Gurcharan Singh vs Union Of India & Others
2010 Latest Caselaw 263 Del

*            IN THE HIGH COURT OF DELHI AT NEW DELHI

+                          W.P.(C.) No. 56/2008

%                     Date of Decision: 19th January,2010


#     GURCHARAN SINGH
                                                                .....PETITIONER

!                     Through:   Mr.K.K. Mehrotra, Advocate.

                                      VERSUS

$     UNION OF INDIA & OTHERS
                                                             .....RESPONDENTS

^                     Through:   Mr. B.V. Niren, Advocate.


CORAM:
Hon'ble MR. JUSTICE S.N. AGGARWAL

1. Whether reporters of Local paper may be allowed to see the judgment? YES

2. To be referred to the reporter or not? YES

3. Whether the judgment should be reported in the Digest? YES

S.N.AGGARWAL, J (ORAL) The petitioner before his death was a CGHS beneficiary. He died

during the pendency of the present writ petition filed for directions to the

respondents to reimburse medical expenses incurred by him on the

treatment of his wife in Sir Ganga Ram Hospital firstly on 02.07.2005 and

again on 03.08.2005. After his death on 29.04.2008, his widow Smt.

Surjeet Kaur was substituted as his legal heir vide order passed by this

Court on 21.10.2008.

2 The only short question that arises for consideration in the present

writ petition is whether the petitioner was entitled for reimbursement of

medical expenses at the scale of approved rates approved by the

Government in 2001 or was he entitled to reimbursement of actual

expenses charged by the Hospital from him in 2005 for the treatment of

his wife.

3 Briefly stated the facts of the case giving rise to the above question

are that the wife of the petitioner was admitted in Sir Ganga Ram

Hospital on an emergency call on 26.05.2005 and she was got discharged

from the Hospital on 02.07.2005 upon payment of Rs.31,557/- against Bill

No.0149876 dated 02.07.2005. As per the petitioner, he got his wife

discharged from the Hospital on 02.07.2005 as permission for treatment

in Sir Ganga Ram Hospital was not taken from the concerned CGHS

dispensary before her admission in view of emergency on 26.05.2005.

The petitioner after getting his wife discharged from the Hospital on

02.07.2005 approached the concerned CGHS dispensary which referred

his wife for further procedure to Sir Ganga Ram Hospital vide approval

granted on 04.07.2005. Upon such approval being granted by the CGHS

dispensary to the petitioner, he got his wife admitted again in Sir Ganga

Ram Hospital for operation of removal of her kidney on 13.07.2005 where

she underwent treatment till 03.08.2005. She was discharged from the

Hospital on 03.08.2005 upon payment of Rs.1,73,391/- by the petitioner

against Bill No.0155711 dated 03.08.2005.

4 The petitioner after treatment of his wife as stated above submitted

his medical claim for reimbursement of expenses of Rs.1,73,391/- and

Rs.31,557/- incurred by him for the treatment of his wife in Sir Ganga

Ram Hospital. These bills were partly paid by the respondents. Against

expenses of Rs.31,557/- incurred by the petitioner and paid by him in the

Hospital on 02.07.2005, the respondents paid him Rs.14,365/- only and

deducted Rs.17,192/-. Against the medical bill of Rs.1,73,391/- paid by

the petitioner for the treatment of his wife to the Hospital on 03.08.2005,

the respondents paid him only an amount of Rs.67,553/- and deducted an

amount of Rs.1,06,038/- out of the said bill.

5 As per the petitioner, he was entitled to reimbursement of

expenses incurred by him on the treatment of his wife to the full extent

because according to him, the rates approved by the respondents in

2001 could not have been applied for treatment taken by the petitioner

for his wife in 2005.

6 The respondents in their counter affidavit filed in response to the

present petition have taken a stand that the medical expenses have been

reimbursed to the petitioner as per Policy of the respondents relating to

reimbursement of medical claims. The respondents have referred to an

order of Hon'ble Supreme Court dated 20.03.2007 in Civil Appeal No.

319/2001 titled UOI & Others Vs. Nunihal Singh in support of their

defence that the petitioner was entitled for reimbursement of his medical

claim in terms of rates approved by the respondents in 2001.

