High Court of Punjab and Haryana, Chandigarh
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Avtar Singh v. Uttar Haryana Bijli Vitaran Nigam - CWP-16913-2005  RD-P&H 1845 (21 March 2006)
IN THE HIGH COURT OF PUNJAB AND HARYANA AT CHANDIGARH
CWP No. 16913 of 2005
Date of Decision: 29.03.2006
Avtar Singh ..Appellant
Uttar Haryana Bijli Vitaran Nigam
Coram: Hon'ble Mr. Justice H.S.Bedi,
Hon'ble Mr. Justice Vinod K.Sharma,
Present: Mr. S.M.Sharma, Advocate,
for the petitioner.
Mr.Amandeep Hooda, Advocate,
for the respondents.
Vinod K.Sharma, J.
Avtar Singh petitioner by way of present writ petition has sought a writ of mandamus for re-imbursement of the medical expenses CWP No. 16913 of 2005 (2)
incurred for treatment of his wife at Sir Hurkisondas Nurrotumdas Hospital and Research Centre, Mumbai for being operated upon and has also sought quashing of order dated 31.5.2005 vide which his claim was rejected by the Managing Director, Uttar Haryana Bijli Vitran Nigam (hereafter called the Nigam), Panchkula on the ground that the treatment was taken from a private hospital without taking advice of the authorities of the Government Hospital.
The facts leading to the filing of the present petition are that the petitioner is employed as Assistant Line Man in the office of the Sub Divisional Officer of the Nigam at Chour Mastipur, Ambala. Wife of the petitioner, Smt. Kamaljit Kaur, while in Mumbai on his visit to her parents house developed problem pertaining to heart and being a case of emergency she was taken to Brihan Mumbai Mahanagar Palika Hospital on 11.10.2004. The illness was diagnosed as acute heart problem and she was advised admission. However,since that hospital did not have adequate arrangement for immediate operation she was admitted in T.N.Medical College and B.Y.L. Nair Hospitals, where she remained admitted up to 27.10.2004. However, as her problem deteriorated further, she was admitted in Sir Hurisondas Nurrotumdas Hospital and Research Centre, Mumbai CWP No. 16913 of 2005 (3)
where facilities for operation were available and she was operated upon on 29.10.2004 and in the process expenses to the tune of Rs.1,31,954/- as per details given in Annexure P.4 to the writ petition were incurred on her treatment. The petitioner accordingly submitted his claim for medical reimbursement along with essentiality certificate attested by Dr.S.M.Doshi who was doctor in-charge of the wife of the petitioner.
The policy of the Government framed for medical reimbursement has been upheld by the Hon'ble Supreme Court in case State of Punjab and others Vs. Ram Lubhaya Bagga and others 1998 (2) RSJ
313. The State of Haryana has also framed a policy which is made applicable to the Universities, Municipal Committees, Market Committees, State Boards and Corporations and thus the policy for reimbursement of medical expenses was applicable to the employes of the Nigam.
The Nigam has adopted the policy of the reimbursement of medical expenses and by way of Memo. No.CH/50/UH/GA/Reg-70 dated 11.12.2002 issued instructions relating to medical claim for treatment from Non-Government/ Non recognised Hospitals in emergency, relevant portion of which reads as under:
"The issue regarding medical claim for treatment from Non CWP No. 16913 of 2005 (4)
Government/ Non recognised Hospitals in emergency was discussed by the WTDs in their meeting held on 21.11.2002 on the basis of instructions issued by HVPNL and DHBVNL and it has been decided as under:
"The medical claims for the treatment taken in emergency from Non-Government/ Non recognised Hospitals shall hence forth be submitted to SE/ Admn. by all the employees/ retirees. The SE/Admn. shall forward such claims to Chief Medical Officer for examination whether the medical claim falls within the definition of emergency treatment and treatment has been taken from a hospital of repute fulfilling the criteria/ qualification for providing emergency treatment. In those cases where the Chief Medical Officer is satisfied that the medical claim falls in the ambit of emergency treatment and also fulfills the qualification of a hospital prescribed for emergency treatment, the medical claim shall be submitted to the competent authority for consideration and approval in relaxation of rules.
