Punjab-Haryana High Court
Raj Singh vs Uttar Haryana Bijli Vitran Nigam Ltd And ... on 2 August, 2024
Author: Jasgurpreet Singh Puri
Bench: Jasgurpreet Singh Puri
Neutral Citation No:=2024:PHHC:099188
CWP-10801-2018 -1-
212
IN THE HIGH COURT OF PUNJAB & HARYANA
AT CHANDIGARH
***
CWP-10801-2018
Date of Decision: 02.08.2024
Raj Singh
..... Petitioner
Versus
Uttar Haryana Bijli Vitran Nigam Ltd. and others
..... Respondents
CORAM: HON'BLE MR. JUSTICE JASGURPREET SINGH PURI
Present: Ms. Nidhi Sharma, Legal Aid Counsel,
for the petitioner.
Mr. Nayandeep Rana, Advocate,
for the respondents.
****
JASGURPREET SINGH PURI, J. (ORAL)
1. The present writ petition has been filed under Articles 226/227
of the Constitution of India for issuance of a writ for direction to the
respondents to reimburse the medical bill of the petitioner on PGI rates +
75% of balance amount of ventilator charges, procedure charges, OT
charges, Anesthesia charges, ICU charges, Room Rent, Physiotherapy visit
charges etc. and to direct the respondents to reimburse the remaining amount
of medical bills to the petitioner as vide orders dated 22.03.2017 (Annexure
P-3) and 22.05.2017 (Annexure P-5) Rs.50,341/- and Rs.65,150/- have only
been sanctioned against the total amount of Rs.1,15,378/- and Rs.2,59,934/-.
2. Learned Legal Aid Counsel appearing for the petitioner
submitted that the petitioner was working as Junior Engineer in the
respondent-Nigam and he retired in the year 2010. However, on 07.10.2016,
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he was admitted in an emergency condition in the hospital, namely, Aarvy
Hospital due to breathing difficulty @ gen weakness-appetite-severe insp.
Discern, attend sensorium plus patient is a k/c/o COPD-H/o Exp.
Laprotomy-Colostormy and he was immediately given oxygen support and
was treated conservatively, regarding which, an Emergency Certificate of
the concerned hospital is annexed with the present petition as Annexure P-2
(Colly.). The petitioner again suffered similar problem on the next day i.e.
on 08.10.2016 and was again admitted in the same hospital with the same
symptoms and was immediately put to Bipap support and was again treated
conservatively. She also submitted that for the aforesaid treatment, the
petitioner had submitted the medical bills of an amounting to Rs.1,15,378/-
to the respondents, out of which, the respondents-Nigam had paid only
Rs.50,341/-. Thereafter, the petitioner was again admitted in the aforesaid
hospital in an emergency condition on 04.01.2017 and an Emergency
Certificate was issued by the hospital is annexed with the present petition as
Annexure P-4 and this time he was admitted on emergency basis because of
high grade temper chills, retaction of colostomy inside abd. distention,
severe pain abd., recumbent episode of vomiting c-tend men in abd. and
regarding this treatment, the petitioner had submitted the medical bills for an
amount of Rs.2,59,936/-, out of which, only Rs.65,150/- has been paid to
him.
3. Learned Legal Aid Counsel further submitted that once the
petitioner was admitted in a hosptial which was not an empanelled hospital
in an emergent condition, then he should have been granted full medical
reimbursement instead of partial medical reimbursement because at that time
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he had no choice except to approach the nearest best hospital in order to save
his life. She also referred to a Division Bench judgment of this Court in
CWP-3586-2007 titled as "Raghuvir Prasad Mittal Vs. State of Haryana
and others" decided on 04.04.2008 and also a judgment passed by this
Court in CWP-19105-2021 titled as "Roshan Lal Garg Vs. State of
Haryana and others" decided on 08.07.2024 and also the judgment passed
by Hon'ble Supreme Court in "Shiva Kant Jha Vs. Union of India", (2018)
