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Keshav Kishore Sharma v. Municipal Corp. Of Delhi

Delhi High Court
Dec 13, 2004
Smart Summary (Beta)

Structured Summary of the Opinion (Manmohan Sarin, J.)

Factual and Procedural Background

The petitioner sought quashing of a communication dated 4.4.2001 which rejected his request for reimbursement of medical charges (Annexure P-17). He also sought quashing of Resolution No. 4017 dated 27.9.1994 insofar as it was pressed to deny reimbursement of expenditure on disease, and a mandamus directing the Municipal Corporation of Delhi (MCD) to pay and reimburse his medical claim.

The petitioner had joined MCD as a Lower Divisional Clerk on 24.9.1998 and superannuated on 31.8.1993 in the position of Head Clerk (dates as recorded in the opinion). He suffered cardiac trouble in April 1999, underwent angiography in July 1999 and was advised surgical re-vascularisation. On 6.8.1999 the petitioner applied to MCD for sanction of the estimated amount for cardiac surgery and later attended Hindu Rao Hospital, from where he was referred to AIIMS by Dr. R.P. Mittal, Head of Cardiology. The petitioner was admitted to AIIMS (admission recorded as 19.9.1999), underwent open heart surgery (surgery recorded as 2.9.1999) and was discharged (discharge recorded as 26.9.1999). He incurred expenses amounting to Rs. 77,002.40 and submitted bills and vouchers seeking reimbursement.

Reimbursement was denied by the impugned communication dated 4.4.2001 on the ground that there was no policy for reimbursement of medical expenses to municipal pensioners and that any new scheme being considered would have future effect only. The respondents also relied on an Office Order dated 3.10.1994 stating that "In no case reimbursement of expenditure incurred by a pensioner on treatment will be made."

Legal Issues Presented

  1. Whether the communication dated 4.4.2001 rejecting the petitioner's request for reimbursement of medical charges could be quashed.
  2. Whether Resolution No. 4017 dated 27.9.1994 (insofar as it was relied upon to deny reimbursement) could be quashed.
  3. Whether a writ of mandamus should issue directing the MCD to pay and reimburse the petitioner's medical claim of Rs. 77,002.40.

Arguments of the Parties

Petitioner's Arguments

  • The petitioner complied with the formalities for submission of the medical claim and furnished requisite bills, vouchers and prescriptions.
  • He relied on the adoption by MCD of the Central Services (Medical Attendance) Rules, 1944 (CSMA) and various Resolutions and circulars (including Resolution No. 105 and Resolution No. 4017) which, in his case, entitled him to medical facilities and reimbursement where treatment was not available in municipal hospitals.
  • The petitioner had become a member of the scheme under Resolution No. 4017 and had been issued an identity card covering him and his family.
  • He had exercised his option to join the new scheme and offered to pay the subscription for life where relevant.

Respondents' Arguments

  • The Municipal Health Officer's communication of 4.4.2001 stated that there was no existing policy for reimbursement to municipal pensioners and any new scheme being studied would have only prospective effect.
  • The respondents relied on an Office Order dated 3.10.1994 which stated that "In no case reimbursement of expenditure incurred by a pensioner on treatment will be made."
  • The respondents referenced internal minutes (Expert Committee meeting of 29.1.2003) relating to framing and joining of a new scheme and contributions by pensioners.

Table of Precedents Cited

Precedent Rule or Principle Cited For Application by the Court
Surjit Singh v. State of Punjab and Others, 1996 (1) Services Law Reporter 786 Authority for the proposition that the right to health is an integral part of life and that the Government has a constitutional obligation to provide health facilities to employees or retired employees. The court relied on this precedent to reinforce the principle that the State has an obligation to provide health facilities to employees/retirees and to support petitioner's entitlement to medical benefits where treatment was not available in municipal hospitals.
Narender Pal Singh v. Union of India & Ors., 79 (1999) Delhi Law Times 358 Support for the view that pensioners/retirees are entitled to reimbursement where rules/policy support it; demonstrated by the fact that an LPA in that case was disposed with the Delhi Administration making reimbursement to a retired employee with costs. The court noted that the LPA in that matter had been disposed of with the Delhi Administration agreeing to reimburse expenses, using that outcome to support the petitioner's claim and the applicability of similar benefits to MCD pensioners.
Union of India v. T.S. Oberoi and Smt. Raj Chawla (CM.No Nill in LPA No. 898/2002), decided 7.11.2003 Principle that acceptance of life membership (in a scheme such as CGHS) can relate back to the date of hospitalization and that the benefit cannot be restricted to the date of membership only. The court applied that reasoning to hold that where a pensioner accepts/opts for a scheme, the benefit may relate back and therefore reimbursement may cover expenses incurred prior to formalization of membership, supporting petitioner's entitlement from March 1997.

