Mangat Ram Petitioner v. State Of Haryana And Others S

AUGUSTINE GEORGE MASIH, J. (ORAL)

Petitioner has approached this Court, praying for quashing of order dated 12.1.2012 (Annexure P-9) being violative of Haryana Government instructions dated 30.11.1993, according to which if an employee takes treatment from an unrecognized/unauthorized Institution, he would be entitled to reimbursement at the rates admissible to All India Institute of Medical Sciences, New Delhi plus 75% of the expenditure in excess thereof in accordance with the policy decision dated 30.11.1993, which instructions have not been taken into consideration by the respondents. In support of this contention, counsel has placed reliance upon the Division Bench judgement of this Court reported as Baldev Kishan Khanna v. State of Haryana, 2006 (3) SLR 791.

On the other hand, counsel for the respondents has submitted that on the date when the petitioner was operated upon i.e 19.6.2010 and till his discharge from Medanta, the Medicity Hospital, Gurgaon, the said Hospital was not approved/recognized by the Government of Haryana as an Institute from which reimbursement for the medical expenses would be made. The said approval was only granted to the said Hospital on 23.2.2011, which is subsequent to the date when the petitioner had already been discharged. His further submission is that as per the Haryana Government instructions/policy, the petitioner has already been paid the medical reimbursement to the extent of PGI rates and, therefore, no further amount is to be paid to the petitioner. In support of this contention, he has placed reliance upon three decisions of the Supreme Court i.e State of Punjab v. Ram Lubhaya Bagga, 1998 (1) SCT 716, State of Karnataka v. Sri. R. Vivekananda Swamy, 2008 (2) SCT 756 and State of Rajasthan v. Mahesh Kumar Sharma, 2011 (2) SCT 482.

I have considered the submissions made by counsel for the parties and with their assistance have gone through the records of the case.

The facts, as have been narrated above, are not in dispute. The petitioner had got his treatment done from Medanta, the Medicity Hospital, Gurgaon, which was admittedly, on the date when he was admitted and was operated upon and thereafter discharged, not an approved hospital from which full medical reimbursement could be drawn. However, lateron vide decision dated 23.2.2011, the said hospital was approved for full medical reimbursement.

Respondent-State is not disputing the fact that the petitioner was operated upon and remained admitted in Medanta, the Medicity Hospital, Gurgaon, and took treatment from there. This is further fortified from the fact that the reimbursement at the PGI rates has been made to the petitioner. Therefore, the only question, which requires to be decided by this Court, is whether the petitioner is entitled to the benefit of the instructions dated 30.11.1993, on which the claim is based by the petitioner.

This would, in the considered opinion of this Court, go in favour of the petitioner in the light of the observations made in Paras 3 and 4 of the Division Bench judgement of this Court in Baldev Kishan Khanna's case (supra), which read as under:-

“We have heard learned counsel for the parties and are of the view that while passing order dated 14.11.2003 (R-2) instructions dated 30.11.1993 (Annexure P-2) issued by the respondents have not been kept in view which provide that the amount spend on heart disease if exceed the rates of All India Institute of Medical Sciences, New Delhi/P.G.I would be reimbursed to the extent of 75% and rest of the amount of 25% has to be borne by the employee himself. The matter is no longer res integra as the Division Bench of this Court in CWP No. 6462 of 1999 decided on 29.7.1999 has taken a view that the employee like the petitioner would be entitled to reimbursement at the rates admissible by All India Institute of Medical Sciences, New Delhi plus 75% of the expenditure in excess thereof in accordance with the policy adopted by the respondent State. In that case also the defence pleaded was that the surgery had not been performed by a recognized institution. A similar objection has been pressed before us that FORTIS Hospital is not a recognized institution and, therefore, the clause concerning payment of 75% is not applicable to the case of the petitioner.

4. The aforementioned contention cannot be accepted in view of the aforementioned decision taken by the Division Bench of this Court. In any case, the respondents have now recognized the FORTIS Hospital, Mohali as is evident from letter dated 31.10.2002 (Annexure R-3).”

The petitioner would, thus, be entitled to the benefit, as has been granted in Baldev Kishan Khanna's case (supra).

The judgements, on which reliance has been placed by counsel for the State apparently are those in which it has been stated that medical reimbursement claim is based upon the policy instructions of the Government and an employee can only get benefit to the limited extent as is permissible under the said policy. There can be no quarrel with the proposition as laid down by the Hon'ble Supreme Court in those judgements. However, in the present case, the instructions dated 30.11.1993, when taken into consideration, entitles the petitioner to the claim as has been made by him in the present writ petition.

Accordingly, the present writ petition is allowed and the impugned order dated 12.1.2012, Annexure P-9, is quashed to the extent that full reimbursement was not made to the petitioner. Petitioner is held entitled to the benefit of instructions dated 30.11.1993 and would be, thus, reimbursed the remaining balance amount of 75% over and above the PGI rates as per the abovesaid policy. The amount be disbursed to the petitioner within a period of two months from the date of receipt of certified copy of this order.