Madhya Pradesh High Court
The State Of Madhya Pradesh Secretary vs Smt. Padma Sharma on 25 February, 2025
Author: Milind Ramesh Phadke
Bench: Milind Ramesh Phadke
1
IN THE HIGH COURT OF MADHYA PRADESH
AT GWALIOR
BEFORE
HON'BLE SHRI JUSTICE MILIND RAMESH PHADKE
&
HON'BLE SHRIRAJENDRA KUMAR VANI
Writ Appeal No.2246 of 2024
STATE OF M.P. & OTHERS
Vs
SMT. PADMA SHARMA
APPERANCE
Shri Shri Deepak Khot - Government Advocate alongwith Shri Sohit
Mishra - Government Advocate for the appellants/State
Shri Sunil Kumar jain - Advocate for the for the respondent.
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Reserved on : 19/02/2025
Delivered on : 25/2/2025
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Ther petition having been heard and reserved for orders, coming
on for pronouncement ther day, the Hon'ble Shri Justice Milind
Ramesh Phadke pronounced/passed the following:
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ORDER
The present intra-Court appeal, under Section 2(1) of Madhya
Pradesh Uchcha Nyayalaya (Khandpeeth Ko Appeal) Adhiniyam,
2005 has been filed by the appellants/State assailing the order dated
25.10.2023 passed by learned Single Judge in Writ Petition No.4871 of
2023; whereby, in view of the judgment passed by the Hon'ble Apex
Court in the matter of State of Madhya Pradesh vs. M.P. Ojha &
Another reported in AIR 1998 SC 659 and the order dated 11.02.2010
passed in Writ Petition No.6228 of 2006, the respondents were
directed to reimburse the medical bills amounting to Rs.54,761/- and
as they had delayed payment of medical bills, and had denied the
legitimate claim of the petitioner/appellant herein.
2. Assailing the said order, Shri Deepak Khot - Government
Advocate alongwith Shri Sohit Mishra - Government Advocate for the
appellants/State has argued before this Court that the impugned order
passed by the learned Single Judge in light of judgment of the Hon'ble
Apex Court in the matter of State of Madhya Pradesh vs. M.P. Ojha
(supra) and the order dated 11.02.2010 passed in Writ Petition
No.6228 of 2006 in the matter of petitioner herself is unsustainable, as
on the date on which the medical reimbursement for medical bills in
respect of treatment of her husband was claimed, there was no
provision or any rules or circular of the State for reimbursement of
medical charges incurred outside the State of Madhya Pradesh for a
retired employee and as per the Circular dated 30.04.1973 issued by
the State Government, in only two categories of cases wherein a
Government servants were either deputed outside the State or the
Government employees or their families going outside the State during
leave taken by the Government servant and if he or any family
member is falling ill and receiving medical treatment outside the State
then only reimbursement of medical charges incurred outside the State,
could be claimed and reimbursed. As there was no rule or circular to
the effect of reimbursement of medical expenses incurred outside the
State to a retired Government employee, the claim for reimbursement
of a sum of Rs.54,761/- was rightly rejected by the department, but
learned Writ Court relying on the aforesaid two judgments, which were
not applicable to the facts of the present case, had allowed the claim
and had directed the respondents to reimburse the medial bills which is
per se illegal.
3. Though learned Counsel for the appellants/State had tried to
raise another issue with regard to dependency of the husband of the
petitioner over her being a pensioner but thereafter, candidly submitted
that the aforesaid issue has already been settled therefore, he is not
pressing hard upon it.
4. Learned counsel for the appellants/State has further argued that
in the matter of State of Madhya Pradesh vs. M.P. Ojha (supra), the
facts were altogether different as there a son who was a Government
servant, with whom his father, who was a pensioner was living, had
taken him to Bombay for his bypass surgery as the said facility was not
available in the State Government hospital and later on, had applied
for reimbursement of the expenses incurred towards treatment of his
father alleging his father to be wholly dependent upon him, which was
earlier denied by the department and in that facts and circumstances,
the Hon'ble Apex Court has held that the father though was a
pensioner could be termed as wholly dependent on his son and he
having a separate capacity of being a retired Government servant is
immaterial, if his case falls within the Medical Rules being a member
of the family of his son and wholly dependent upon him, but herein
case, the facts are altogether different, therefore, the analogy of the
said case could not have been applied in the present case.
5. It was further argued that the order passed by the learned Single
Judge in the matter of the petitioner herself in Writ Petition No.6228 of
2006 was also based upon the decision of the State of Madhya
Pradesh vs. M.P. Ojha (supra) wherein in similar set of facts, the
Writ Courts had allowed the reimbursement of the petitioner's husband
since was based upon a judgment which was factually different from
the facts of the present case, therefore, the same would also not have
been applicable. On these counts, it was prayed that the present appeal
deserves to be allowed and the impugned order passed by the learned
Writ Court be quashed.
