Ramesh Chand Shrivastava v. Secretary The State Of Madhya Pradesh

Petitioner, working as Superintendent, in the office of Superintending Engineer, Public Works Department, retired on 31.7.2007 on attaining the age of superannuation. He was detected with the ailment of hypertension and Ischaemic heart disease for that he underwent treatment at Neaji Subhash Chandra Bose Medical College, Jabalpur. That, on 19.8.2008 the physical condition of the petitioner deteriorated, therefore, had to rush to Wockhardt Hospital, Nagpur; wherein he underwent corinary artery bye-pass surgery on 28.8.2008 Petitioner incurred an amount of Rs. 2,02,784/- towards medical expenses.

That, after recovering from his illness petitioner sought reimbursement of medical expenses from the State Government whereon 15.4.2009 he was informed that he will not be entitled for the reimbursement for the reason that medical treatment was taken by him in a private hospital which does not find mention in the list of State recognized hospital. Aggrieved, the petitioner has filed this petition seeking direction to the respondents to reimburse the medical expenses incurred by him.

Issue raised vide this petition as to whether a retired government servant would be entitled for reimbursement of expenses incurred in availing medical treatment in a hospital not in the list of State recognized hospital is no more res integra and has been settled at rest by a decision in State of Madhya Pradesh v. Dr. Vishwanath Prasad Khare [2009 (III) MPJR SN 9]; wherein the Division Bench of this Court while relying upon the decision in State of Karnataka v. R. Vivekanand Swamy(2008) 5 SCC 328 and Suman Rakheja v. State of Haryana - 2006 SCC (L&S) 890 held:

“In the present case, for reimbursement, rules have been framed by the State Government namely Madhya Pradesh Pensioners Welfare Fund Rules, 1997. From a perusal of the said Rules, it appears that there is no provision in the aforesaid Rules, which will de-bar the petitioner from claiming the medical reimbursement on the ground that he has taken the treatment from a hospital, which is not recognized by the State Government. Open heart surgery is also provided in schedule one of the list framed under Rule 6 and thus, it is one of the severe illness, which provides for medical reimbursement. There is no mention of amount in the rules ceiling the expenditure for open heart surgery. On the contrary, it is mentioned that in case of open heart surgery, the matter shall be decided on merits. There is no rule to deny the medical reimbursement on the ground that the hospital, from where the treatment was taken by the employee was unrecognized by the State Government.

On the other hand the Apex Court in the case of Suman Rakheja v. State of Haryana, 2006 SCC (L&S) 890 has laid down that in case of emergency, if a retired government servant rushed to the hospital, which is not recognized then also the State Government is liable to make reimbursement to the extent of 100%.

In view of the aforesaid judgment, we do not find any merit in the appeal. The writ Court has rightly directed to reimburse he entire amount to the petitioner towards medical expenses. Appeal stands dismissed with no order as to costs.”

Single Bench of this Court in another case L.P Sanodia v. The State of M.P - 2010 (4) MPHT 188 further placing reliance on provisions of M.P Civil Services (Medical Attendance) Rules, 1958 held that in case where the government servant has contacted the ailment while in service and had to undergo treatment after his retirement would be entitled for reimbursement. It as observed:

“5. …….. Though sub-rule (3) of Rule 1 of M.P Civil Services (Medical Attendance) Rules, 1958 provides that these Rules shall not apply to a retired Government servant, but in this case fact remains that the ailment occurred before the age of superannuation of the petitioner, he was admitted in the hospital on 15.7.2003 and during the treatment he suffered an operation of Open Heart Surgery and only on 20th September, 2003, he could recover and return to home. Meaning thereby that during treatment in the hospital, petitioner attained the age of superannuation. Though sub-rule (3) of Rule 1 of the Rules provides that the Rules shall not apply to retired employee, but factual position in this case is entirely different when the petitioner was admitted in the hospital on 15.7.2003, he was not retired and during the period of treatment in the hospital, petitioner suffered Open Heart Surgery. In the facts of this case, petitioner cannot be denied with the reimbursement of the medical expenses. …….”

In view whereof the order dated 15.4.2009; whereby the claim of the petitioner for reimbursement of the amount incurred in medical expenses has been rejected is hereby set aside. The respondents are directed to settle the claim of the petitioner within a period of three months from the date of communication of this order.

The petition is allowed to the extent above. No costs. C.c as per rules.