Punjab-Haryana High Court
Naresh Pal vs State Of Haryana And Others on 5 July, 2024
Author: Jasgurpreet Singh Puri
Bench: Jasgurpreet Singh Puri
Neutral Citation No:=2024:PHHC:083703
CWP-9856-2023 (O&M) 1
226
IN THE HIGH COURT OF PUNJAB & HARYANA
AT CHANDIGARH
CWP-9856-2023 (O&M)
Date of Decision:05.07.2024
Naresh Pal
.......Petitioner
Versus
State of Haryana and others
.....Respondents
CORAM: HON'BLE MR. JUSTICE JASGURPREET SINGH PURI
Present:- Mr. Naveen Daryal, Advocate for the petitioner.
Ms. Dimple Jain, DAG, Haryana.
Mr. Rajesh Lamba, Advocate for respondents No.3 and 4.
*****
JASGURPREET SINGH PURI J.(Oral)
1. The present petition has been filed under Article 226 of the
Constitution of India seeking issuance of a writ in the nature of
mandamus directing the respondents to release the medical reimbursement
bills of Rs.90025/- as accrued on the emergency treatment of wife of the
petitioner during the period of Covid-19.
2. Reply filed on behalf of respondent No.3 is taken on record.
3. Learned counsel for the petitioner submitted that wife of the
petitioner was admitted in Arvind Hospital, Karnal on 05.06.2020 in an
emergency condition regarding which a certificate dated 05.06.2020 has
also been annexed in the present petition vide Annexure P-1. She was
admitted on 05.06.2020 and had taken treatment till 10.06.2020 and with
1 of 7
Neutral Citation No:=2024:PHHC:083703
regard to the same a bill of the hospital was raised for an amount of
Rs.90025/- which is so evident from Annexure P-2. Learned counsel for
the petitioner referred to Annexure P-3 wherein a certificate dated
15.10.2020 has been issued by the Civil Surgeon, Nuh in which it has
been so stated that as per record wife of the petitioner was in an
emergency condition at the time of her admission. He further submitted
that once wife of the petitioner was admitted in an emergency condition
then even if the respondent-hospital was not an approved hospital, the
petitioner is entitled for full reimbursement. He further submitted that,
however, some calculations have been made by the respondent-
department vide Annexure P-6 to show bifurcation of some amount and
on the basis of which an amount of Rs.43,391/- has been shown. He
further submitted that aforesaid action of the respondent-department in
not paying the full reimbursement of the medical bill to the petitioner on
account of admission of the wife of the petitioner in an emergency
condition is totally contrary to the authoritative judgment of Hon'ble
Supreme Court passed in "Shiva Kant Jha Vs. Union of India",
(2018)16 SCC 187, a Division Bench judgment of this Court passed in
"Sunita Rani Vs. Union of India", 2008(3) RSJ 562, another judgment
of a Division Bench of this Court in "Kundan Lal Vs. Haryana Vidyut
Parsaran Nigam Ltd. and another", 2009(3) RSJ 727 and a judgment of
Single Bench of this Court in "Krishna Kumari (dead) through LRs. Vs.
State of Haryana" 1999(4) RSJ 386 to contend that when an employee or
dependent of the employee is taken to hospital in an emergency condition,
then the benefit of full reimbursement cannot be denied only on the
ground that the same was not an approved hospital.
2 of 7
Neutral Citation No:=2024:PHHC:083703
4. On the other hand, learned counsel for respondents No.3 and
4 submitted that wife of the petitioner was admitted in a private hospital
which was not an approved hospital and therefore at the most an amount
of Rs.43,391/- could have been paid to the petitioner in view of the
instructions of the Government of Haryana vide Annexure P-8 since the
hospital was an unapproved hospital and as such the petitioner is entitled
only for the aforesaid amount i.e. Rs.43,391/- instead of full amount of
Rs.90025/-
5. I have heard learned counsels for the parties.
6. The only issue involved in the present case is as to whether
the petitioner is entitled or not for full reimbursement of the medical bills
on account of admission and treatment of his wife who was admitted in an
emergency condition of Seizure disorder. The certificate issued by the
hospital at Annexure P-1 as well as certificate issued by the Civil
Surgeon, Nuh at Annexure P-3 are also reproduced as under:-
"Annexure P-1
TO WHOM IT MAY CONCERN
It is to certify that Patient Sangeeta Devi,
Age/Sex: 40/F, W/o Sh. Naresh Pal, R/o H.no.-1358, Gali-1,
Shiv Colony, Karnal, admitted in our Hospital in emergency
on 05/06/20 with C/o Fever x 10 days, altered sensorium.
Patient was diagnosed as a case of ? TBM with severe
anaemia with thrombocytopenia with seizure disorder which
is an emergency and she was managed accordingly."
Annexure P-3
No.Med-Re-Imb/2020/59 dated 15-10-2020
"From
Civil Surgeon, Nuh
To
Assistant Director
3 of 7
Neutral Citation No:=2024:PHHC:083703
Welfare Centre for Persons with Speech &
Hearing Impairment, (Mewat).
Sub:- Medical Reimbursement Case-Regarding
Emergency Certificate.
Mr./Mrs. Naresh Pal, Teacher.
In reference to your letter No.WCPSHI/2020-21/129
dated 24.09.2020.
Mr./Mrs. Sangeeta w/o Naresh Pal has taken the
treatment at Arvind Hospital, Karnal from 05.06.2020 to 10-
06-2020 due to TBM & severe anaemia & thrombocytopenia.
with Seizure disorder.
I have gone through the records of medical
reimbursement & report submitted by
Gynecologists/Pediatrician/Physician G.H. Mandikhera. I
am of the opinion that the patient was in emergency
condition at the time of admission as per record.
Original medical reimbursement case with all
enclosures is attached herewith as record.
Sd/-
Encl: As above Civil Surgeon, Nuh"
7. A perusal of the aforesaid would show that wife of the
petitioner was admitted in a private hospital and the same was not an
approved hospital of respondents No.3 and 4 but the wife of the petitioner
was admitted in an emergency condition. It is a settled law that when a
person is admitted in an emergency condition, the first priority of a person
is to save the life of the patient and not to go to a hospital which is an
empanelled hospital. The law in this regard is no longer res integra.
Hon'ble Supreme Court in "Shiva Kant Jha Vs. Union of India"
(supra), observed 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
4 of 7
Neutral Citation No:=2024:PHHC:083703
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.
xxxxx xxxxx xxxxx xxxxx
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 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
5 of 7
Neutral Citation No:=2024:PHHC:083703
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 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."
8. In view of the aforesaid facts and circumstances, this Court is
of the considered view that since the wife of the petitioner was admitted
in the hospital in an emergency condition, the petitioner is entitled for full
medical reimbursement amounting to Rs.90025/- instead of any restricted
amount.
9. Consequently, the present petition is allowed. The
respondents are directed to pay Rs.90025/- to the petitioner along-with
interest @6% per annum (simple) from the date of submission of the bills
to the respondents No.3 and 4 till the date of its actual payment within a
period of three months from today.
6 of 7
Neutral Citation No:=2024:PHHC:083703
10. In case the aforesaid amount is not paid to the petitioner
within the aforesaid time period then the petitioner shall be entitled for the
future rate of interest @ 9% per annum (simple). However, there shall be
no order as to costs.
(JASGURPREET SINGH PURI)
JUDGE
05.07.2024
shweta
Whether speaking/reasoned : Yes/No
Whether reportable : Yes/No
7 of 7
