case that his claim has been rejected solely on the ground that he took treatment to cure his cancer at the MPMMCC, which the respondents regard as a private hospital. It is also the petitioner’s ground to assail the denial of his claim that the view that for treatment taken at a private hospital, no medical reimbursement can be claimed, is based on a mere memo issued by the Managing Director of the U.P. Jal Nigam, whereas the right to claim medical reimbursement flows from The Uttar Pradesh Government Servants (Medical Attendance) Rules, 2011 (for short, ‘the Rules of 2011’). The petitioner has prayed for a mandamus ordering the respondents to reimburse his medical expenses to the tune of Rs.3,64,303/-spent on his treatment within a stipulated period of time.

5. When this petition came up for admission on

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