RANJIT SINGH J.
C.M No. 6584 of 2009
Application allowed.
Policy taken on record.
Civil Writ Petition No. 4373 of 2009
It is rather unfortunate to notice that poor employees have to approach this Court for getting their medical expenses reimbursed. It is further sad to notice that even the authorities do not themselves apply their mind to such cases by keeping in view the instructions and for this people have to fight for seeking such like claims.
The petitioner, who is working as Ahlmad in District Court at Faridabad, had incurred expenses of Rs. 1,41,940/- for treatment of his father at Metro Heart Institution Hospital, Faridabad. Rs. 1,00,000/- out of this claim was satisfied by the insurance company. The petitioner accordingly submitted the bill of Rs. 41,940/- to be paid to him. In lieu of this, however, the petitioner was paid Rs. 17,440/-, on the ground that he is entitled as per AIIMS/PGI rates. The petitioner has placed on record a policy instructions on the subject, which provides that as per the policy instructions, dated 11.8.1992, all medical expenses incurred on chronic diseases at indoor and outdoor are to be reimbursed full. Still the claim of the petitioner is being contested on the ground that the amount claimed has been paid and nothing is due.
I am not impressed with the stand taken by the respondents that the petitioner himself has reduced his amount of medical reimbursement to Rs. 17,440/-, which has been paid to him. The real thing will come out from Annexure R-4, which gives out that the clarification was obtained from the Health Department and thereafter the final bill amounting to Rs. 17,940/- was sent. Apparently, what seems to have happened is that the petitioner was apprised of this clarification that he is only entitled what is payable as per AIIMS/PGI rates. So guided, the petitioner appears to have reduced this amount. It is required to be seen if the petitioner is entitled to the amount claimed. Since the father of petitioner was suffering from chronic disease and had undergone a bye pass surgery, he would be entitled to the full reimbursement of the amount spent by him in terms of the instructions, which has been now placed on record. Even the view taken by the Division Bench in the case of Mukesh Kumar Gupta v. Chairman, Pepsu Road Transport Corporation Patiala and others 2007 (4) S.C.R 89, would cover the prayer made in the writ petition. It has clearly been held that the petitioner, who had undergone bye pass heart surgery in Escort Hospital and spending some amount including the amount on the post indoor treatment, would be entitled to full reimbursement. This view has been taken on the basis of judgment of the Supreme Court. The relevant observation in this regard is as under:
“The matter is no longer res integra as in similar facts and circumstances, this Court after considering the instructions dated 1.9.2000 and other subsequent instructions has held that an employee is entitled to reimbursement of medical bills incurred by him on treatment of his complicated chronic disease. The views of the Division Bench is based on various judgments of the Hon'ble Supreme Court in the cases of Chameli Singh v. State of U.P, (1996) 2 SCC 549, All India Imam Organisation and others v. Union of India and others, 1993 (3) SCT 531 : (1993) 3 SCC 584 and other cases. We are further of the view that the issue is also covered by another judgment of the Hon'ble Supreme Court in the case of Surjit Singh v. State of Punjab, 2005 (2) SCT 136 (P&H).
The prayer made in the writ petition is thus not only covered by the policy instructions but also by the judgment of this Court. The petitioner is, accordingly, held entitled to full amount of Rs. 41,940/- as a reimbursement for the medical expenditure incurred by him. The remaining amount due to him be also released within a period of two months from the date of receipt of copy of this order.
The writ petition is accordingly disposed of.
September 07, 2009 (RANJIT SINGH) rts JUDGE