Kerala High Court
Rephy T.H. vs State Of Kerala on 4 March, 2021
IN THE HIGH COURT OF KERALA AT ERNAKULAM
PRESENT
THE HONOURABLE MR. JUSTICE DEVAN RAMACHANDRAN
THURSDAY, THE 04TH DAY OF MARCH 2021 / 13TH PHALGUNA, 1942
WP(C).No.18509 OF 2016(K)
PETITIONER:
REPHY T.H., AGED 49 YEARS
W/O.K K ABDUL SALAM KAYAMKULAM, THOPPIL HOUSE,
ARAVATHOOR P O, KOCHU KADAVU, MALA 680734
SRI.BABU KARUKAPADATH
SMT.AMRIN FATHIMA
SRI.MITHUN BABY JOHN
SRI.K.A.NOUSHAD
SRI.J.RAMKUMAR
SRI.N.SATHEESH KUMAR(NEMMARA)
SMT.M.A.VAHEEDA BABU
SHRI.P.U.VINOD KUMAR
RESPONDENTS:
1 STATE OF KERALA
REPRESENTED BY ITS SECRETARY, GENERAL EDUCATION
DEPARTMENT, GOVERNMENT SECRETARIAT,
THIRUVANANTHAPURAM 695001
2 DISTRICT MEDICAL OFFICER
THRISSUR 680001
3 DEPUTY DIRECTOR OF EDUCATION
THRISSUR 680001
4 THE ADMINISTRATIVE ASSISTANT
OFFICE OF THE DEPUTY DIRECTOR OF EDUCATION, THRISSUR
680001
SRI.SUNIL KUMAR KURIAKOSE-GP
THIS WRIT PETITION (CIVIL) HAVING BEEN FINALLY HEARD ON
04.03.2021, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:
WP(C).No.18509 OF 2016(K)
2
JUDGMENT
Dated this the 4th day of March 2021
The petitioner says that while she was working as a Full
Time Arabic Teacher in the "Sree Krishna Vilasam Lower
Primary School", Aravathoor, she submitted a claim for
medical reimbursement on account of cardiac arrest suffered
by her husband - Sri.Abdul Salam. She says that the medical
claim was supported by the necessary Essentiality Certificate
issued by the Professor and Head of the Department,
Cardiothoracic Surgery, Medical College, Kozhikode, who has
certified that all the medicines and articles shown in the bills
are essential for the treatment of Sri.Abdul Salam.
2. The petitioner alleges that in spite of this, the District
Medical Officer has rejected more than 90% of the claim,
saying that the medicines and articles mentioned in the bills
and supported by the Essentiality Certificate were not
permissible. The petitioner, therefore, prays that Ext.P3,
which sanctions only an amount of Rs.5,875/- against the total
claim of Rs.83,419/-, be set aside and the Authorities be
directed to grant her the entire amount as claimed by her.
WP(C).No.18509 OF 2016(K)
3. In response to the afore submissions made on behalf
of the petitioner by her learned counsel Sri.P.Hisham, the
learned Senior Government Pleader - Sri.P.M.Manoj submitted
that a counter affidavit has been filed on record, wherein, the
following have been stated:
"It is submitted that the petitioner has submitted
medical reimbursement application for the treatment
of her husband amounting to Rs.83,419/- in 3 rd
respondent office. As per the rules and conditions in
connection with the Medical reimbursement claim the
essentiality certificate and original bills are submitted
to the District Medical officer, Thrissur for verification
of admissibility of medicines and its cost. Accordingly
the essentiality certificate and the medical bills
provided by the petitioner had sent to the 2nd
respondent for verification. As per the Kerala
Government Servants Medical Attendance Rule 1960,
the petitioner was eligible for reimbursement on the
basis of admissibility of medicines as verified by the
District Medical Officer.
In the case in hand the 2nd respondent, the
District Medical Officer, Thrissur had verified the bill
and the essentiality certificate produced by the
petitioner. There is a limit for sanctioning of the bill
on verification by the District Medical Officer ie.,
between Rs.10,000/- to Rs.1,00,000/-. The petitioner's
claim falls within that limit. On the basis of
verification report and the proceedings have issued for
sanctioned bill on the basis of admissibility of the
petitioner claim as verified by the District Medical
Officer. As far as this office is concerned no intimation
was received from the District Medical Officer with
regard to the insufficient fund in the State Exchequer
to honour the claim of the petitioner. Therefore,
reimbursement was sanctioned on the basis of
approval made by the District Medical Officer,
Thrissur. Hence there is no merit in the contentions
made by the petitioner is liable to be dismissed."
