Punjab-Haryana High Court
Shri Ram Chopra vs State Of Haryana And Others on 7 August, 2023
Neutral Citation No:=2023:PHHC:101797
CWP-798-2020 2023:PHHC:101797 1
IN THE HIGH COURT OF PUNJAB AND HARYANA
AT CHANDIGARH
(232) CWP-798-2020
Date of Decision : August 07, 2023
Shri Ram Chopra .. Petitioner
Versus
State of Haryana and others .. Respondents
CORAM: HON'BLE MR. JUSTICE HARSIMRAN SINGH SETHI
Present: Mr. Nipun Vashisht, Advocate, for the petitioner.
Mr. Tapan Kumar Yadav, Deputy Advocate General, Haryana.
Mr. Munish Kapila, Advocate, for respondent No.4.
HARSIMRAN SINGH SETHI J. (ORAL)
1. Reply on behalf of respondent No.4 has been filed in the Court
today and the same is taken on record.
2. Present petition has been filed with a prayer that the action of
the respondents in not reimbursing the total medical bill of the petitioner,
may kindly be quashed and the letter dated 02.01.2019 (Annexure P-5) by
which, only part of the medical bill has been sanctioned, be declared as
illegal and arbitrary with a further direction to the respondents to reimburse
the total cost of the implant which the petitioner had incurred while
undergoing the treatment for the Ischemic Cardiomyopathy.
3. The facts as stated in the petition are that the petitioner retired
from service as a Deputy District Education Officer, Ambala on 31.05.2007.
1 of 5
Neutral Citation No:=2023:PHHC:101797
On 29.10.2012, the petitioner, who was suffering from chronic heart disease
was advised immediate treatment for Ischemic Cardiomyopathy, which was
available in Fortis Hospital, Mohali.
4. For getting the treatment done, the petitioner incurred a total
cost of Rs.5,95,500/- which bill was submitted by him for the
reimbursement to the respondent-State. The respondent-State accepted the
medical bill but the petitioner was not given full reimbursement on the
ground that the sanction has only been accorded for reimbursement of an
amount of Rs.3,53,300/-.
5. The prayer of the petitioner in the present petition is that once
the petitioner has incurred a particular sum on his treatment, which
treatment is not being disputed by the respondents, the petitioner is entitled
for full reimbursement of the medical bills.
6. Upon notice of motion, the respondents have filed the reply. In
the reply, the respondents have mentioned that keeping in view the
instructions issued on 21.05.2015, certain guidelines have been issued for
the implant cost and packages which are being offered by the hospital qua
their reimbursement and as per the said instructions, with regard to the
implant which the petitioner has been given under the treatment, cost
Rs.3,53,300/-, has already been reimbursed to him and therefore, the claim
of the petitioner beyond the said amount is not covered under the
instructions in question.
7. I have heard learned counsel for the parties and have gone
through the record with their able assistance.
8. It may be noticed that it is not the case that the treatment which
the petitioner undertook, was not emergent or the treatment for which the
reimbursement is sought, has not been undertaken by the petitioner. The
2 of 5
Neutral Citation No:=2023:PHHC:101797
only dispute being raised for full reimbursement as being claimed by the
petitioner is that as per the instructions dated 21.05.2015, the amount of
implant which has already been fixed in the instructions, can be extended
and not beyond that.
9. The said question already came up for consideration before this
Court in CWP No.22833 of 2015 titled as Ayoudhia Prasad Duggal vs.
CAT, Chandigarh and others, decided on 20.02.2017 where the Division
Bench of this Court has held that merely because the Government does not
revise the package deal amount under Medical Attendance Rules from time
to time, a person who has undergone surgery cannot be denied actual
medical costs undertaken of the implant or otherwise and the medical
reimbursement has to be of the actual medical expenses incurred. The
relevant paragraph 10 of the said judgment is as under:-
"10. In this view of the matter and considering that it was the
categoric contention of the Petitioner that the MRI compatible Pacemaker
as well as Stents were installed strictly as per the recommendation of the
Treating Surgeon, taking into account the situation prevailing at the time
of Operation, we have no hesitation in coming to the conclusion that the
purported letters of Consent/Undertakings signed by the Petitioner's
Attendants on 1.8.2013 and 20.9.2013 cannot become a hindrance to him
for the purpose of seeking disbursement, since the same were undoubtedly
signed under grave mental pressure and fear at the relevant time of
Operation, considering the patient's actual situation, and also as a result
of 7 of 9 aggressive or forceful representation from the side of the
Hospital Authorities or the Treating Surgeon(s). We are therefore,
inclined to concur with the decision of the Delhi High Court in a
substantially identical matter being 'Daljit Singh Versus Govt. of N.C.T.
Of Delhi & Ors.' WP (C) No.16651/2006 in which, relying upon an earlier
decision in the case of 'State of Punjab & Ors. vs. Mohan Lal Jindal'
3 of 5
Neutral Citation No:=2023:PHHC:101797
2001(9) SCC 217 wherein 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 of life, it was observed-
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.........
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."
10. Relying upon the said judgment in Ayoudhia Prasad Duggal's
case (supra), this Court while passing order in CWP No.24498 of 2016
titled as Rajinder Singh vs. State of Haryana and others, decided on
27.07.2023, granted the same benefit where, the full amount of medical
expenses were not being reimbursed on the ground that the implant costs as
fixed by the Government is to be given and not actual costs incurred by the
patient, was held to be bad.
11. The question of law settled by this Court in Ayoudhia Prasad
Duggal's case (supra) and Rajinder Singh's case (supra), is applicable in
the facts and circumstances of the present case as the petitioner has been
given an implant which has actually costed him Rs.5,42,200/-, which
amount needs to be reimbursed and the full reimbursement cannot be denied
only on the ground that the ceiling has been fixed for the reimbursement of
4 of 5
Neutral Citation No:=2023:PHHC:101797
the said implant @ Rs. 3 lacs.
12. Consequently, the present writ petition is allowed. The sanction
of the part medical expenses incurred is set aside and the petitioner will be
entitled for the full reimbursement of the implant done @ Rs.5,42,200/-
rather than on the ceiling of Rs.3 lacs fixed by the respondents. The
respondents are directed to reimburse the full amount for which the
petitioner has submitted the bills i.e. Rs.5,95,500/- with a period of two
months from the receipt of certified copy of this order as no dispute has
been raised qua the spending of the said amount on the medical treatment
by the petitioner. Amount already paid to the petitioner should be adjusted.
August 07, 2023 (HARSIMRAN SINGH SETHI)
harsha JUDGE
Whether speaking/reasoned : Yes
Whether reportable : Yes
Neutral Citation No:=2023:PHHC:101797
5 of 5