Court's Reasoning and Analysis

The court undertook a step-by-step analysis grounded in MCD resolutions, applicable rules and administrative orders:

  1. Adoption of CSMA Rules: The court noted MCD's adoption of the Central Services (Medical Attendance) Rules, 1944 (CSMA) through administrative recommendations and Standing Committee Resolution No. 130 (23.3.1984) and Resolution No. 105. The CSMA rules and related instructions (as applicable to Delhi Administration) were taken to apply, mutatis mutandis, to municipal employees.
  2. Earlier administrative steps and circulars: The opinion records an Office Memorandum/circular dated 10.7.1984 issued by Delhi Administration to provide free medical facilities to pensioners of Delhi Administration (Annexure P-3). The court accepted that where rules/orders applicable to the Delhi Administration were extended, the same would apply to municipal employees by the approach adopted in MCD resolutions.
  3. Specific content of the adopted scheme: The court recited terms approved by Resolution No. 105, including free medicines and diagnostics for pensioners and families, priority attention when referred from dispensaries to hospitals, and issuance of identity cards to pensioners for identification.
  4. Resolutions and effective date: The court observed that the Government of NCT of Delhi extended benefits effective from 13.3.1997 to all its pensioners and retired employees, and MCD passed a later resolution (Resolution No. 77 of 15.5.2002) adopting the scheme "from the date it was implemented in NCT of Delhi" (i.e., March 1997). On that basis the court concluded the substantive right to claim reimbursement accrued from March 1997.
  5. Inconsistency of the Office Order: The Office Order of 3.10.1994 (stating no reimbursement will be made) was held by the court not to be in consonance with MCD's Resolution No. 4017 (27.9.1994) and subsequent Resolution No. 77 of 15.5.2002. The court therefore treated such an office order as ineffective to defeat the petitioner's right arising from the adopted scheme and the effective date fixed by the Government of NCT.
  6. Factual nexus to entitlement: The court accepted that the treatment was not available in municipal hospitals, that the municipal hospital's Head of Department referred the petitioner to AIIMS, and that the petitioner incurred the recorded expenses at AIIMS which he sought to recover.
  7. Reliance on case law and scheme membership: The court relied on precedents recognizing the government's obligation to provide medical facilities (Surjit Singh; Narender Pal Singh) and the principle that membership or acceptance of a scheme may relate back to the date of hospitalization (Union of India v. T.S. Oberoi & Smt. Raj Chawla). The petitioner had also opted for the new scheme and offered payment for life subscription.
  8. Conclusion of accrual: Taking these factors together, the court concluded that the petitioner's substantive right to claim reimbursement for treatment not available in municipal hospitals had accrued from March 1997 and that the denial based on the impugned communication of 4.4.2001 and reliance on the 3.10.1994 office order could not prevail.

Holding and Implications

WRIT PETITION ALLOWED; MANDAMUS ISSUED.

Holding (direct order): The court allowed the writ petition and directed issuance of a writ of mandamus commanding the respondents to pay the sum of Rs. 77,002.40 to the petitioner within one month. If the respondents fail to comply within that period, the petitioner is entitled to interest at the rate of 9% per annum on the said amount in future.

Implications: The direct effect of this decision is the payment of Rs. 77,002.40 to the petitioner and entitlement to interest on delayed payment. The court treated the MCD resolutions and the adoption of CSMA rules, together with the effective date of benefits as implemented in the NCT of Delhi (w.e.f. 13.3.1997), as establishing the petitioner's substantive right to reimbursement for treatment not available in municipal hospitals. The opinion does not state that it is creating a new legal precedent beyond applying the cited authorities and administrative resolutions to the facts of the case.

This summary is based exclusively on the content of the provided opinion and contains no information that was not present in the text of the opinion.

Show all summary ...

Manmohan Sarin, J.:— Petitioner seeks quashing of the communication dated 4.4.2001, rejecting the request for reimbursement of medical charges (Annexure P-17). Petitioner also seeks quashing of Resolution No. 4017 dated 27.9.1994, insofar as the same is pressed to deny reimbursement of expenditure incurred on diseases. Petitioner also seeks a mandamus, directing MCD to pay and reimburse the amount of medical claim.