6. On the other hand, learned counsel for the respondent/writ
petitioner while relying upon the aforesaid two judgments has
submitted that on earlier occasion in the case of petitioner herself,
reimbursement of medical bills for heart surgery undergone by the
husband of the petitioner was allowed and the same has not been
challenged further by the State, rather had made the payment; thus,
when in similar set of facts on earlier occasion, the reimbursement has
already been made to the appellant and now agitating the same issue is
of no consequence. It was, thus, prayed that the present appeal being
sans merits be dismissed.
7. Heard counsel for the parties and perused the record.
8. Herein case, on 16.03.2006, husband of the petitioner underwent
operation of heart (by-pass) and after that, when he was taken for
medical checkup at Bhopal, he was again advised to get immediately
operated for blockage in the leg at AIIMS, Delhi.
9. On 30.03.2009, an application was moved by the petitioner
seeking permission for treatment of her husband for the aforesaid at
AIIMS, Delhi under special circumstances and the said application
was rejected on 23.07.2009 but since there was an emergency, the
petitioner got her husband operated in AIIMS, Delhi. Thereafter, vide
application dated 30.09.2009, the medial bills and travelling expenses
totaling Rs.54,761/- were submitted to the Principal, Govt. Girls
Middle School, Guna but the same were not reimbursed alleging that
since the rules or circulars doesn't provide for any reimbursement for
medical expenses incurred by a retired employee outside the State,
therefore, the reimbursement of the aforesaid amount cannot be done.
10. In the matter of petitioner herself vide Writ Petition No.6228 of
2006, the Writ Court had allowed reimbursement of the medical bills
towards expenses incurred at AIIMS, Delhi on 16.03.2006 for by-pass
surgery. In the aforesaid judgment, apart from State of Madhya
Pradesh vs. M.P. Ojha (supra) to another judgment of this Court in
the matter of Vishwanath Prasad Khare (Dr.) vs. State of M.P. &
Others reported in 2009 (III) MPJR SN 8, was referred which was
affirmed by Division Bench of this Court vide order dated 07.07.2009
in Writ Appeal No.179 of 2009 [reported in 2009 (III) MPJR SN 9]
and was held that the husband of the petitioner was immediate need of
open heart surgery and therefore, he was rushed to AIIMS Delhi, he
being totally dependent upon the petitioner, as he was receiving
meagre pension thus was held to be entitled for reimbursement of the
amount therein.
11. Herein case so far as dependency of the husband of the petitioner
over her is not in dispute as much stress has not been laid upon the
said argument, but another aspect with regard to non-applicability of
Circular dated 30.04.1973 which deals with reimbursement of the
medical charges incurred by a Government employee outside the State
over the pensioner is concerned, admittedly the case of the petitioner
was not covered under the said Circular nor the case of the petitioner
would be governed by the Madhya Pradesh Civil Services (Medical
Attendance) Rules, 1958 which was formulated for regulating the
medical attendance and treatment of Government servants and as
under Rule 1(3)(a) of the said Rules, the Rules would not be applicable
to a retired Government servant thus in absence of any Rules or
Circular governing reimbursement of medical expenses incurred by a
retired Government employee, the claim of petitioner had to be judged
in the light of the judgments of the Apex Court as well as the Rules of
M.P. Pension Welfare Fund Rules, 1997.
12. Rule 4 of the Rules of 1997 provides for the person eligible for
taking benefit from the fund.
13. As per Rule 7 of the Rules of 1997, the maximum amount which
can be claimed for the ailments as provided under the Rules is to be
calculated as under:
"7. Amount of assistance. The maximum amount of
assistance for the purposes as specified in Rule 5, shall
be us under:-
(i) For prolong and serious illness. As per merit of each case.
(ii) Handicaptness due to accidents As per merit of each case.
or other natural calamities.
(iii) For specticles Rs.350/- (Three hundred fifty only).
(iv) For dentures Rs.1000/- (One thousand only).
(v) For hearing aid Rs.700/- (Seven hundred only),
(vi) For technical education Rs.1000/- (One thousand only).
(vii) For scanning/dialysis/Stress Rs.1500/- (Fifteen hundred only).
test/E.C.G. and other special type
of test
14. As per Rule 9 of the Rules of 1997, the State Government shall
constitute a Committee for scrutinizing the claims. Rule 9 is quoted
hereinbelow:
"9. Constitution and powers to Executive Committee.-(1)
There shall be constituted an Executive Committee for
the purposes of these rules.
(2) The Executive Committee shall consist of-
(i) Chairman to be nominated by the State
Government,
(ii) Four non officials to be nominated by the
State Government amongst the members of the
Pensioners Welfare Toe Additional Director of
Treast Expertension Work shall be the Member
Secretary of the Executive Committee
(3) The Executive Committee shall have full powers to
sanction assistance from the fund:
Provided that during the period of non-exercise of
Executive Commit tee, such powers shall be exercised by
the Finance Secretary/Director for cases of
outside/within the State respectively."
15. Rule 10 of the Rules of 1997 provides for the procedure for for
scrutiny of the claim application. Rule 10 is quoted hereinbelow:
"10. Procedure for sanctioning assistance. -(a)
Applications for assistance shall be scrutinized by the
Director and incomplete applications or not covered by
these rules, shall be returned to the applicant.
