Judgment:
1 S.B.Civil Writ Petition No.1615/2010 Smt.Chandra Lunkar versus The State of Rajasthan & ORS.IN THE HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR ORDER
S.B.CIVIL WRIT PETITION NO.1615/2010 Smt.Chandra Lunkar versus The State of Rajasthan & ORS.Date of order : 31.7.2015 HON'BLE Mr.JUSTICE SANDEEP MEHTA Mr.MR Singhvi Sr.Advocate with Mr.Bhavit Sharma, for the petitioner.
Mr.SM Toshniwal, AGC, for the respondents.
<><><> By way of the instant writ petition, the petitioner seeks a direction to be issued to the respondents to reimbuRs.the medical expenses borne by her late husband Sh.Man Mohan Lunkar for the treatment, which he had to undergo in an emergent condition at the Bombay Hospital, Mumbai in 2004.
The petitioner’s husband Sh.Man Mohan was posted as Jr.Engineer in the Irrigation Department at the relevant point of time.
On 12.3.2004, he submitted a leave application for proceeding to Mumbai for visiting his ailing younger brother.
The leave application was accepted and leave was sanctioned to Sh.Man Mohan.
He proceeded to Mumbai, where, all of a sudden, he was taken seriously ill and had to be hospitalized immediately at the Bombay Hospital, Mumbai.
Despite best possible treatment being provided, the petitioner’s husband failed to recover and passed away at Mumbai on 1.5.2004.
The 2 S.B.Civil Writ Petition No.1615/2010 Smt.Chandra Lunkar versus The State of Rajasthan & ORS.petitioner’s husband being a public servant in the State services was entitled for reimbursement of the medical expenses borne in his treatment and as such, pursuant to his death, the petitioner moved an application to the respondents claiming reimbursement of the expenditure incurred in treatment of her husband, which as per the case set up in the writ petition was about 2,19,643/- (including medical and misc.
expenses).Inter-departmental communications were exchanged for processing the said medical bills.
The petitioner was forwarded a communication dated 15.10.2005 (Annex.3) informing her that reimbursement of the bills was only possible after approval from the State Government.
The petitioner kept on submitting representations and reminders to the authorities concerned but to no avail.
The petitioner was informed by another letter dated 7.2.2006 (Annex.7) that approval of the State Government had not been received.
Thereafter, the petitioner was informed that the department was agreeable to reimbuRs.the medical bills to the extent of the expenditure incurred for a similar treatment at the SMS Hospital.
The petitioner consented that she was agreeable for reimbursement to that extent.
However, to her utter surprise, she received a letter dated 12.11.2008 with a demand draft of Rs.88,958/- towards reimbursement of the medical expenses as against the claim of Rs.2,19,643/-.
The petitioner 3 S.B.Civil Writ Petition No.1615/2010 Smt.Chandra Lunkar versus The State of Rajasthan & ORS.thereupon served a notice for demand of justice (Annex.13) to the respondents.
In reply thereto, a sanction letter (Annex.14) dated 7.5.2008 and reply (Annex.15) dated 4.2.2009 were sent to her justifying the decision to reimbuRs.a sum of Rs.88,958/- only, to the petitioner.
Dissatisfied with the quantum of the amount, the petitioner has approached this Court assailing the action of the respondents in not fully reimbursing the expenditure incurred in the treatment of her husband at Mumbai.
The stance of the respondents in the reply to the writ petition is that the petitioner initially submitted a claim of Rs.2,19,643/-, which was scrutinized and thereafter returned back to the petitioner for filing afresh.
The petitioner thereafter resubmitted a fresh claim for a sum of Rs.1,56,298/- with a letter dated 27.11.2004.
Ultimately, a sanction of Rs.89,210/- was issued by the Chief Engineer and a reimbursement of the abovementioned amount was made and accepted by the petitioner.
In the background of these facts, it is asserted in the reply that the petitioner was only entitled for and was rightly reimbursed the expenditure incurred on medicines and investigation at the rates of SMS Hospital, Jaipur and is not entitled to claim any amount beyond that.
I have heard the arguments advanced by the learned counsel for the parties and have gone through the material 4 S.B.Civil Writ Petition No.1615/2010 Smt.Chandra Lunkar versus The State of Rajasthan & ORS.available on record.
In view of the facts narrated above, it is evident that the respondents have themselves not disputed the petitioner’s right to claim reimbursement of the medical expenses borne in the treatment of her husband at the Bombay Hospital.
They themselves assessed the claim submitted by the petitioner to the permissible extent applying the rates of the SMS Hospital for the treatment undergone by the petitioner’s husband at the Bombay Hospital.