Sd/ Under Secretary/GA
for MD/UHBVN, Panchkula"
CWP No. 16913 of 2005 (5)
It was on the basis of these instructions the petitioner had submitted the claim for reimbursement of medical expenses which was rejected by the Nigam merely on the ground that no prior sanction was taken from the authorities of the government Hospital. While passing the impugned order the authorities have not taken note of the fact that it was a case of emergency and therefore, the petitioner was not in a position to have obtained the permission from the Government authorities especially when the emergency developed while the wife of petitioner was at Mumbai. The matter regarding reimbursement of medical expenses in the case of emergency was considered by this Court in the State of Punjab Vs. Prem Kumar 2001 (4) SCT 404 wherein it was held as follows: "7 It is settled principle of law that in given circumstances a Government employee maybe left with no option but to take treatment from a hospital,which is nearby in the case of emergency. If that be so, it will be totally unjust and unfair to deny the claim of reimbursement to the plaintiff merely because the hospital was not recognised by the State Government for treatment of its employees. Once it is established as a matter of fact that the plaintiff had met with an CWP No. 16913 of 2005 (6)
accident and, he received the treatment then his claim for reimbursement cannot be denied on the ground put forward by the learned counsel for the State in regard to non-recognition of the hospital, which otherwise is a hospital of repute. The plaintiff had discharged his onus in this regard. A right to life would obviously include such a protection to the Government employee as emergency of the kind as indicated in the facts of the present case leaves the employee with no option but to take treatment in a nearby hospital. Resultantly, I see no reason to interfere in this finding arrived at by the learned Courts below" The Hon'ble Supreme Court in Suman Rakheja Vs. State of Haryana and another (2004) 13 Supreme Court Cases 562 approved the decision of this Court in case of Sant ParkashVs. State of Haryana (CWP No.599 of 19P98) wherein the medical reimbursement was ordered to be given for treatment in non-recognised hospital. The relevant part of judgment by Hon'ble Supreme Court reads as under: "4. Counsel for the appellant submitted that in similar case (Annexure P.4) i.e. by the order of the High Court of Punjab and Haryana in Sant Prakash Vs. State of Haryana wherein in CWP No. 16913 of 2005 (7)
an emergency case the patient had to be immediately admitted in hospital,the relief has been granted. In the present case also the appellant's husband had to be rushed to the private hospital because he had developed a paralytic stroke on the left side of the body, as there was blood clotting on the right side of the brain and therefore, was admitted in an emergency condition in the hospital. In the present case the discharge certificate also shows that the case as an emergency one. In Sant Prakash case the Division Bench held that the petitioner therein would be entitled to 100% medical expenses at the AIIMS rates and 75% of the expenditure in excess thereto." Learned counsel appearing for the respondents in support of the impugned order submitted that the treatment given to the wife of the petitioner was not of such a nature which required emergency treatment and, therefore,it was necessary to take prior approval from the authorities of the Government Hospital. However, we do not agree with this contention of learned counsel that it was not a case of emergency. The facts of the case reveal that the condition of the wife of the petitioner had deteriorated and needed immediate attention Thus, we find that the order Annexure P.7 is CWP No. 16913 of 2005 (8)
totally arbitrary and has been passed without taking into consideration the facts of the case which deserves to be quashed. However, we made it clear that the petitioner would only be entitled to the PGI/AIIMS rate for treatment.
Accordingly, we accept the present writ petition and quash the order Annexure P.7 rejecting the claim of the petitioner and issue a direction to respondent Nos. 1 and 2 to reimburse the medical bills/claims of the petitioner at the rates applicable to the PGI/ AIIMs within 2 months from the receipt of a certified copy of this order.
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