ORDER
The petitioner has filed the instant petition under Article 226 of the Constitution of India challenging the legality and validity of the orders dated 15.4.2021, Annexure P-4, 26/7/2021 Annexure P-2 issued by respondent No.4, 28/2/2022 Annexure P-10 issued by respondent No.3, 13/4/2022 Annexure P-11 and 11/7/2022 Annexure P-12 issued by respondent No.4 whereby the respondents have partly sanctioned the amount of medical reimbursement.
2. It is submitted that the denial of the remaining amount of medical reimbursement is illegal and contrary to the Rules called M.P Civil Services (Medical Attendance) Rules, 1958. The petitioner is further aggrieved by non payment of medical reimbursement to the tune of Rs.9,18,187/- incurred to the petitioner for the period 1/3/2021 to 23/9/2021 in CHL hospital, Indore and a sum of Rs.3,00,000/- towards expenses incurred in getting treatment on 8/6/2021 in Global Dental Center, Indore.
3. The respondents have filed reply. The paras 4&5 of the said reply are reproduced as under:-
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4. That, the answering respondents most humbly and respectfully submitted that the petitioner has raised claim of medical reimbursement of. expenses. incurred by him in receiving treatment of post Covid-19 complications including Mucormycosis (Black Fungus) for the period 18.10.2020 to 27.11.2020 to the tune of Rs. 32,60,000/- and as per rules answering respondents vide order dated 15.04.2021 (AnnexureP/4) has sanctioned the amount to the tune of Rs.27,28,851/- as per provisions mentioned under the Madhya Pradesh Civil Services (Medical Attendance) Rules, 1958.
5 It is most humbly submitted that the petitioner raised claim for reimbursement of a sum of Rs. 15,01,822/- addressed to the office of Regional Director, Health Services, Ujjain Division, Ujjain and the respondent No. 4 approved and sanctioned amount to the tune of Rs. 14,62,613/- as per provisions mentioned under the Madhya Pradesh Civil Services (Medical Attendance) Rules, 1958. That, clause-7 of the Madhya Pradesh Civil Services (medical attendance) 1958 provides definition of hospitals, for the ready reference of this Hon'ble Court same is being reproduced as under:-
"Hospital" means a hospital : maintained the State Government or by a local authority or any other hospital aided by the State Government or such private hospital as - may be recognized as'hospital for purposes of these rules and includes a maternity home."
4. It is stated that the petitioner claims for reimbursement of Rs.17,85,391/- from various private hospitals was forwarded by Civil Surgeon cum Hospital Superintendent, Ujjain vide communication dated 11/11/2021 to the Regional Director and the matter of the petitioner was forwarded to Commissioner, Health Services, Bhopal due to abnormal high amount of reimbursement and the decision was taken vide orders dated 13/4/2022 and 11/7/2022 in which it is stated that the petitioner is not entitled for the reimbursement of OPD medical expenses of private hospitals as per the Rules of 1958.
5. Upon perusal of the Rules, 1958 filed as Annexure R-1 and referring Rules 4 & 7 of the said rules this Court finds that the OPD Medical expenses are not excluded in the reimbursement of private hospitals.
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(VIJAY KUMAR SHUKLA)
JUDGE
6. Counsel for the petitioner submits that even otherwise the aforesaid bills are not of OPD medical expenses. The petitioner was hospitalized and was undergoing treatment for the aforesaid period. According to the petitioner, the remaining amount of medical reimbursement of private hospital is Rs.19,17,949/- which is evident from Annexure P-8, Annexure P-9, Annexure P-10 and Annexure P-12.
7. Counsel for the State submits that out of the said amount further reimbursement amount was paid.
8. Considering the aforesaid submissions and Rules 4 & 7 of the Rules, 1958, the impugned orders dated 15.4.2021, 26.7.2021, 28.2.2022, 13.4.2022 & 11.7.2022 are quashed. The respondent No.4 is directed to examine the medical bills regarding reimbursement of the petitioner and shall ascertain the actual due amount to the petitioner and after ascertaining the same, it shall be paid to the petitioner forthwith. The aforesaid exercise be carried out by the respondent No.4 within four weeks' from the date of filing of the order passed today.
9. With the aforesaid present petition is allowed and disposed off.
PK
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