Sandeep Kumar vs State Of Haryana And Others
2024 Latest Caselaw 6048 P&H

Punjab-Haryana High Court

Sandeep Kumar vs State Of Haryana And Others on 18 March, 2024

Author: Jasgurpreet Singh Puri

Bench: Jasgurpreet Singh Puri

                                       Neutral Citation No:=2024:PHHC:039023



                                               Neutral Citation No.2024:PHHC:039023
CWP-138-2020                                                                 -1-



229

             IN THE HIGH COURT OF PUNJAB & HARYANA
                         AT CHANDIGARH

                                                    CWP No.138 of 2020
                                                    Date of Decision: 18.03.2024

Sandeep Kumar
                                                                       ..... Petitioner
                                      Versus

State of Haryana & ors.
                                                                    ..... Respondents

CORAM: HON'BLE MR. JUSTICE JASGURPREET SINGH PURI

Present:            Mr. Sumit Sangwan, Advocate,
                    for the petitioner.

                    Mr. Gaurav Jindal, Addl.A.G., Haryana.

                    Ms. Nikita Goel, Advocate,
                    for respondents No.2 to 5.

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 in the nature of certiorari to

quash the rejection letter dated 26.09.2018 (Annexure P-1), whereby the claim, of

the petitioner regarding reimbursement of medical bills for an amount of

Rs.5,32,205.69 spent by the petitioner on his treatment has been rejected.

2. Learned counsel for the petitioner submitted that the

petitioner is working as Assistant Sub-Station Attendant in the respondent-

Nigam and on 23.04.2017, he met with a road accident while he was going

home and he was admitted in Government Hospital, Jhajjar under OPD

No.10261, dated 23.04.2017. From the aforesaid hospital, he was referred to

PGIMS, Rohtak. He was admitted there at about 9.30 PM under COD

No.98548 on the same date i.e. 23.04.2017. Learned counsel submitted that the

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petitioner had suffered multiple injuries and due to his serious condition, he was

required to be put on ventilator, but at that point of time, PGIMS, Rohtak did

not have any ventilator available since all were occupied. Therefore, he was

shifted to a private hospital i.e. Sunflag Global Hospital, Rohtak, in a critical

condition and due to compelling circumstances and there he was granted the

facility of ventilator and his life was saved. He submitted a medical

reimbursement bill for an amount of Rs.5,32,205.69 to the respondent-Nigam for

medical reimbursement under the policy of the Government. He further submitted

that the aforesaid amount was not reimbursed to the petitioner. Therefore, he has

filed the present petition.

3. During the pendency of the petition, an amount of

Rs.2,42,197/- has been reimbursed to the petitioner, but the remaining has not been

paid on the ground that he got his treatment done from a non-empanelled hospital.

He submitted that as per the instructions, when an employee is admitted to a

non-empanelled hospital then no medical reimbursement is granted until it is a

case of emergency and when an employee is admitted to a non-empanelled

hospital under emergency then there cannot be a full medical reimbursement

and the same is only to the extent of PGI rates. He submitted that as per the

reply filed by the Nigam, the petitioner has been granted reimbursement of

Rs.2,42,197/- on the basis of PGI rates, whereas the petitioner was entitled to the

entire amount of Rs.5,32,205.69 because it was not by choice that the petitioner

had gone to the private hospital rather he went to the Government Hospital,

Jhajjar, from where he was referred to PGIMS, Rohtak as there was no ventilator

available there and therefore, by compulsion, he had to go to a non-empanelled

hospital. He further submitted that even otherwise also the aforesaid hospital at

that point of time was non-empanelled hospital but later on after few months, the

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aforesaid hospital was empanelled as a hospital of the Nigam vide Annexure P-7

dated 27.08.2018. He submitted that in view of the aforesaid facts and

circumstances, the petitioner is entitled for the grant of full medical

reimbursement. He also referred to judgment of Hon'ble Supreme Court in Shiva

Kant Jha Vs. Union of India, 2018 (16) SCC 187, in this regard.

