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2010 DHC 1479
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2010 DHC 1479
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Smart Summary

Factual and Procedural Background

The petitioner, a retired District Employment Officer from Delhi Cantt, suffered a heart attack on 2nd April 2005 and incurred substantial medical expenses for treatment and surgery at Amar Leela Hospital and Sir Ganga Ram Hospital. Despite paying the medical bills and applying for reimbursement from the respondents, his requests were repeatedly rejected on grounds related to his non-membership in a medical scheme. The petitioner subsequently filed a petition under Article 226 of the Constitution of India seeking directions for reimbursement of his medical expenses.

Legal Issues Presented

  1. Whether a retired government employee is entitled to medical reimbursement despite not having opted for or being a member of the relevant medical scheme before or after retirement.
  2. Whether the respondents are obligated to reimburse medical expenses incurred by the petitioner under the constitutional and legal framework governing retired government employees’ medical benefits.

Arguments of the Parties

Respondents' Arguments

  • The respondents contended that under the applicable rules and the revised medical scheme announced by the Delhi Government, the petitioner was not entitled to medical reimbursement as he did not opt to become a member of the scheme after retirement.
  • The scheme is prospective, and benefits accrue only to those who have enrolled; since the petitioner had not become a member prior to his treatment, reimbursement is not due.

Petitioner's Arguments

  • The petitioner relied on prior judgments of this Court, including V.K Jagdhari v. Union of India & Ors, Government of NCT of Delhi v. Som Dutt Sharma, and S.K Sharma v. Union of India, which established that retired employees cannot be denied medical reimbursement merely for not opting into the scheme before treatment.
  • He argued that the entitlement to medical reimbursement is independent of scheme membership and that the respondents’ refusal violated established legal principles and constitutional obligations.

Table of Precedents Cited

Precedent Rule or Principle Cited For Application by the Court
S.K Sharma v. Union of India, 2002 (64) DRJ 620 Retired employees cannot be denied medical reimbursement for non-membership in the scheme. Confirmed the entitlement of the petitioner despite non-membership, establishing that scheme membership is not a prerequisite for reimbursement.
V.K Jagdhari v. Union of India & Ors, 125 (2005) DLT 636 Medical reimbursement entitlement is not lost if pensioner opts for CGHS card after treatment. Supported the petitioner’s claim that late scheme membership does not disentitle reimbursement.
Government of NCT of Delhi v. Som Dutt Sharma, 118 (2005) DLT 144 (DB) Employees entitled to reimbursement even if membership under scheme is not processed. Reinforced the principle that reimbursement is due regardless of scheme membership processing status.
Mohinder Pal v. Union of India, 117 (2005) DLT 204 Retiree entitled to benefits of the medical scheme even if membership is not processed. Applied to confirm entitlement to reimbursement independent of formal membership.
Milap Singh v. Union of India & Anr., 113 (2004) DLT 91 Full medical expenses must be reimbursed; government and hospital to settle correct amount. Guided the court to order full reimbursement of the petitioner’s medical expenses.
Ran Deep Kumar Rana v. Union of India, 111 (2004) DLT 473 Full reimbursement of medical expenses by employer. Supported the principle of full reimbursement applicable to the petitioner.
P.N Chopra v. Union of India, 111 (2004) DLT 190 Reimbursement due if hospital is in approved list. Applied to validate petitioner’s claim as the hospitals were approved.
B.R Mehta v. Union of India, 79 (1999) DLT 388 Full reimbursement due regardless of cardholder status. Confirmed petitioner’s entitlement despite not being a cardholder at the time of treatment.
V.K Gupta v. Union of India & Another, 97 (2002) DLT 337 Retired employee’s status independent of scheme membership for medical benefits. Supported the petitioner’s position that entitlement is not dependent on scheme rules.
Narender Pal Singh v. Union of India, 79 (1999) DLT 358 Government obliged to grant ex post facto sanction for emergency specialty treatment. Applied to justify reimbursement for emergency treatment incurred by the petitioner.