WP(C).No.18509 OF 2016(K)
4. The learned Senior Government Pleader submitted
that since the claim had to be vetted by the District Medical
Officer as per the applicable Government Orders, the
Authorities could not have released anything more than what
has been permitted by the said Authority and that, as is
evident from Ext.P3, only an amount of Rs.5,875/- had been
found eligible by the said Medical Officer. The learned Senior
Government Pleader, therefore, prayed that this writ petition
be dismissed.
5. I notice that this Court had earlier issued an interim
order directing the petitioner to place on record the
pharmacological names of the medicines and the character of
the articles mentioned in the bills and supported by Ext.P4
Essentiality Certificate and that the petitioner has done so
through a memo dated 28.07.2017. In the said memo, the
petitioner has enumerated the chemical composition of the
various medicines and its pharmacological names; and
Sri.P.Hisham asserts that, going by the same, the respondents
were obligated to allow the entire claim, supported by Ext.P4
Essentiality Certificate, without any reduction therefrom.
6. When I examine the materials available on record, it is
WP(C).No.18509 OF 2016(K)
clear that this Court will not be in a position - it being
completely bereft of any expertise in this field - of verifying
whether the earlier opinion of the District Medical Officer
denying the claim for the articles and medicines shown in
Ext.P4 to be credible or otherwise.
7. I, therefore, asked the learned Senior Government
Pleader whether Ext.P4 Essentiality Certificate and the claim
of the petitioner can be re-verified by a competent Authority
to which, he fairly conceded that the present District Medical
Officer, who is different from the one who had taken a decision
earlier, will be in a position to do so; and that if he finds that
the claim of the petitioner can be granted fully or partially, the
same can then be acceded to by the competent Authorities.
8. Taking note of the afore submissions and since I am of
the certain view that this is the best course available to the
petitioner, I order this writ petition and direct the incumbent
District Medical Officer to reconsider Ext.P4 Essentiality
Certificate in the light of the details provided by the petitioner
in the memo dated 28.07.2017, after affording her an
opportunity of being heard - either physically or through video
conferencing - thus culminating in an appropriate decision
WP(C).No.18509 OF 2016(K)
from his side as to what extent the claim of the petitioner
must be allowed.
9. This exercise shall be completed by the District
medical Officer as expeditiously as is possible, but not later
than two months from the date of receipt of a copy of this
judgment and he will then forward his opinion to the third
respondent - Deputy Director of Education, Thrissur, without
any avoidable delay thereafter.
On the opinion of the District Medical Officer thus
reaching him, the Deputy Director of Education, Thrissur, will
process the same and pay the balance amount, if any, due to
the petitioner within a period of one month thereafter.
Sd/- DEVAN RAMACHANDRAN
Stu JUDGE
WP(C).No.18509 OF 2016(K)
APPENDIX
PETITIONER'S EXHIBITS:
P1 A TRUE COPY OF THE RELEVANT PORTION OF THE GO(P)NO
45/97/H & FWD DTD 18/2/1997 PROVIDING THAT FOR
CORONARY, ARTERY BY-PASS SURGERY, RS 1,00,000/-IS
ADMISSIBLE AS TREATMENT CHARGES
P2 A TRUE COPY OF GO(MS)NO 378/2012/H & FWD DTD
7/11/2012
P3 A TRUE COPY OF THE ORDER DTD 1/3/2016 OF THE 4TH
RESPONDENT
P4 A TRUE COPY OF THE RELEVANT PORTION OF THE
ESSENTIALITY CERTIFICATE WHICH WAS VERIFIED BY THE
2ND RESPONDENT, A COPY OF WHICH WAS SUPPLIED BY THE
3RD RESPONDENT TO THE PETITIONER
P5 A TRUE COPY OF THE FORM EVIDENCING RECEIPT OF AN
AMOUNT OF RS.5,875/- SANCTIONED BY THE DEPARTMENT
TOWARDS THE MEDICAL REIMBURSEMENT CLAIM SUBMITTED
BY THE PETITIONER
