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Smart Summary

Background:

The case at hand involves a petition challenging the order of the Central Administrative Tribunal (CAT) which granted medical reimbursement to the respondent for expenses incurred due to heart surgery. The respondent filed an Original Application (O.A.) seeking reimbursement for medical bills associated with this surgery.

Facts:

1. The respondent underwent heart surgery on March 25, 2000.

2. The respondent became a member of the relevant medical reimbursement scheme on September 14, 2000.

3. The petitioner contended that since the surgery occurred before the respondent's enrollment in the scheme, the reimbursement should not be granted.

Legal Issues:

The primary legal issue revolves around the interpretation of the medical reimbursement scheme and whether the timing of the respondent's surgery in relation to his membership in the scheme constitutes grounds for denying reimbursement.

Arguments:

Petitioner’s Argument:

- The petitioner, represented by Counsel Mrs. Avnish Ahlawat, argued that the CAT’s order was legally flawed. The petitioner contended that the respondent was not entitled to reimbursement since the surgery took place prior to his enrollment in the scheme, thereby violating the scheme's provisions.

Respondent’s Argument:

- The respondent argued that the provisions of the scheme should be applied in a manner that does not unjustly deny him the benefits for medical expenses incurred, particularly in light of the urgency of medical care.

Tribunal’s Findings:

The Central Administrative Tribunal found no merit in the petitioner’s argument. It ruled that the principles of fair application of the scheme should prevail, and the timing of the respondent's surgery did not preclude him from receiving the necessary reimbursement for medical expenses. The Tribunal emphasized the need for equitable treatment under the scheme, regardless of the specific enrollment date.

Conclusion:

The Court upheld the decision of the Central Administrative Tribunal, finding no legal infirmities in its order. The petitioner's claims were dismissed, and the Court ruled that there was no sufficient ground to interfere with the Tribunal's decision.

Decision:

Outcome:

Writ Petition dismissed.

Implication:

The ruling reinforces the importance of equitable treatment in the application of administrative schemes, particularly in urgent medical situations.

    Government Of Nct Of Delhi & Ors. v. Som Dutt Sharma .

    Vijender Jain, J.— This petition has been filed challenging, inter alia, the order of the Central Administrative Tribunal, granting relief to the respondent, in O.A filed by him for medical reimbursement of bill pertaining to heart surgery undergone by him.

    2. Mrs. Avnish Ahlawat, learned Counsel for the petitioner has vehemently contended that the impugned order is bad in law as it has not taken into consideration that the respondent became a member of the scheme on 14.9.2000 whereas he had undergone heart surgery on 25.3.2000 At first blush, the argument seems logical, but as we analyse the scheme and its purport, the argument becomes fallacious. The scheme is at page 13 of the paper book. It is for the persons who are working with the Govt. of NCT of Delhi as well as the pensioners of the Govt. of NCT of Delhi. Admitted position is that the respondent retired from service on 31.8.1997 whereas the scheme came into existence on 1.4.1997 Page 21 is the letter dated 12.8.1997, which clinches the issue in question. The relevant paragraph is reproduced as follows:

    “The concerned scheme is not applicable to teachers and is also optional for other non teaching staff. If any staff members desirous of not opting for the scheme he or she should give her/his option in this regard immediately, failing which it will be presumed that all the employees (Except teaching staff) have opted for the scheme and deductions be made accordingly as per circular dated 13.3.97”

    3. From the perusal of aforesaid paragraph, the only stipulation in the scheme is that the scheme was not applicable to teachers and was also optional for other non teaching staff. In the aforesaid paragraph, there is a negative covenant, inter alia, stating that those persons who are not desirous of opting the scheme should give his/her option in this regard, failing which it was presumed that the employee had opted for such scheme. Therefore, there is no question of respondent not opting for the scheme as nothing was filed on record as to whether information of the scheme was sent by the petitioner to the respondent.

    4. An argument was raised by the learned Counsel appearing for the petitioner that these are public schemes and there was a deemed service of the notice on the respondent. We fail to appreciate this argument of the petitioner. Even the scheme itself is not published by a notification nor by general publication. It was only a copy of the letter received from Officer on Special Duty (Medical), Deptt. of Medical and Public Health, Govt. of NCT of Delhi regarding scheme for providing medical facilities to the employees/pensioners of Govt. of NCT of Delhi. Nothing was placed on record by the petitioner before the Tribunal as to how this scheme was brought to the notice of the pensioners. If a scheme is formulated for the benefit of pensioners and other employees and there is a covenant which says that scheme is applicable until and unless the beneficiary opts out, the scheme is applicable to all employees and pensioners. The argument that the contribution was paid by the respondent in 2000 is of no significance. Under the scheme. It was the petitioner who had to deduct the contribution from the pension of the respondent.

    5. Taking into consideration that the scheme was for the benefit of the pensioners like respondent, the petitioner was expected to give a humane and sympathetic treatment to their pensioners. Non-application of their own scheme for reimbursement of medical expenses is against the provision of the scheme formulated by the petitioner as has been rightly held by the Tribunal. We find no infirmity with the order passed by Central Administrative Tribunal.

    6. No ground to interfere.

    Dismissed.

    Writ Petition dismissed.
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    Government Of Nct Of Delhi & Ors. v. Som Dutt Sharma .
    (Jan 23, 2005)