16 SCC 187 in this regard.
4. On the other hand, Mr. Nayandeep Rana, learned counsel
appearing on behalf of the respondents-Nigam submitted that although the
petitioner was admitted in an emergent condition for two times but at the
time when the bills were submitted by the petitioner, he had submitted the
entire bills for medical reimbursement but as per the Instructions of the
Nigam, when an employee is admitted in an unapproved hospital but in an
emergency condition then the reimbursement shall be paid at the rates
equivalent to the PGI, Chandigarh rates which the department has already
reimbursed to the petitioner and therefore, the petitioner is not entitled for
full medical reimbursement. He also supplied a photocopy of the aforesaid
Instructions of the Nigam in Court today, which are taken on record and
marked 'X'.
5. I have heard the learned counsel for the parties.
6. The only issue involved in the present case is as to whether the
petitioner is entitled for the medical reimbursement equivalent to PGI,
Chandigarh rates or full reimbursement. Before considering the facts of the
instant case, it is necessary to refer to various judgments in this regard.
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Hon'ble Supreme Court in Shiva Kant Jha's case (supra) dealt with this
issue as to whether the full medical reimbursement should be granted to a
patient, who is admitted in an non-empanelled hospital in an emergency
condition or not. The relevant para of the aforesaid judgment is reproduced
as under:-
"13. Further, the writ petitioner was admitted in
emergency condition with complaint of breathlessness on
11.11.2013 in Fortis Escorts Health Institute, which was
a non-empanelled hospital at the relevant time. He
underwent angiography on 12.11.2013 which revealed
diffused disease in left anterior descending coronary
artery 50-60%. He had been implanted the CRT-D device
(Combo) as part of cardiac resynchronization therapy
(CRT) on 12.11.2013. The hospital charged an amount of
₹11,56,293/- for the said treatment, out of which, an
amount of ₹10,70,000/- was for the cost of the unlisted
cardiac implant (CRT-D) and an amount of ₹3,19,950/-
was paid by the Insurance company directly to the
hospital.
xxx xxx xxx xxx
17. It is a settled legal position that the Government
employee during his life time or after his retirement is
entitled to get the benefit of the medical facilities and no
fetters can be placed on his rights. It is acceptable to
common sense, that ultimate decision as to how a patient
should be treated vests only with the Doctor, who is well
versed and expert both on academic qualification and
experience gained. Very little scope is left to the patient
or his relative to decide as to the manner in which the
ailment should be treated. Speciality Hospitals are
established for treatment of specified ailments and
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services of Doctors specialized in a discipline are availed
by patients only to ensure proper, required and safe
treatment. Can it be said that taking treatment in
Speciality Hospital by itself would deprive a person to
claim reimbursement solely on the ground that the said
Hospital is not included in the Government Order. The
right to medical claim cannot be denied merely because
the name of the hospital is not included in the
Government Order. The real test must be the factum of
treatment. Before any medical claim is honoured, the
authorities are bound to ensure as to whether the
claimant had actually taken treatment and the factum of
treatment is supported by records duly certified by
Doctors/Hospitals concerned. Once, it is established, the
claim cannot be denied on technical grounds. Clearly, in
the present case, by taking a very inhuman approach, the
officials of the CGHS have denied the grant of medical
reimbursement in full to the petitioner forcing him to
approach this Court.
18. This is hardly a satisfactory state of affairs. The
relevant authorities are required to be more responsive
and cannot in a mechanical manner deprive an employee
of his legitimate reimbursement. The Central
Government Health Scheme (CGHS) was propounded
with a purpose of providing health facility scheme to the
central government employees so that they are not left
without medical care after retirement. It was in
furtherance of the object of a welfare State, which must
provide for such medical care that the scheme was
brought in force. In the facts of the present case, it
cannot be denied that the writ petitioner was admitted in
the above said hospitals in emergency conditions.
