Harpal Kaur vs Dtc And Anr.
2007 Latest Caselaw 1033 Del

JUDGMENT

Hima Kohli, J.

1. The petitioner has filed the present writ petition praying inter alia for directions to the respondent/DTC to pay the balance sum of Rs. 1,02,251/- incurred by the petitioner for her medical treatment.

2. In a nutshell, the facts of the case are that the petitioner, who is working as a Store Attendant at the dispensary of the Wazirpur Depot of the respondent/DTC, suffered from cardiac arrest on 21.4.2004 and immediately thereupon, she was rushed by her neighbours to the nearest hospital i.e. Amar Leela Hospital, from where she was taken by her family members to Batra Hospital on the same day. At Batra Hospital, the petitioner underwent treatment of angiography, angioplasty and other procedures, and was discharged by the said hospital on 24.4.2004 The total bill raised by the hospital upon the petitioner was for a sum of Rs. 2,42,170/- which amount was duly paid by the petitioner.

3. The petitioner claimed reimbursement of the medical expenses incurred by her at the Batra Hospital from the Respondent No. 1. As against a claim of Rs. 2,41,970/- the respondent/DTC sanctioned the medical reimbursement to the tune of Rs. 1,39,919/- and released the said amount to the petitioner on 24.9.2004 But the balance amount was not released to her.Aggrieved by the refusal to pay her balance bills for a sum of Rs. 1,02,251/- towards medical reimbursement, the petitioner made a representation to the Chairman of the respondent/DTC on 01.11.2004 The said representation was rejected by the respondent/DTC, vide letter dated 2.3.2005, on the ground that her case for reimbursement of the entire amount of specialized medical bill of Rs. 2,41,970/- was not payable as it did not come within the purview of the judgment referred to by the petitioner in the case of Milap Singh v. Union of India and Anr. reported as .

4. The respondent/DTC in its counter affidavit has taken a stand that the DTC has adopted and enforced the circulars with regard to medical facility issued by the Govt. of NCT of Delhi, respondent No. 2 herein, which has in turn adopted the rate list revised and formulated by the Govt. of India to its employees. Under the said new policy, the employees are given free choice to get treatment in any private hospital in Delhi (listed with the Corporation) but the amount of reimbursement is regulated by fixing the rate list.

5. Counsel for the respondent/DTC refers to circulars dated 12.11.2003 and 19.8.2003. In the circular dated 12.11.2003, the respondent noted that the CGHS rates have been enforced in DTC for reimbursement against specialized treatment cases under Office Order of the Govt. of NCT of Delhi dated 19.8.2003, where the CGHS rates have been revised with the approval of the Govt. of India. It was further noted that the said rates were duly approved by the Chairman-cum-Managing Director of the respondent/DTC for implementation, vide his decision dated 15.9.2003. The second circular dated 19.8.2003, regarding revision of rates under DGHS, Delhi for specialized and general purpose treatment and diagnostic procedures and fixation of package/ceiling rates in respect of Govt./private hospitals/diagnostic centres, etc., was issued in partial modification of the earlier circular dated 25.10.2002 revising the rates circulated for various treatments vide earlier O.M. Dated 7.9.20001. Clause (c) of Item 2 of the said circular specifies that the claims of the members shall be restricted in accordance with the rates approved under the scheme and Clause (c) of Item 5 of the said circular stipulates that the DGHS beneficiaries/members taking treatment in the recognized hospitals of the DGHS will be entitled for reimbursement as per the package rates given in Annexure-A to the said circular.

6. Learned Counsel for the respondent/DTC submits that in view of the aforesaid circulars, the respondent/DTC was justified paying the rates as per the package rates for the hospital. It is further stated that the petitioner was first admitted in Amar Leela Hospital and as the said Hospital was not covered under the health scheme of the respondent/DTC, no reimbursement in respect of expenses incurred there could be claimed by the petitioner. Counsel for the respondent has relied upon the following judgments in support of the stand of the respondent that the policy of the Government for fixation of the rates and scales is justified and no State of any country can have unlimited resources to spend on any of its projects:

1. State of Punjab and Ors. v. Ram Lubhaya Bagga and Ors. reported as ; and

2. State of Punjab and Ors. v. Mohan Lal Jindal reported as .

7. Learned Counsel for the petitioner contended that the rejection of the petitioner's claim for full reimbursement of medical expenses incurred by her is unreasonable and unfair as the same is based on actual expenses incurred by the petitioner for her medical treatment undergone at a speciality hospital duly recognised by the respondent. In support of his case, counsel for the petitioner relied upon the following judgments:

1. J.K. Saxena v. Govt. of NCT of Delhi reported as ; and

2. Milap Singh v. Union of India and Anr. reported as .

8. I have heard learned Counsels for the parties and have also perused the record. It is now settled law that right to health is an integral part of the right to life and that it is the duty of the State to bear the expenditure incurred by a Government servant suffering from ailments which require treatment at approved speciality hospitals. Reliance in this regard can be placed on the judgment of the Supreme Court in the case of State of Punjab and Ors. v. Mohinder Singh Chawla reported as , relevant extract of which is reproduced hereinbelow:

Para 4: ...It is now settled law that right to health is integral to right to life. Government has constitutional obligation to provide the health facilities. If the Government servant has suffered an ailment which requires treatment at a specialized approval hospital and on reference whereas the Government servant had undergone such treatment therein, it is but the duty of the State to bear the expenditure incurred by the Government servant. Expenditure, thus, incurred requires to be reimbursed by the State to the employee. The High Court was, therefore, right in giving direction to reimburse the expenses incurred towards room rent by the respondent during his stay in the hospital as an inpatient.

9. In the present case, as the petitioner has not claimed any reimbursement of medical expenses incurred by her in respect of treatment undertaken at Amar Leela Hospital where she was taken first before being shifted to Batra Hospital there is no merit in the contention of the respondent that the payment made by the petitioner to the aforesaid hospital cannot be disbursed by the respondent, as the same was not covered under the health scheme of the respondent. On perusal of the bills annexed with the writ petition, it is apparent that the petitioner has claimed for reimbursement of the bills issued by the Batra Hospital which is apparently a recognized hospital for specialized treatment by the respondent. Concededly, the petitioner had undergone treatment at the aforesaid Hospital on an emergent basis and bills had been raised by the said Hospital on the petitioner for treatment rendered to her, for angiography, angioplasty and other procedures. Therefore, the only question that arises for consideration is that whether the respondent is justified in denying payment of full medical reimbursement to the petitioner in the present case.

10. Once the respondent has itself recognized the hospital concerned, from where the petitioner took treatment, as an approved hospital for specialized treatment, there is no justification for the respondent to deny the petitioner full reimbursement on the basis of charges as the petitioner incurred over and above the package rates which the respondent has agreed upon with the hospital. The plea of the respondent that the respondent is bound by the terms and conditions laid down in the Office Memorandum dated 19.8.2003 for making reimbursement of charges for treatment of angiography, angioplasty and other procedures in respect of the private recognized hospital in terms of the said memorandum, is liable to be turned down as it is the very same private hospital recognized and duly approved by the respondent which has charged rates over and above the prescribed package rates.

11. Thus, if the respondent has reservations with regard to the rates charged by the hospital in question, it is for the respondent to take up the issue with the hospital. However, this plea cannot be permitted to be taken by the respondent for defeating the claim of the petitioner for reimbursement in terms of the package duly offered to the petitioner. The respondent is under an obligation to pay such charges as the petitioner has incurred over and above the prescribed package rate fixed at the concerned hospital. This, however, does not preclude the respondent from recovering the said amounts over and above the rate required to be charged by the private recognized hospitals, from the concerned hospital itself.

12. The petitioner cannot be deprived of her right to reimbursement of the entire amount incurred by her on account of her treatment. Reference made by the respondent to the judgment of the Supreme Court in the case of Ram Lubhaya Bagga (supra) can be of no help in this case as the respondent has itself permitted the petitioner to take medical treatment at a duly recognized private hospital. Once package rates to be charged by the private recognized hospitals have been fixed by the respondents, there is no reason whatsoever to contend that the difference in the rates prescribed and those charged by the private hospital is to be borne by the Government servant. In this regard, reference may be made to the following judgments:

1. Mohinder Singh Chawla (supra);

2. Narendra Pal Singh v. Union of India and Ors. reported as 1999 III AD (Delhi) 769;

3. M.G. Mahindra v. UOI reported as 92 (2001) DLT 59

4. V.K.Gupta v. UOI reported as

5. Sq. Commander Randeep Kumar Rana v. Union of India reported as 111 (2004) DLT 463 (DB);

6. Prithvi Nath Chopra v. Union of India and Anr. reported as 111 (2004) DLT 190;

7. Keshav Kishore Sharma v. Municipal Corporation of Delhi reported as ;

8. K.S. Mathew v. Union of India and Anr. reported as 122 (2005) DLT 450; and

9. R.D. Gupta v. DDA and Ors. reported as .

13. For the reasons stated hereinabove, the writ petition is allowed. The respondent No. 1 is directed to reimburse the petitioner for the full amount paid by her to Batra Hospital for the treatment of angiography, angioplasty and other procedures, in terms of the medical reimbursement bills issued by the hospital for a sum of Rs. 2,42,170/-, within a period of six weeks, after deducting the amount of Rs. 1,39,919/- already released by the respondent No. 1 in favor of the petitioner.

No orders as to costs.