2. Petitioner had joined MCD as a Lower Divisional Clerk on 24.9.1998 Petitioner superannuated on 31.8.1993 in the position of Head Clerk. Petitioner suffered cardiac trouble in April, 1999 and was taken to G.B Pant Hospital. An angiography was done and in July, 1999. Petitioner was advised surgical re-vascularisation. Petitioner thereupon applied to MCD on 6.8.1999, along with the report of G.B Pant Hospital for sanction of the estimated amount for cardiac surgery operation. Petitioner thereafter visited Hindu Rao Hospital of MCD for getting treatment in the Cardiology Department. Dr. R.P Mittal, Consultant and Head of the Cardiology, immediately referred the petitioner to AIIMS for treatment, since the said facilities were not available at Hindu Rao Hospital. In the event, petitioner was admitted to AIIMS on 19.9.1999 The open heart surgery was carried out on 2.9.1999 and he was discharged on 26.9.1999 Petitioner incurred an expenses of Rs. 77,002.40 paise and he has sought reimbursement of the same. Petitioner has duly complied with the formalities required to be done for submission of the medical claim and has furnished all the requisite bills, vouchers, prescription etc.

3. Reimbursement to the petitioner has been denied by the impugned communication dated 4.4.2001, based on the following observations of the Municipal Health Officer:

“There is no policy for reimbursement of medical expenses to municipal pensioners at present. However, on representation from pensioners it has been decided to de novo examine the medical facilities being provided to employees and pensioners. A Board has been constituted to study the schemes prevalent in CGHS and Delhi Govt. and working modalities for a suitable scheme in MCD also on these lines. The scheme will have future benefits, but is not retrospectively.”

It would thus be seen that the rejection of the request is on the ground that there was no existing policy for reimbursement of medical expenses to municipal pensioners and a study was being made of the schemes prevalent in CGHS and Delhi Government and working modalities for a suitable scheme in MCD on similar lines had to be worked out. Respondent, apart from the above, have also placed reliance on an Office Order dated 3.10.1994 on the following:

“In no case reimbursement of expenditure incurred by a pensioner on treatment will be made.”

4. Let us examine the position that emerges from various Resolutions passed by MCD, its orders and Circulars, insofar as it relate to reimbursement of medical expenses to pensioners. Based on the recommendation made by the Municipal Commissioner in his letter No. F.33.Health/560.C&C dated 9.2.1984 and as recommended by the Standing Committee vide its Resolution No. 130 dated 23.3.1984, the Central Services (Medical Attendance) Rules 1944 were adopted in their application to municipal employees. Resolution No. 105 is in the following terms:—

“Resolved that as proposed by the Commissioner in his letter No. F.33.Health/560.C&C dated 9.2.1984 and recommended by the Std. Committee vide its Res.No 130 dt.23,3.84, adoption of Central Service (Medical Attendance) Rules, 1944 with necessary instructions and amendments as are issued from time to time after re-defining the terminology used in the rules for their proper application to Mpl. Employees as framed and mentioned in the aforesaid letter be approved.”

5. It may be noted that the Central Services (Medical Attendance) Rules, 1944, hereinafter referred to as CSMA were adopted along with necessary instructions and amendments, as issued from time to time after redefining the terminology in the use for their proper application to municipal employees. On 10.7.1984, Office Memo/circular No. F.27/7/76-M&PH(I) was issued by Delhi Administration for providing free medical facilities to the pensioners of Delhi Administration (Annexure P-3). As the CSMA Rules, orders and instructions, as applicable to Delhi Administration mutatis mutandi apply to municipal employees. It is the petitioner' case that petitioner got entitled to the same benefit. The said Resolution approved the following treatment for the pensioners:—

“(i) All the medicines etc., including diagnostics facilities as is required for the treatment of the patient (Pensioners and their families) will be provided to them free of charges at the hospitals/dispensaries.

(ii) The pensioners and their families when referred from the dispensaries to the hospitals for specified treatment will be attended to on priority basis. Such medicines etc., which are considered essential for the treatment if not available will be purchased by the hospital authorities and provided to the patients within a reasonable time.

(iii) In order to identify the pensioners for providing medical facilities they will be issued Identity cards by deptt. from where one has retired or will be retiring.”

Petitioner had also become member of the scheme in terms of Resolution No. 4017 and Identity Card was issued in the name of the petitioner and his family members.