Moreover, the law does not require that prior permission
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has to be taken in such situation where the survival of the
person is the prime consideration. The doctors did his
operation and had implanted CRT-D device and have
done so as one essential and timely. Though it is the
claim of the respondent-State that the rates were
exorbitant whereas the rates charged for such facility
shall be only at the CGHS rates and that too after
following a proper procedure given in the Circulars
issued on time to time by the concerned Ministry, it also
cannot be denied that the petitioner was taken to hospital
under emergency conditions for survival of his life which
requirement was above the sanctions and treatment in
empanelled hospitals."
7. A Co-ordinate Bench of this Court in CWP-14577-2008 titled
as "Sanjay Rana Vs. State of Haryana through the Financial
Commissioner & Secretary to Government of Haryana, Health
Department, Haryana and others" also while referring to the aforesaid
judgment of Hon'ble Supreme Court in Shiva Kant Jha's case (supra),
granted the full medical reimbursement to the employee of that case. This
Court had also an occasion to deal with the aforesaid proposition in CWP-
10669-2017 titled as "Raghbir Singh Vs. Chief Administrator and others"
and Roshan Lal Garg's case (Supra) whereby this Court while referring to
the aforesaid judgment of Hon'ble Supreme Court in Shiva Kant Jha's case
(Supra) was of the view that when an employee is in an extreme emergent
situation, then he will never see as to which hospital is an approved hospital
or which is an unapproved hospital because the main focus and emphasis is
always to save his life or his dependent's life and not to think about the fact
that whether full medical reimbursement will be given to him or not because
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the impetus is only on saving the life or relieving from the pain. This Court
was also of the view in the aforesaid judgments that non-payment of full
medical reimbursement when it was a case of an extreme emergency, would
be violative of Article 21 of the Constitution of India. Similar instructions
were also relied upon by the Nigam in the aforesaid judgments as well.
8. Now coming to the facts of the present case, it is not disputed
by the Nigam that the petitioner was not admitted for 2-3 times in an
emergency condition. Rather a perusal of the Emergency Certificates
(Annexures P-2-Colly. & P-4) would show that the petitioner was actually
admitted in an emergent medical condition, regarding which, the aforesaid
certificates have also been attached with the present petition. No doubt as
per the Instructions, if a patient is admitted in a non-empanelled hospital but
in an emergency condition, then only amount equivalent to the PGI,
Chandigarh rates will be given to him but in the light of the aforesaid
judgment of Hon'ble Supreme Court and also in the light of the judgment of
the Co-ordinate Bench of this Court and also of this Court, the petitioner will
be entitled for full medical reimbursement.
9. During the course of arguments, learned counsel for the
respondents-Nigam has also referred to a judgment passed by a Division
Bench of this Court in "Gurnam Singh Mann Vs. Punjab Agricultural
University, Ludhiana and others", 2006(1) SLR 561 and submitted that
reimbursement can be made only to the extent of PGI, Chandigarh rates
when the hospital is a non-empanelled hospital. However, a perusal of the
aforesaid judgment would show that it has been so observed that rather in
such like situation at least the reimbursement of the medical expenses at the
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rates prevalent for the treatment at PGI, Chandigarh is to be given but there
is no observation to the extent that only PGI rates are to be given. Therefore,
this Court will be guided by the law laid down by Hon'ble Supreme Court in
Shiva Kant Jha's case (Supra) and the aforesaid judgment of Division
Bench of this Court would be distinguishable on facts.
10. In view of the aforesaid facts and circumstances, the present
petition is allowed. The petitioner shall be entitled to full medical
reimbursement. The respondents are directed to pay full medical
reimbursement to the petitioner after adjusting what has already been paid
and what has been due to him based upon the actual bills within a period of
four months from today. However, there shall be no order as to interest on
aforesaid payment of remaining medical bills.
02.08.2024 (JASGURPREET SINGH PURI)
Bhumika JUDGE
1. Whether speaking/reasoned: Yes/No
2. Whether reportable: Yes/No
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