Nandkishore Tiwari vs The State Of Madhya Pradesh
2021 Latest Caselaw 7275 MP

                                                                   1                              WP-20073-2016
                                         The High Court Of Madhya Pradesh
                                                  WP No. 20073 of 2016
                                          (NANDKISHORE TIWARI Vs THE STATE OF MADHYA PRADESH AND OTHERS)

                                 3
                                 Jabalpur, Dated : 11-11-2021
                                       Shri J.K. Tiwari, counsel for the petitioner.
                                       Shri Kaustubh Singh, Panel Lawyer for the respondents-State.

The petitioner before this Court has filed the present petition being aggrieved by the order dated 1.2.2016 passed by respondent No.2 by which claim of the petitioner for reimbursement amount of medical expenses has

been rejected.

It is submitted that the late wife of petitioner Smt. Bina Tiwari was in at employment of Netaji Subhash Chandra Bose Medical College Jabalpur on the post of ANM. She was suffering from Acute Coronary Syndrome, SAH, ruptured Aneurysm, meningitis hence for her better treatment she was taken to SIMS Hospital Nagpur on 6.2.2012 wherein her treatment continued till 21.2.2012. However, due to ailment she passed away during her treatment itself. Total expenses incurred in the medical treatment were Rs.3,95,336/- which was incurred by the petitioner. The petitioner filed an application to the

respondent authorities asking for reimbursement of the amount which has been incurred by him but his application was considered and rejected by the authorities vide impugned order despite being forwarded by the respondent No.3. The respondent No.2 has considered the case of petitioner and has rejected the application by the impugned order pointing out the fact that the case of petitioner was rejected considering the fact that it is of the year 2012 and treatment was taken in an unauthorised institution. It is also considered that the case of petitioner was rejected on earlier occasion also but in terms of the Note mentioned by the Commissioner, the matter was reconsidered.

It is pointed out that with respect to medical urgency the treatment could have been done at any place for which prior permission was not Signature Not Verified SAN required and this Court has considered the aforesaid aspects in several cases

Digitally signed by MOHD IRFAN SIDDIQUI Date: 2021.11.16 11:05:08 IST 2 WP-20073-2016 and the petitions were allowed. The authorities were directed to consider the cases for medical reimbursement. He has placed reliance upon the judgment passed by this Court in the case of Smt. Madu Meena Vs. M.P.P.K.V.V. Co. Ltd. and others in W.P. No.1542/2016 decided on 1.5.2018 and in W.P. No.17408/2017(S) Poonam Chand Pal Vs. State of M.P. and another, decided on 14.8.2019 wherein an identical circumstances the

directions were given to consider the case of the employee for grant of medical reimbursement.

Per contra counsel appearing for the State by filing a return has denied all the contention and has submitted that the case of medical reimbursement of the petitioner was already considered in the year 2012 itself and was rejected but as the learned Commissioner has recommended for reconsideration of the case, the committee has again examined the case of the petitioner and has found it is not tenable as the treatment was done outside from the State from a unrecognized hospital without seeking prior sanctioned. In such circumstances, no case for medical reimbursement is made out. He has prayed for dismissal of the writ petition.

Heard learned counsel for the parties and perused the record. From perusal of the record, it is not disputed that wife of petitioner is suffering from Acute Coronary Syndrome, SAH, ruptured Aneurysm, meningitis and was initially treated at Jabalpur Hospital but subsequently looking to the seriousness of her ailment she was transferred to SIMS Hospital at Nagpur where she continued the treatment for considerable period and ultimately due to prolong ailment she passed away during the treatment. The total medical expenses incurred by the petitioner in her treatment was Rs.3,95,336/- for which the claim was made by the petitioner for medical reimbursement. However, the claim was rejected in the year 2012 but subsequently on the recommendation of Commissioner the same was again considered by the committee and rejected vide impugned order. The legal preposition with respect to the reimbursement of medical expenses in acute Signature Not Verified SAN

Digitally signed by MOHD IRFAN SIDDIQUI Date: 2021.11.16 11:05:08 IST 3 WP-20073-2016 emergency cases was considered by the Supreme Court in the case of State of Karnataka and another Vs. Vivekanand Swamy (2008) 5 SCC 326 wherein the Hon'ble Supreme Court has held as under:-

-In the present case, for reimbursement, rules have been framed by the State Government namely Madhya Pradesh Pensioners Welfare Fund Rules, 1997. From a perusal of the said Rules, it appears that there is no provision in the aforesaid Rules, which will de-bar the petitioner from claiming the medical reimbursement on the ground that he has taken the treatment from a hospital, which is not recognized by the State Government. Open heart surgery is also provided in schedule

one of the list framed under Rule 6 and thus, it is one of the severe illness, which provides for medical reimbursement. There is no mention of amount in the rules ceiling the expenditure for open heart surgery. On the contrary, it is mentioned that in case of open heart surgery, the matter shall be decided on merits. There is no rule to deny the medical reimbursement on the ground that the hospital, from where the treatment was taken by the employee was unrecognized by the State Government.

From perusal of the aforesaid judgment, it is seen that in acute cases of emergency the treatment is taken from the unrecognized institutions then no denial to the medical reimbursement cases can be made only on this aspects that the treatment was taken from an unrecognized institution.

The aforesaid aspects was further considered by the Division Bench of this Court in W.A. No.732/2013 dated 15.5.2014 wherein the Division Bench has held as under:-

-The question has been considered by the Supreme Court in the case of State of Karnataka and another vs. R. Vivekanand Swamy (2008) 5 SCC 328 and again in

Signature Not Verified SAN the case of Suman Rakheja vs. State o f Haryana and

Digitally signed by MOHD IRFAN SIDDIQUI Date: 2021.11.16 11:05:08 IST 4 WP-20073-2016 another, 2006 (Labour & Service) 890 and in the said case, specific reference is made to the M.P. Pensioners Welfare Fund Rules, 1997 and similar objection raised have been rejected. Learned Writ court has referred to the said judgments and reliance placed o n a Supreme Court Judgment by a Coordinate Bench of this Court in the case of State of Madhya Pradesh and others v. Dr. Vishwanath Prasad Khare, 2009 (III) MPJR S N 9, to come to the said conclusion.

Keeping in view the order passed by learned Writ court and the Supreme Court judgments referred to therein, we see no error in the matter warranting consideration.

Accordingly, the writ appeal is dismissed.

The Division Bench taken reliance upon the case of R.

Vivekanand Swamy (supra) has upheld the order passed in Writ Petition and dismissed the appeal filed by the State.

The reliance placed by the petitioner in the case of Smt. Madu Meena (supra) and Poonam Chand Pal (supra) are also applicable to the case of petitioner. In such circumstances, rejecting the case of petitioner for medical reimbursement is unjustified.

The impugned order is hereby quashed.

The matter is relegated back to the authorities for reconsideration of the case of petitioner in the light of judgments pointed out herein above. The case of petitioner for medical reimbursement will not be rejected on the ground that her treatment was taken from an unrecognized institution.

The aforesaid exercise be completed by the authorities within a period three months from the date of receipt of certified copy of this order. Signature Not Verified SAN The authorities are directed to pass a self contained speaking order Digitally signed by MOHD IRFAN SIDDIQUI Date: 2021.11.16 11:05:08 IST 5 WP-20073-2016 after providing opportunity of audience to the petitioner.

C.C. as per rules.

(VISHAL MISHRA) JUDGE

irfan

Signature Not Verified SAN

Digitally signed by MOHD IRFAN SIDDIQUI Date: 2021.11.16 11:05:08 IST