Delhi High Court
Daljit Singh vs Govt. Of N.C.T. Of Delhi & Ors. on 10 January, 2013
Author: Valmiki J. Mehta
* IN THE HIGH COURT OF DELHI AT NEW DELHI
+ WP(C) No.16651/2006
% January 10, 2013
DALJIT SINGH ...... Petitioner
Through: None.
versus
GOVT. OF N.C.T. OF DELHI & ORS. ..... Respondents
Through: Ms.Sujata Kashyap, Adv. for R-1.
CORAM:
HON'BLE MR. JUSTICE VALMIKI J.MEHTA
To be referred to the Reporter or not?
VALMIKI J. MEHTA, J (ORAL)
1. The petitioner was an employee of the Government of NCT
of Delhi as he retired from the post of a superintendent from the District
Courts, Delhi on 31.5.1995. The petitioner holds the valid medical
facility card No.17604 issued by the respondent No.1. The petitioner
went through CABG heart operation in the Escorts Heart Institute at New
Delhi on 30.5.2002 by informing the District and Sessions Judge office in
advance on 22.5.2002. For the treatment and operation of the petitioner a
total amount of Rs.2,02,343/- was charged by the Escorts Heart Institute,
however, petitioner was only given a reimbursement of Rs.1,01,746/- by
the respondent No.1, leading to filing of the present petition seeking the
difference of amount not reimbursed.
2. On behalf of the respondent No.1 it is argued that the
petitioner is governed by the CCS (Medical Attendance) Rules, 1944 of
which Rule 8 states that the decision of the Government as to the Medical
Attendance for treatment is final and under the same Rules there is GOI
Decision No.15(A) which provides that the hospitals will be given a
package deal with respect to the treatment for the ailments like heart,
kidney coronary etc. and therefore it is argued that only the package deal
amount can be granted to the petitioner and not the actual medical cost.
3. This issue of whether reimbursement should be of actual
amount or only the package deal amount has been the subject matter of
various decisions of this Court. One such judgment is the judgment of a
learned Single Judge of this Court in Milap Singh vs. Union of India,
2004(113) DLT 91 wherein three earlier judgments of this Court as also
the judgment of the Supreme Court in the case of State of Punjab & Ors.
vs. Mohan Lal Jindal, 2001 (9) SCC 217 were referred. Paras 9 to 14 of
the said judgment read as under:-
"9. The judgment in V.K. Gupta v. Union of India & Anr.,
97(2002)DLT337 is also of a patient treated in the said
Hospital. Once again this Office Memorandum dated
18.09.1996 was considered and it was noticed that the rates
given in the said Memorandum were to be followed for a
period of two years. The Court found that the respondents
have to be more responsive and cannot act in a mechanical
manner to deprive the employees of their legitimate
reimbursement, especially on account of their own failure
in not revising the rates after expiry of the initial period.
The petitioner was held entitled therein for reimbursement
of the full amount.
10. In M.G. Mahindru v. Union of India & Anr. (2001)
DLT 59, it has been held that full reimbursement of
medical expenses to a speciality hospital, which is on an
approved list of CGHS, cannot be denied to a retired
Government servant.
11. It has to be appreciated that in cases of emergency like
that in the present case, ex post facto sanction can always
be granted for specialised treatment. In fact, there is no real
dispute in this behalf and the only issue is to the extent of
the reimbursement made by the CGHS.
12. In State of Punjab & Ors. v. Mohan Lal Jindal
(2001)9SCC217 , the stand of the Government in refusing
to reimburse the in-patient charges for the treatment in the
said Hospital was rejected and the Government was held to
be under a constitutional obligation to reimburse the
expenses since the right to health is an integral to the right
to life.
13. The attention of this Court is also drawn to the
judgment in CWP No. 6658/2002 titled as `V.K. Abbi v.
Director General of Health Services & Anr.' decided on
04.04.2003 on the same issue. It may be noticed that this
judgment has been affirmed in appeal by the Division
Bench in LPA No. 480/2003 decided on 19.09.2003.
14. The undisputed position that emerges is that a patient is
entitled to reimbursement of the full amount of medical
expenses and not only at the rates specified in the circular
of 1996 and in case respondent No. 2 has charged a higher
rate, than could have been charged, it is for respondent No.
1 to settle the matter with respondent No. 2. The petitioner
cannot be deprived of the reimbursement. The observations
in para 26 of Prithvi Nath Chopra's case (supra) are useful
in this behalf, which are as under :-
"26. It can also not be disputed that the Indraprastha
Apollo Hospital has been made available land at token
amount and it was for the respondents to have settled
the amounts of reimbursement at the hospital. If the
respondents have any grievance about the
quantification of the amounts charged, it is for the
respondents to take up the matter in issue with the
Apollo Hospital. But that cannot deprive the petitioner
of full reimbursement of the amount as charged by the
recognised Indraprastha Apollo Hospital. In fact, the
petitioner has been compelled to pay the charges first
and thereafter reimbursement is taking place while the
present policy is stated to be one where the
respondents are directly billed by the approved
hospitals which policy is salutary since the patient
may not at a time have the funds available to first pay
the amount and then claim the reimbursement."
(underlining added).
4. In view of the above it is no longer res integra that merely
because the Government does not revise the package deal amount under
the Medical Attendance Rules from time to time a person cannot be
denied actual medical costs, and there has to be reimbursement of the
actual medical expenses incurred.
5. In view of the above, the writ petition is allowed. The
respondent No.1 is directed to give medical reimbursement to the
petitioner for a sum of Rs.1,41,399/- alongwith interest at 8% per annum
simple from the date of filing of the petition till the date of payment. The
amount be paid within six weeks. Writ petition is allowed and disposed
of accordingly.
VALMIKI J. MEHTA, J
JANUARY 10, 2013
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