7 I have heard the learned counsel for both the parties and have

given my anxious consideration to their rival arguments advanced before

me.

8 Mr. K.K. Mehrotra, learned counsel appearing on behalf of the

petitioner, has argued that his client cannot be deprived of the payment

charged by the Hospital for the treatment of his wife and according to the

learned counsel, it is for the respondents to deal with the Hospital

regarding the rates charged by it. As against this argument advanced on

behalf of the petitioner, Mr. Niren, learned counsel appearing on behalf of

the respondents, relying upon the above referred order of the Hon'ble

Supreme Court has argued that the petitioner was entitled to

reimbursement of medical claim as per Policy of the respondents to

reimburse medical claims as per rates approved by it in 2001. Mr. Niren

has further argued that the Government undertakes the exercise of

updating the approved rates after every five years and since according

to him, in the present case the rates were revised in 2001 and as the

petitioner had taken treatment for his wife in 2005 during the currency of

the approved rates, he was entitled for reimbursement only as per

approved rates of 2001. Mr. Niren has further submitted that the

petitioner cannot take the benefit of revised rates of 2006.

9 On giving my anxious consideration to the above rival arguments

advanced by the learned counsel for the parties, I have not been able to

persuade myself to agree with the arguments advanced on behalf of the

respondents. The judgment of the Hon'ble Supreme Court referred to and

relied upon by the learned counsel appearing on behalf of the

respondents is not applicable to the facts of the present case. In that

case, the Hon'ble Supreme Court has upheld the Policy of the

Government for reimbursement of medical claims of CGHS beneficiaries.

In that case also, the Hon'ble Supreme Court had granted it approval to

the full reimbursement of medical expenses incurred by the medical card

holder in that case. On a perusal of the order of the Hon'ble Supreme

Court on which reliance is placed by the counsel for the respondents, the

date on which the treatment was taken by the medical card holder is not

borne out. It is not clear whether the treatment was taken by the medical

card holder in that case close to a date when rates were approved by the

Government. In the present case, the treatment was taken by the

petitioner for his wife in Sir Ganga Ram Hospital on the recommendations

of the concerned CGHS dispensary after more than four years of the rates

approved by the Government in 2001.

10 In K.P. Singh Vs. Union of India & Others (2001) 10 SCC 167 ,

directions were given by the Supreme Court to the Government to

up-date its approved rates on an annual or at least on biennial basis. It

seems that the said directions given by the Hon'ble Supreme Court to the

Government were not heeded to by the Government as the Court has

been informed that instead of up-dating the approved rates on an annual

or biennial basis, the Government has undertaken an exercise for

revising the approved rates after 2001 in 2006 only. This clearly shows

that the Government is acting in defiance of the directions of the Hon'ble

Supreme Court on the subject. There are any number of judgments both

of this Court and also of the Hon'ble Supreme Court where a duty has

been cast upon the Government to up-date its approved rates from time

to time. Once a CGHS beneficiary is recommended for treatment in an

approved hospital on the list of the Government, then he cannot be

denied the reimbursement of expenses actually incurred by him unless

the beneficiary opt of his own to go for a luxury treatment and incur

expenses beyond the approved rates of the Government for a normal

treatment. It is not the case of the respondents that the petitioner in the

present case had taken any such luxury treatment for his wife for which

claim was made by him. In the opinion of this Court, the respondents

acted arbitrary and without any justification in denying the medical claim

made by the petitioner in regard to actual payment made by him to the

Hospital for the treatment of his wife. Reference can be made to some of

the judgments of this Court in Jai Prakash Vs. Union of India 2007 (6) AD

Delhi 518; Ram Niwas Jain Vs. Central Government Health Scheme

2007 (139) DLT 237 and B.R. Goel Vs. Union of India 2007 (1) AD Delhi

341.

11 In view of the foregoing and having regard to the facts and

circumstances of the present case, this writ petition is allowed and the

respondents are hereby directed to make balance payment towards

medical claim made by the petitioner for treatment of his wife after

adjusting the payment already made to him. The balance payment be

made by the respondents to the widow of the deceased petitioner within

six weeks from today failing which the respondents shall be liable to pay

interest on the balance amount @ 12% per annum till the date of actual

payment.

JANUARY 19, 2010                                    S.N.AGGARWAL, J
'A'