4. On the other hand, learned counsel for respondents No.2 to 5

submitted that as per the instructions of the Nigam, since the petitioner had taken

treatment from a non-empanelled hospital and he had gone there in emergency

condition, he was only entitled for the grant of medical reimbursement to the

extent of PGI rates, which has been calculated to be Rs.2,42,197/- and has already

been paid to the petitioner and he was not entitled for full reimbursement. She

submitted that at the time of accident, the petitioner was taken to Sunflag Global

Hospital, Rohtak, which was not empanelled. But later on after few months in the

year 2018, the aforesaid hospital was brought within the purview of the

empanelled hospitals and in this way, since at the time when the petitioner met

with an accident, it was not an empanelled hospital, therefore, he was not entitled

for full reimbursement but to the extent of PGI rates, in view of the instructions of

the Nigam.

5. I have heard learned counsel for the parties.

6. It is the case where the respondent-Nigam has issued

instructions that in case the petitioner seeks treatment from the empanelled

hospital then he will be granted full reimbursement but in case he is admitted in

private hospital, which is not empanelled, no medical reimbursement is to be

granted unless he is admitted in an emergency and in case he is admitted in an

emergency then the entitlement is to be restricted only to the extent of PGI rates.

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The relevant portion of instructions as supplied by learned counsel for respondents

No.2 to 5 is reproduced as under:-

"4. Un approved Hospitals:-

a) The reimbursement for the treatment taken in an emergency in an un approved hospital will be allowed equal to PGI, Chandigarh rates with the approval of the Administrative Department.

b) Head of the department in consultation with concerned Civil Surgeon is competent to certify an emergency."

7. In the present case, after meeting with an accident, the

petitioner went to Government Hospital, Jhajjar, from where he was referred to

PGIMS Rohtak being in critical condition. A perusal of Annexure P-5 would show

that the father of the petitioner had requested the Medical Superintendent of

PGIMS, Rohtak that COD Number be provided to him because he had to be

shifted to Sunflag Global Hospital because there was no ventilator in the PGIMS,

Rohtak. However, a stand has been taken by the respondents to contend that the

petitioner has not been able to show the documents that there was no ventilator

available in the PGIMS Rohtak. This Court disagrees with the argument raised by

learned counsel for the respondents that the petitioner was to show that there is no

ventilator in view of Annexure P-5 and also in view of the fact that once the

petitioner was referred to a hospital i.e. PGIMS, Rohtak, then why he would get

himself shifted to a smaller hospital i.e. Sunflag Global Hospital, Rohtak. There

can be no reason to believe that the petitioner despite the fact that the ventilator

was there he is shifted to a private hospital. The petitioner got shifted from

PGIMS Rohtak to a private hospital because of want of ventilator, which was a life

saving device. When he was shifted to Sunflag Global, Hosptial, Rohtak, he was,

as per the learned counsel for the petitioner, put on ventilator and in this way, his

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life was saved. It is not the case of the parties that the petitioner had straight away

approached the private hospital or a non-empanelled hospital, so as to deprive him

the full medical reimbursement under the instructions. Firstly, it is a case where

the petitioner went to a Government Hospital, Jhajjar from where he was referred

to PGIMS, Rohtak and thereafter, under compulsion he was shifted to Sunflag

Global Hosptial, Rohtak. This was done in order to save the life of the petitioner

so as to put him on ventilator and actually his life was saved. The Supreme Court

in Shiva Kant Jha's case (supra) also observed that because of such kind of

medical technicalities, the legitimate rights of reimbursement cannot be defeated.

If the treatment of an employee in a non-empanelled hospital was genuine because

there was no other option left with him then he is entitled for entire

reimbursement.

8. In view of the aforesaid facts and circumstances of the present

petition, the same is allowed and the impugned order (Annexure P-1) is hereby set

aside. The respondent-Nigam is directed to pay the balance of the medical

reimbursement to the petitioner within a period of two months from today.

However, there is no order as to any interest or costs.

18.03.2024                                 (JASGURPREET SINGH PURI)
monika                                             JUDGE
                    1. Whether speaking/reasoned: Yes/No
                    2. Whether reportable:        Yes/No




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