Shyam Sunder v. Indian Council Of Agricultural Research

HONBLE MR. SANJEEV KAUSHIK , MEMBER (J) The applicant has filed this Original Application for quashing the order dated 15.02.2013 (Annexure A-1)) vide which his claim for full medical reimbursement has been declined and for issuance of direction to the respondents to reconsider the issue and allow him full medical expenses incurred on treatment of his wife to the tune of Rs.2,32,055/- along with interest in accordance with CS (MA) Rules, 1944 and judgments of the Principal Bench of this Tribunal, New Delhi.

2. The applicant pleads that his wife underwent medical treatment in Indraprastha Apollo Hospital, New Delhi, in emergency and ultimately declared dead on 23.8.2006. The applicant incurred an expenditure of Rs.2,32,055/- on her treatment. The applicant submitted the same for reimbursement to the respondents who sanctioned only a sum of Rs.1,34,103/- on package rate basis. The claim of applicant is that the medical reimbursement cannot be restricted in view of rule 3, 6 & 8 of C.S (M.A) Rules, 1944 which talks of full reimbursement and identical view has been taken by this Tribunal in the celebrated case of R.P. Mehta Vs. Union of India etc. holding that unless genuineness of the claim is disputed, one is entitled to full medical reimbursement. The applicant filed representations for full reimbursement which were rejected vide order dated 15.2.2013 (Annexure A-1) hence this Original Application.

3. The respondents have resisted the claim of the applicant by filing a detailed reply. They submit that the applicant could get treatment of his wife at the Government Hospital or in case of such facility was not available, she could have been referred to PGIMER, Chandigarh, / PGI, Rohtak or AIIMS, New Delhi. However, the applicant took her to a private hospital and his claim was restricted as per rules and admissible amount has been paid to him. In such like cases only package rates are to be allowed which has since been paid to the applicant and as such the claim of the applicant in this O.A. merits dismissal.

4. The learned counsel for the applicant has placed reliance decisions of C.A.T. Principal Bench in the cases of Sohanbir Singh Vs. Union of India (O.A.No. 1603/2007) decided on 19.12.2007; Dr. M.A. Haque Vs. Secretary, Ministry of Environment & Forest, Govt. of Punjab, (O.A.No. 179/2007) dated 4.12.2007 and K.P. Singh Vs. Govt. of NCT, Principal Secretary Health & another, (O.A.No. 821 of 2007 decided on 28.9.2007 (A-3) & O.A.No.1439/2011  Smt. Gayatri Devi Vs. Govt. of NCT of Delhi decided on 3.5.2012 (A-7) to claim that the applicant is entitled to full medical reimbursement. On the other hand learned counsel for the respondents placed reliance on O.A.No. 335-PB-2013 (Prem Kumari Vs. Union of India & Others) decided on 7.1.2014 to claim that in the facts and circumstances of this case one can be allowed medical reimbursement at package rate only.

5. We have heard learned counsel for the parties at length and examined the material on the file with the able assistance of learned counsel for the respective parties.

6. We need not delve over the issue any more as an identical plea came to be raised in O.A.No.1046-PB-2013 titled Banarsi Dass Gupta Vs. Union of India & Others, in which only package rate of medical reimbursement was allowed by a Single Bench of this Tribunal on 23.10.2013 in the following words :- From the material on record, it is seen that the courts/tribunals have time and again held that the retired Government officials not residing in CGHS areas are entitled to avail medical care in emergency from privately managed health institutions and get the same reimbursed to the extent of rates prescribed under the CGHS Scheme. This is also the position taken in OA No. 401/PB/13 titled Surjit Kaur Vs. UOI and Ors. decided on 7.8.2013. It is also clear that in view of OM dated 20.1.2011 issued by Government of India, Ministry of Health and Family Welfare, medical claim of the applicant should be allowed as per the rates prescribed by the CGHS. Accordingly, the impugned order is quashed and set aside. The respondents are directed to reimburse the medical claim of the applicant as per the rates prescribed by the CGHS. Exercise in this regard, may be carried out within a period of two months from the date of certified copy of this order being served upon the respondents No. 2 & 3

7. Similarly, in the case of Avtar Singh Jassal versus Union of India & Ors in O.A.No.260/PB/2010, the applicant therein had availed of treatment in a private hospital and the respondents were directed to reconsider his case for grant of medical reimbursement on package rates prescribed by the respondents and prevalent in the government. In the case of Suinderjit Sharma versus Union of India & Ors (O.A.No.17/PB/2012) also, the applicant was held entitled to reimbursement of medical expenses at PGI rates. Even recently, this Bench of the Tribunal in O.A.No. 335-PB-2013  Prem Kumari Vs. Union of India & Others, decided on 7.1.2014 has taken the same view.

