Social security health schemes warrant purposive, beneficial interpretation favouring employees; acceptance of belated or lump-sum contributions precludes denial of medical reimbursement despite employer delays in scheme adoption.

JUDGMENT :

Manoj Kumar Gupta, C.J.

1) Heard Mr. Rajendra Dobhal, learned Senior Counsel assisted by Mr. Bhupendra Bora, learned counsel for the petitioner and Mr. Gajendra Tripathi, learned Standing Counsel for the respondents.

2) The present writ petition has been filed seeking a writ of mandamus commanding the respondents to reimburse the medical bills of the petitioner amounting to Rs.11,12,992/- along with interest of 18% as per the State Government Health Scheme.

3) Briefly stated, the facts are that, the petitioner retired from the post of Principal from Shri Guru Ram Rai (P.G.) College, Dehradun on 31.08.2022 upon attaining the age of superannuation. The petitioner claims that he is a Golden Card holder under the health scheme provided by the State Government for Government employees. The petitioner is a patient of lung cancer and was under treatment for the said disease at Madanta the Medicity, Gurugram. He submitted the medical bills of medical expenses through Principal of the college on 20.05.2024 for a sum of Rs.13,05,476.35 for the period from 19.09.2022 to 17.05.2024. The petitioner also submitted essentiality certificate along with original bills. The claim of the petitioner for reimbursement of the medical bills remained pending and, consequently, the present writ petition has been filed.

4) In pursuance of order of this Court, the respondents have supplied written instructions through the Chief Standing Counsel, and the same have been taken on record. The stand taken by the respondents is that as per Clause 22 of the Medical Department’s Government Order No. 1256 dated 25.11.2021, the reimbursement of medical treatment expenses for Non-Government Aided Colleges is permissible subject to certain restrictions, which are as follows:

“(a) The concerned institutions shall be entitled to adopt the scheme after getting the proposal passed by their Governing Body, Board etc.

(b) The said scheme will be mandatory for all the employees of the concerned institutions/bodies/corporations.

(c) The concerned institutions shall make monthly deductions from the salary / pension of the employees / pensioners and make the amount available online to the State Health Agency.”

5) It is stated that in order to avail the benefit of the scheme the monthly contribution ought to have been deducted in advance after exercising the option under the scheme. However, in the case of petitioner, a lump sum deduction of Rs.20,000/- was made in the month of April 2024 by estimating the monthly contribution from August 2022 i.e. one month prior to the commencement of his medical treatment, which continued from 19.09.2022 to 17.05.2024. It is further stated that another sum of Rs.1,000/- was deducted from the pension in November 2024. It is stated that due to non-adoption of the scheme by the college on time and non-submission of the option for the scheme in time by the petitioner and for the reason that the monthly contributions were deposited in lump sum, the claim of the petitioner for reimbursement is not admissible and has consequently been rejected by the Medical Department on 16.09.2025.

6) Mr. Rajendra Dobhal, learned Senior Counsel appearing for the petitioner contends that the respondents have themselves made lump sum deduction of the monthly contributions from the pension of the petitioner for the entire period for which the reimbursement has been claimed and, therefore, they cannot now take the stand that because of any delay on part of the petitioner in depositing monthly contributions the claim is not acceptable. He further submi