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2024 Supreme(Online)(TRI) 386
HIGH COURT OF TRIPURA
MR. APARESH KUMAR SINGH, CJ, MR. JUSTICE S. DATTA PURKAYASTHA, J
The State of Tripura – Appellant
Versus
Sentu Das – Respondent
WA 130 / 2023
Mr. D Sarma, Addl. GA; Mr. P Roy Barman, Sr. Adv.; Mr. S Bhattacharjee, Adv.; Mr. K Nath, Adv.; Mr. D Paul, Adv.; Mr. S M Chakraborty, Sr. Adv.; Ms. P Chakraborty, Adv.; Ms. M Chakraborty, Adv.
The court directed the State to reconsider the discriminatory aspects of the medical reimbursement policy, particularly the differential treatment based on disease type for employees.
Headnote:(A) Medical Reimbursement Policy - Clause (e) of the policy dated 22nd December, 2022 - Distinction in reimbursement eligibility between Group-A, B and Group-C, D employees - The writ petitioners, wives of Group-C employees, sought reimbursement for treatment outside the State, which was denied based on the policy's provisions. The learned Writ Court found the policy potentially discriminatory and directed reconsideration of the clause. (Paras 5, 7, 10)
(B) Discrimination in Policy - The court noted the lack of rationale for differentiating reimbursement eligibility based on the type of disease, specifically for cancer treatment for Group-C and D employees versus other diseases for Group-A and B employees. (Paras 9, 11)
Facts of the case:
The writ petitioners underwent successful treatment outside the State upon referral but were denied reimbursement under the new policy, which only allowed reimbursement for cancer treatment for Group-C and D employees.
Findings of Court:
The court did not quash the policy but directed the State to reconsider the discriminatory aspects of the reimbursement policy.
Issues: The main issue was whether the distinction in reimbursement eligibility based on disease type was justified.
Ratio Decidendi: The court emphasized the need for the State to provide a rationale for the differential treatment in the reimbursement policy, particularly regarding the treatment of cancer.
Result: Writ appeals disposed of; the State directed to reconsider the policy.
Order
24.09.2024
Heard Mr. D Sarma, learned Addl. GA appearing for the State and the learned counsel appearing for the writ petitioners.
[2] The appellant-State is aggrieved by the impugned judgment dated 13th July, 2023 passed in WP(C) No.1096 of 2022 (in Writ Appeal No.130/2023) and the judgment dated 13th July, 2023 passed in WP(C) No.419 of 2023 (in WA No. 155 of 2023) which was disposed of in terms of judgment and order dated 13th July, 2023 passed in WP(C) No. 1096 of 2022.
[3] The case of the writ petitioners was of medical reimbursement. In both the cases, the treatment was incurred before coming into force of the medical reimbursement policy dated 22nd December, 2023 but the cases of both the writ petitioners were considered and rejected after coming into force of the policy dated 22nd December 2022.
[4] The medical reimbursement policy contained in memorandum dated 22nd December, 2022 (Annexure-16 to the Writ Appeal No.130/2023) in the opening paragraph itself records that in supersession/partial modification of all existing guidelines which are also referred to therein, the Government of Tripura has been pleased to lay down the following guidelines with regard to admissibility of medical expenses to State Government officials inside/outside the State:
(a) Group-A and Group- officials of the State Government employees and their dependent family members when referred by the Standing Medical Board to a particular listed referral institution/hospital as Annexed (A) for medical treatment but undertakes the treatment at some other Institution /Hospital of his/her own choice/volition, he/she shall be entitled to get reimbursement for treatment /investigation is undertaken at the rates of their referred institution including journey expenses for the purpose as existing TA Rules
(b) Medical re-imbursement expenses to Group-A and Group- B of the State Government employees and their dependent family members may avail treatment in any enlisted referral hospital inside /outside the State approved by the State Govt. without referral of the Standing Medical Board subject to condition that ex-post facto approval shall be given only in case of emergency or acute illness arising while the govt. servant is staying outside the State with station leave permission. In such case a certificate stating the emergency status and ICD diagnosis has to be obtained from the treating hospital. If treatment is undertaken in any such hospital reimbursement would be at CGHS rate.
(c) The dependent family members of State Government Group-A & B employees, who are not residing with the concerned government employees due to staying outside the State and require medical treatment in any health institution, will be eligible to get reimbursement of treatment expenses at latest CGHS rates.
(d) Group-C & D officials of the State Government employees when referred by the Standing Medical Board to a particular listed referral institution/hospital for medical treatment but undertakes the treatment at some other Institution /Hospital of his/her own choice/volition, he/she shall be entitled to get reimbursement for treatment/investigation(s) undertaken at the rates of their referred institution including journey expenses for the purpose as existing T.A. Rules.
(e) Medical reimbursement expenses to Group-C & D of the State Government employees himself/herself or any member of his/her family suffers from cancer and is referred to a particular medical institution/hospital outside the State on being referred by the State Standing Medical Board, Govt. of Tripura but undertakes the treatment at some other Institution/Hospital of his/her own choice/volition, he/she shall be entitled to get reimbursement for treatment/investigation(s) undertaken at the rates of their referred institutions including journey expenses for the purpose as existing T.A. Rules.
(f) In case of all categories of the State Government employee (Group-A, B, C and D), while being outside the State in connection