The Rajasthan Civil Services (Medical Attendance) Rules, 2008 only allow for such reimbursement and nothing beyond that.
The petitioner herself in her affidavit dated 16.6.2006 submitted to the department with the fresh claim, agreed that the amount incurred in her husband’s treatment was Rs.1,61,144/-.
The respondents made an assessment of the procedures performed on the petitioner’s husband at the Bombay Hospital and the expenditure which would be incurred for similar treatment at the SMS Hospital and communicated to the petitioner vide order (Annex.8) dated 13.6.2006 that she would be receiving a sum of Rs.11,330/- lesser than the claim submitted by her upon applying the rates of the SMS Hospital.
As per the communication (Annex.10) dated 4.7.2006, the Executive Officer of the Water Resources Department, got the assessment of the medical expenditure done at the rates of 5 S.B.Civil Writ Petition No.1615/2010 Smt.Chandra Lunkar versus The State of Rajasthan & ORS.the SMS Hospital and recommended to the Chief Engineer of the Water Resources Department that a reimbursement of Rs.1,49,468/- was permissible on applying the SMS Hospital’s rates.
Thereafter, the order (Annex.12) dated 12.11.2008 came to be conveyed to the petitioner alongwith the demand draft of Rs.88,958/-.
The petitioner, immediately objected to the said demand draft and forwarded a notice for demand of justice to the department, in response whereto, the order (Annex.14) dated 7.5.2008 was communicated to the petitioner that 100% sanction was approved towards the cost of medicines, whereas regarding the expenditure on investigations to the tune of Rs.33,965/- on applying the SMS Hospital’s rates, the reimbursement of a sum of Rs.11,322/- was allowable, which was sanctioned to the petitioner.
The said letter however deals with the petitioner’s claim to the extent of Rs.77,888+33,965 i.e.Rs.1,11,853/- only.
The fact remains that the fresh claim which was submitted by the petitioner on 27.11.2004 alongwith the medical bills was to the tune of Rs.1,65,000/-.
The respondents have not clarified as to why the remaining amount of the claim was not reimbursable.
In the reply, contrary stands are taken by the respondents.
An initial objection is taken that reimbursement was not permissible because treatment was undertaken by the petitioner’s husband in a hospital outside the State without 6 S.B.Civil Writ Petition No.1615/2010 Smt.Chandra Lunkar versus The State of Rajasthan & ORS.procuring prior reference.
The said issue has long since been set to rest by the decision of Hon’ble Division Bench of this Court in the case of Anil Kumar Surolia versus State of Rajasthan reported in 2005(3) WLC(Raj.)-396 wherein it was held as below:- “Government cannot insist upon an employee to get himself treated at recognized government institution.
All that the Government in these circumstances can do is to reimbuRs.the concerned employee at the rates that may be applicable in the recognized government institution.
Reference in this connection may be made to the judgment of the Hon’ble Supreme Court in Surjit Singh versus State of Punjab reported in AIR1996SC-1388 and State of Punjab & ORS.versus Mohan Lal Jindal reported in (2001) 9 SCC-217.
Consequently, the reimbursement of the medical expenses borne by the State Government employees and pensioners has to be done even if the treatment is undertaken at unrecognized hospital outside the State even though reference may not have been taken prior to treatment.”
.
That apart, the respondents have themselves partially sanctioned and reimbursed the petitioner’s medical claim and therefore, they are not entitled to take a plea that the reimbursement cannot be sanctioned.
The only controversy, which thus, now remains alive for consideration in this case is regarding the quantum of the reimbursement.
In this regard, as per the facts narrated above, it is evident that the respondents whilst making the assessment of the medical bills, only dealt with the expenses 7 S.B.Civil Writ Petition No.1615/2010 Smt.Chandra Lunkar versus The State of Rajasthan & ORS.towards the medicines and the investigations.
An apparent discrepancy is reflected in the order dated 7.5.2008 (Annex.14) in the manner of assessment of the medical claim in this regard.
No reason is reflected as to why the remaining amount was not reimbursable.
In this background, the writ petition is disposed of directing the respondents to make a fresh detailed assessment of the total medical claim submitted by the petitioner.
If upon assessment, any difference is noticed, the same shall be reimbursed to the petitioner forthwith.
If not, then a detailed consideration shall be made dealing with all the heads of the medical claim submitted by the petitioner and the order passed thereupon shall be conveyed to the petitioner within a period of six weeks from the date of submission of copy of this order.
The accrued amount if any shall carry interest @ 9% per annum from the date of submission of medical claim till the date of actual payment.
No order as to cost.
(SANDEEP MEHTA).J.
/tarun/