6. The Government of NCT issued an office order/Circular of streamlining the system for providing medical facilities to employees of NCT of Delhi. The benefit of the said Circular in terms of Resolution No. 105 dated 9.2.1994 and Resolution No. 4017 dated 27.9.1994 could be applicable to all the employees/pensioners of MCD, inasmuch, all the rules and changes mutatis mutandi apply to the MCD. The position, which emerges is that since Delhi Administration extended the benefits by an order dated 13.3.1997, to all its pensioners and retired employees, the same benefit would become applicable to the retired employees and pensioners of MCD. Reference may also further invited to Resolution No. 77, passed by MCD, which is in the following terms:—

“Resolved that as recommended by the Standing Committee vide its Resolution No. 268 dated 15.5.2002, the proposal of the Commissioner as contained in his letter No. F.33.CED/1199.C&C dated 9..5.2002 be approved. Resolved further that the scheme of medical facilities be adopted from the date it was implemented in NCT of Delhi.”

7. It may also be noted that the Office Order dated 3.10.1994, on which reliance was placed to deny reimbursement in the counter affidavit is not in consonance with the Resolution of the Municipal Corporation No. 4017 dated 27.9.2004 Besides, in view of the later Resolution of 15.5.2002, there is no doubt whatsoever left in the matter. Respondent-Corporation had also during the course of proceedings referred to the minutes of the Expert committee meeting held on 29.1.2003, wherein it is stated that the decision was taken regarding contribution from municipal pensioners/family pensioners for joining the new scheme for providing further benefits to the pensioners. The date of 30.4.2003 was fixed for seeking application for pensioners to join the scheme. Petitioner without prejudice had exercised his option for joining the scheme.

8. The crux of the controversy is whether the pensioners of MCD are entitled to reimbursement of medical expenses? As noticed in the preceding paras, decision to extend the benefit of medical expenses incurred was taken as far back as 9.2.1984 It was also resolved by Resolution No. 105 of 9.2.1984 and 4017 of 27.9.1994 that circulars and amendments, as applicable to the employees/pensioners of NCT would also apply to the Corporation employees. The Government of NCT had extended these benefits to the pensioners w.e.f 13.3.1997 Once the benefits become applicable w.e.f March, 1997, then petitioner cannot be faulted with if the respondents themselves delay the working out of procedural formalities. Petitioner's right to medical facilities cannot be defeated by internal notings making it prospective. Such notings would be of no effect in view of Resolution No. 77 extending the benefits from the same date as it was implemented in NCT of Delhi i.e March, 1997.

9. It is not in dispute that the treatment in question was not available in the Municipal Hospitals. The Head of the Department of Municipal Hospital himself referred the case to AIIMS. Petitioner has incurred these expenses at AIIMS for his treatment. Further, keeping in mind that right to health is an integral part of life and the Government has constitutional obligation to provide health facilities to employees or retired employees, as held by the Apex Court in Surjit Singh v. State of Punjab and Others reported at 1996 (1) Services Law Reporter 786 and in Narender Pal Singh v. Union of India & Ors. reported at 79 (1999) Delhi Law Times 358. The LPA preferred in the case of Narender pal Singh v. Union of India & Ors. (Supra) has also been disposed of with the appellant/Delhi Administration making the payment of reimbursement of expenses to a retired employee of Delhi Administration with costs.

10. Petitioner has also opted for the new scheme, which is sought to be made out and offered to pay the subscription for life. Reference may also be invited to the decision of the Division Bench in Union of India v. T.S Oberoi and Smt. Raj Chawla (CM.No Nill in LPA.NO 898/2002), decided on 7.11.2003 wherein the claimant/Intervenor was held entitled to reimbursement of medical expenses, incurred prior to acquiring life membership under CGHS. It was held while dealing with the case of a constitutional appointee that once life membership was accepted it had to relate back from the date of hospitalization and the benefit cannot be restricted from the date of membership. In the present case, it is held that in view of the Resolutions of MCD, adopting the policy, circulars and instructions of Central Government and NCT of Delhi and the application of CSMA Rules, the substantive right to claim reimbursement of expenses on treatment, which was not available in municipal hospitals stood accrued to the petitioner with effect from March, 1997, the date of implementation of the benefit for Delhi Administration employees and pensioners.

11. In view of the foregoing discussion, the writ petition is allowed. A writ of mandamus shall issue to the respondents to pay the sum of Rs. 77,002.40 within a period of one month, failing which the petitioner would also be entitled to interest @ 9% per annum on the said amount in future.