(b) Proper applications, shall, then be placed before the
Executive Committee's meeting which shall be called by
the Director as per directions of the Chairman of the
executive committee.
(c) The Executive Committee shall meet quarterly for
deciding the assistance in pending cases, at the place and
time mentioned in the notice of the meeting by the
Member Secretary.
(d) The decision shall be taken only in such meeting of
Executive Committee, in which at least two non-official
members are present.
(e) The financial sanctions in the cases sanctioned in the
meeting of executive committee shall be issued by the
Director. Intimation about sanction/rejection shall be
given to the Applicant by the Director."
16. After analyzing the aforesaid provisions, this Court finds that
earlier as per Proviso to Rule 5 of the Rules of 1997, a pensioner was
entitled for getting assistance from outside State for treatment as per
deceases and list of Hospitals as listed in Appendix-I, but later on after
its deletion w.e.f. 12.11.1999, there is no express provision debarring a
retired Government employee to get his/her treatment done from
outside the State and also there is no amendment as such in the
approved list of hospitals outside the State as provided in Appendix-I
and as the ailment of husband of the petitioner had arisen due to
complication of heart by-pass surgery, it was very well covered under
Clause-I of Appendix-I and further the hospital in AIIMS, New Delhi,
from where the treatment was taken is included in Clause-II of
Appendix-I. The said Appendix-I is quote hereinbelow:
"[APPENDIX-I
(The list of deceases and hospitals for treatment outside
the state)
1. List of deceases-
(See Rule 6)
(i) All types of Cancer,
(ii) Open Heart Surgery,
(iii) Cordiac Failure,
(iv) Kidney Transplantation,
(v) Complicated Eye Surgery,
(vi) Complicated Neuro-Surgery,
(vii) Joints Replacement.
2. List of approved Hospitals-
(i) All India Institute of Medical Science, New Delhi,
(ii) L.N.T.P. Hospital, New Delhi,
(iii) G.B. Pant Hospital, New Delhi,
(iv) B.H.U., Varanasi,
(v) K.E.M. Hospital, Mumbai,
(vi) Bombay Hospital, Mumbai,
(vii) Jaslok Hospital, Mumbai,
(viii) B.Y.L. Nayar Hospital, Mumbai,
(ix) Tata Memorial Hospital, Mumbai,
(x) Nanawati Hospital, Mumbai,
(xi) Shree Chitra Tirunal Institute, Trivendrum,
(xii) C.M.C., Vellur,
(xiii) Nijam Institute, Hyderabad,
(xiv) Pandaliya Cardio-theropic Foundation, Chennai,
(xv) Appolo Hospital, Chennai,
(xvi) Shankar Netralay, Chennai,
(xvii) P.G.I. Lucknow,
(xviii) Aurthan Rly. Hospital, Perambur,
(xix) Batra Hospital, New Delhi.
3. The following hospitals of the State shall be treated at
par for the diseases as listed above for outside
assistance:-
(1) Choithram Hospital, Indore,
(2) Cancer Hospital, Gwalior,
(3) Cancer Research Centre, Bhopal,
(4) Birla Hospital, Satna,
(5) Mission Hospital, Padar, Distt. Betul,
(6) All the Government Hospitals & Medical Colleges of State."]
17. In the light of Rule 9 of the Rules of 1997, the claim of the
respondent/writ petitioner, though was required to be sent for scrutiny
before the Committee, as constituted under the Rules of 1997, since
was not sent, this late juncture, this Court doesn't deem it expedient to
send it to the said Committee rather deems it appropriate to allow the
same.
18. In the matter of Suman Rakheja vs. State of Haryana &
Another reported in 2006 SCC (L&S) 890, it has been laid down that
in case of emergency, if a retired government servant is rushed to the
hospital, which is not recognized then also the State Government is
liable to make reimbursement to the extent of 100% and as in the
Rules of 1997, there is no provision which would de-bar the petitioner
for medical reimbursement 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; thus, when 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 un-
recognized by the State Government, it cannot be said that the surgical
operation taken by the husband of the petitioner at AIIMS, Delhi
would not entitle for reimbursement.
19. In light of the aforesaid discussion, this Court finds that no
illegality or perversity has been committed by the learned Single Judge
in allowing the writ petition. Accordingly, the present appeal being
sans merits is hereby dismissed.
(MILIND RAMESH PHADKE) (RAJENDRA KUMAR VANI)
JUDGE JUDGE
pwn*
PAWAN Digitally signed by PAWAN KUMAR
DN: c=IN, o=HIGH COURT OF MADHYA PRADESH BENCH GWALIOR,
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2.5.4.20=b864d1ab4ace2215bfcf3ab301c34d631287f1b1cdd90b4a49f26
KUMAR
5f02d9d593f, postalCode=474001, st=Madhya Pradesh,
serialNumber=61B9D129971D2EA4FD4455ED49EA436EA65E26164BEEE
D89153191C56E98CE21, cn=PAWAN KUMAR
Date: 2025.02.27 10:36:46 +05'30'