Court's Reasoning and Analysis

The Court examined the petitioner’s entitlement in light of established precedents which collectively affirm that retired government employees cannot be denied medical reimbursement solely due to non-membership in the medical scheme. The Court emphasized that the entitlement to medical benefits is independent of scheme membership status and that the Government has a constitutional obligation under Article 21 to bear medical expenses of government employees even after retirement. The Court found the respondents’ reliance on the scheme’s prospective nature and membership conditions to be contrary to settled law and previous authoritative judgments. The Court noted the respondents’ failure to comply with legal obligations despite clear precedents, deeming their stance as legally untenable and inhuman. It concluded that the petitioner’s claim for reimbursement was valid and must be honored with interest and costs.

Holding and Implications

The petition is allowed.

The respondents are directed to pay the petitioner’s medical claim along with 18% interest from the date of bill submission within one month from the date of the order. Additionally, costs of Rs. 10,000/- are imposed on the respondents for the delay. This decision directly enforces the petitioner’s right to medical reimbursement despite his non-membership in the scheme and reaffirms the principle that retired government employees cannot be denied medical benefits on such grounds. No new precedent was set; rather, the Court applied and reinforced existing legal principles.

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    Kishan Chand v. Govt. Of Nct & Ors.

    Kailash Gambhir, J. (Oral)— By the present petition filed under Article 226 of the Constitution of India, the petitioner seeks directions to direct the respondents for reimbursement of the medical expenses incurred by the petitioner.

    2. A conspectus of facts as set out by the petitioner relevant for deciding the present petition are that the petitioner was serving as District Employment Officer, North-West, Kirby Place, Delhi Cantt and retired on 30th April, 2001. On 2.4.2005, the petitioner got a heart attack and was admitted in Amar Leela Hospital, Janak Puri, New Delhi and was discharged on 7.4.2005 The petitioner had paid Rs. 18,000/- to the said Hospital on his discharge and had also spent Rs. 1274/- for the purchase of medicines. But, yet again on 8.4.2005 the petitioner suffered severe chest pain and breathlessness and was admitted to Sir Ganga Ram Hospital, New Delhi and underwent a by pass surgery on 9.4.2005 and paid an amount of Rs. 1,25,032/- towards the bill raised by the said hospital. On 2.5.2005, the petitioner filed an application with the respondent No. 2 requesting them to issue medical facility card and an amount of Rs. 9000/- was deposited by the petitioner towards subscription money. Thereafter, the medical facility card was issued to the petitioner and on 5.7.2005, the petitioner moved an application to the District Employment Officer (NW) for reimbursement of his medical bills which vide order dated 29.8.2005 was rejected. Again, on 17.3.2006 the petitioner moved an application which was disallowed vide letter dated 28.7.2006, and yet again on 22.8.2006, the petitioner moved an application which was dismissed vide letter dated 9.11.2006 Hence feeling aggrieved by the aforesaid circumstances, the petitioner has now approached this Court for relief by way of filing of the present petition.

    3. On the last date of hearing, Ms. Sonia Sharma, Counsel appearing for Govt. of NCT of Delhi took an adjournment on the ground that the respondent shall pay the necessary amount towards the medical reimbursement of the petitioner before the next date. Ms. Sonia Sharma today submits that such instructions were given to her by Mr. Vijay Sharma, Employment Officer, employed with respondents No. 2 and 3. Today, Mr. Umrao Singh, Employment Officer and Mr. A.K Sharma, Superintendent with respondent No. 1 submit that under the relevant rules, the respondents are not obliged to grant the medical reimbursement to the petitioner. Ms. Sonia Sharma, Counsel further submits that under the revised scheme announced by the Delhi Government vide office memorandum dated 25th October, 2007 it was for the petitioner to have opted for the scheme and once having not become a member of the said scheme, the petitioner is not entitled to the medical reimbursement. Counsel further submits that the scheme is prospective in nature and the same would be effective once an employee becomes a member of the scheme and not otherwise. The contention of Counsel for the respondent is that since the petitioner on his retirement failed to opt for the said scheme, therefore, he is not entitled to the benefit of the same.

    4. On the other hand, Counsel for the petitioner placed reliance on the judgment of this Court in the case of V.K Jagdhari… v. Union Of India & Ors…, 125 (2005) DLT 636. The petitioner also placed reliance on the judgment of the Division Bench of this Court in Government of NCT of Delhi v. Som Dutt Sharma, 118 (2005) DLT 144 (DB) and S.K Sharma v. Union of India, 2002 (64) DRJ 620.

