Restricting medical reimbursements to predefined limits despite prior treatment approval is unreasonable when higher charges are incurred.

1. The petitioner, who is an Ext. MLA, has approached this Court by filing the present writ petition for quashing the impugned order dated 3.10.2008 Annexure P - 2 issued by the 2nd respondent though permitting thereby the petitioner to take treatment from Sir Ganga Ram Hospital, New Delhi, however, restricted his entitlement to reimbursement of the expenses he incurred upon his treatment as per the rates of AIIMS, New Delhi, on the basis of clause 9.7 of the Policy decision dated 21.6.2008 Annexure P - 3 being illegal and arbitrary and also for issuing a direction to the respondents to reimburse the entire amount, he actually spent on his treatment.

2. The petitioner had to transplant his kidney and was under treatment in Sir Ganga Ram Hospital, New Delhi. He remained hospitalized during the period from 11.9.2007 to 28.1.2008 and incurred upon an expenditure of Rs. 9,97, 348/- on his treatment. The Director Health Services, Himachal Pradesh had allowed him to undergo treatment in Sir Ganga Ram, Hospital. He submitted all the bills for payment to the 1st respondent, who in turn referred the matter to the 2nd respondent vide Annexure P - 1. The 2nd respondent had conveyed the approval of the Government to the 1st respondent vide Annexure P - 2 for reimbursement of the claim in favour of the petitioner in relaxation of Rules subject to the condition that the same shall be restricted to the rates of AIIMS. Thus the 1st respondent had reimbursed only a sum of Rs.4,25,573/- vide Annexure P - 5 and a further sum of Rs.88,724/- against his bills amounting to Rs.9,97,348/-. Against the part payment so made to him, he had made a representation for payment of balance amount to the 1st respondent vide Annexure P - 6. The 1st respondent, however, had conveyed the petitioner that in view of the approval granted by the Government, he was only held entitled to the reimbursement of Rs.4,25,573 and Rs.88,724/- respectively, vide Annexure P - 7, in full and final settlement of his claim and no balance payment on account of this claim was due to him.

3. Feeling aggrieved and dissatisfied therewith, the petitioner has filed the present writ petition with a prayer to strike out clause 9.7 of the Policy in respect of reimbursement of medical claims framed by the respondents and for a direction to the respondents to reimburse the whole amount he spent on his treatment.

4. The 1st respondent has resisted and contested the claim, as laid in the writ petition, on the ground inter alia that Sir Ganga Ram Hospital is not recognized so far as transplantation of Kidney is concerned. Although the permission was granted to the petitioner by the Director, Health Services to undergo the treatment in this Hospital, yet subject to the condition that the reimbursement of the expenses incurred upon such treatment shall be restricted to the rates of the AIIMS, New Delhi, in accordance with instruction / health policy framed by the State Government and inforce at that time. The administrative approval was also conveyed by the Government accordingly and the petitioner has rightly been reimbursed Rs.4,25,573 and Rs.88,724/- towards full and final settlement of the amount he incurred upon his treatment.

5. Respondents No.2 and 3 have also filed reply to the writ petition and contested the claim of the petitioner on the ground that the medical expenses have been reimbursed to the petitioner in accordance with law and as per his entitlement under S.2(2) of the Himachal Pradesh State Legislative Officers / Minister and Members Medical Facilities Act , 1971 and the Rules framed thereunder. Sir Ganga Ram H