8. The Principal Bench of this Tribunal in O.A.No.3721/2012  R.K.Bhatia, IAS (Retd.) Vs. Secretary, Ministry of Health etc. decided on 6.5.2013 has also considered issue of full reimbursement and held as under :- 6. In Ram Lubhaya Baggas case (supra), a three judge bench of the Honble Apex Court while observing that right to life is not merely a right enshrined under Article 21 of the Constitution of India, but an obligation cast on the State to provide this both under Article 21 and Article 47 of the Constitution, held that the right can be put within reasonable limits under the policy which is framed after taking into consideration various factors, and upheld the policy restricting reimbursement of medical expenses as per the rates fixed by the Government. However, on the peculiar facts and circumstances of that case, allowed Escorts rates (i.e., as charged by a non-empanelled private hospital) by observing that it would not be treated as precedent.

7. In Mahesh Kumar Sharmas case (supra), a two judge bench of the Honble Apex Court, while interpreting the Rajasthan Civil Service (Medical Attendance) Rules, 1970 and following the Judgment in Ram Lubhaya Bagga (supra), upheld the decision of the appellant therein in restricting the reimbursement up to a certain limit, but by noticing that the applicant therein have already reimbursed full medical expenses to the respondent therein and to various others, directed not to effect any recoveries, in the facts of the said case.

8. In Suman Rakhejas case (supra), a two judge bench of the Honble Apex Court observing that the appellant therein undergone the treatment in a non-recognized/approved private hospital in an emergency, directed the respondents therein to reimburse 100% medical expenses at the AIIMS rates and 75% of expenditure in excess thereto.

9. In Smt. Gauri Sen Guptas case(supra), the Honble Gauhati High Court, after considering the case of Ram Lubhaya Bagga (supra), directed the respondents to reimburse the entire medical claim of the petitioner therein, in the facts of the said case.

10. In Shakuntlas case (supra), the Honble High Court of Punjab and Haryana, held that denial of medical reimbursement only on the ground that treatment was not taken from the approved hospital is bad since emergency knows no law and saving the life of a person should be paramount consideration.

11. It is to be noted that the Ram Lubhaya Baggas case (supra) is of a three judge bench and the two judge bench in Suman Rakhejas case (supra), without noticing the Baggas Judgment passed orders for reimbursement of medical expenses in excess of AIIMS rates. Another two judge bench of the Honble Apex Court in a recent case of Mahesh Kumar Sharma, followed Baggas Judgment. In view of the settled legal position, the judgment in Ram Lubhaya Baggas case (supra) is binding and applicable. Hence, the action of the respondents in reimbursing the medical expenses claim of the applicant, only to the extent of admissible amount as per the package rates in terms of OM dated 17.08.2010 (Annexure R1), cannot be interfered with. No other valid reason is also shown to take any different view in the matter.

9. The extracted portion of judgment makes it clear that courts have held that no doubt right to life is not merely a right enshrined under Article 21 of the Constitution of India but carries an obligation for the State to provide this both under Article 21 and Article 47 of the Constitution but such right can be put within reasonable limits under the policy which is framed after taking into consideration various factors including the financial constrains of the State to bear the expenditure and under the garb of providing free medical aid one cannot claim that whatever amount is spent by him, he is entitled to reimbursement. It can only be done if an employee is able to prove that treatment for a particular disease is not available in any of the government hospitals. Even policy restricting reimbursement of medical expenses as per the rates fixed by the Government has also been upheld [State of Punjab & Others v. Ram Lubhaya Bhagga, etc., 1998 (2) SLR 220]. Thus, the various authorities cited on behalf of applicant qua full reimbursement would not apply to the facts of this case.

10. In view of the above discussion, this Original Application is dismissed.

11. The parties are left to bear their own respective costs. (SANJEEV KAUSHIK) MEMBER(J) (RAJWANT SANDHU) MEMBER (A) Place: Chandigarh Dated: 3.11.2014 O.A.NO.1504-HR-2013