    5. I have heard Counsel for the parties.

    6. The issue is no more res integra as in the case of S.K Sharma (supra), this Court clearly held that the petitioner after getting retired cannot be denied the benefit of the medical reimbursement simply because of the fact that he did not opt for the said scheme. In this case also the claim of the employee was rejected on the ground that he was not covered under the CGHS Rule not being a part of the scheme but still a retired Central Government employee residing in non-CGHS area can make a CGHS card for himself and his dependent family members from the nearest centre where CGHS is functional. Further placing reliance on some authoritative pronouncements of the Apex Court, this Court in the above case took a view that the petitioner cannot be discriminated against, merely because he is not a member of the CGHS scheme as he was staying in a non-CGHS area. In this case also the employee had applied to become a card holder later in the period.

    7. In the case of V.K Jagdhari (supra), which has been relied by the petitioner, a similar question arose before the Court and objection was taken that since the employee had opted for the CGHS card after his surgery, therefore, he was clearly disentitled to the claim of reimbursement. Answering the said question in negative, the Court clearly held that the pensioner cannot be discriminated against merely because he has not opted for CGHS scheme or he resides outside a non-CGHS area. Taking into consideration the ratio of the judgments in the S.K Sharma (supra) and Som Dutt Sharma (supra) case, this Court consolidated the legal position and held that:

    “The position emerging from various decisions of this Court may be summarised as follows—

    (1) Even if employee contributes after availing medical facilities, and becoming member after treatment, there is entitlement to reimbursement (DB) Govt. of NCT v. S.S Sharma, 118 (2005) DLT 144.

    (2) Even if membership under scheme not processed the retiree entitled to benefits of Scheme—Mohinder Pal v. UOI, 117 (2005) DLT 204.

    (3) Full amounts incurred have to be paid by the employer; reimbursement of entire amount has to be made. It is for the Government and the hospital concerned to settle what is correct amount in Milap Singh…Petitioner v. Union Of India & Anr.…S, 113 (2004) DLT 91; Ran deep Kumar Rana v. UOI: 111 (2004) DLT 473

    4. The pensioner is entitled to full reimbursement so long the hospital remains in approved list P.N Chopra v. UOI, (111) 2004 DLT 190

    (5) Status of retired employee not as card holder: S.K Sharma v. UOI, 2002 (64) DRJ 620;

    (6) If medical treatment is availed, whether the employee is a cardholders or not is irrelevant and full reimbursement to be given, B.R Mehta v. UOI, 79 (1999) DLT 388.”

    The status of a retired Government Employee was held to be independent of the scheme and rules insofar as the entitlement to medical treatment and/or CGHS benefits were concerned (ref. V.K Gupta. v. Union Of India & Another, : 97 (2002) DLT 337). Similarly in Narender Pal Singh v. Union of India, 79 (1999) DLT 358, this Court had held that a Government was obliged to grant ex post facto sanction in case an employee requires a specialty treatment and there is a nature of emergency involved.”

    8. It is quite shocking that despite various pronouncements of this Court and of the Apex Court the respondents in utter defiance of the law laid down have taken a position that the pensioner is not entitled to the grant of medical reimbursement since he did not opt to become a member of the said health scheme after his retirement or before the said surgery undergone by him. It is a settled legal position that the Government employee during his lifetime or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights on the pretext that he has not opted to become a member of the scheme or had paid the requisite subscription after having undergone the operation or any other medical treatment. Under Article 21 of the Constitution of India, the State has a constitutional obligation to bear the medical expenses of Government employees while in service and also after they are retired. Clearly in the present case by taking a very inhuman approach, these officials have denied the grant of medical reimbursement to the petitioner forcing him to approach this Court. The respondents did not bother even after the judgment of this Court was brought to their notice and copy of the same was placed by the petitioner along with the present petition.

    9. In the light of the aforesaid, the present petition is allowed.

    10. The respondents are directed to pay the said medical claim of the petitioner along with 18% interest from the date of submission of his bill. The said payment shall be made by the respondent within one month from the date of this order. Additional costs of Rs. 10,000/- is also imposed on the respondents for causing delay in making the said payment to the petitioner.

    Writ Petition allowed.
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    Comments

    Kishan Chand v. Govt. Of Nct & Ors.
    (Mar 12, 2010)