Allowed

Pratibha Bhati v. U.P. Power Corporation and Another

Allahabad HC26 Sept 2023WRIA/15296/2023

Case brief

AI extract

What is this about?

Writ petition allowed. Court directed respondent to accept duplicate medical bills and process the petitioner's reimbursement claim of Rs. 4,75,341/- within two weeks in absence of a rule prohibiting partial reimbursement.

What did the court decide?

Petitioner allowed to duplicate medical bills and respondent directed to process claim for Rs. 4,75,341/- within two weeks.

Pratibha Bhati Vs U.P. Power Corporation… — Pension and Retirement Benefits | Allahabad HC (2023)

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Neutral Citation No. - 2023:AHC:187319

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Court No. - 33

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Case :- WRIT - A No. - 15296 of 2023 Petitioner :- Pratibha Bhati

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Respondent :- U.P. Power Corporation And Another Counsel for Petitioner :- Satya Prakash Mishra Counsel for Respondent :- Kaushalendra Nath Singh

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Hon'ble J.J. Munir,J.

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A short counter affidavit has been filed in Court today on behalf of respondent no. 2 in compliance with the order dated 13.09.2023. It is taken on record.

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Mr. Ridham Gupta, Advocate holding brief of Mr. Kaushalendra Nath Singh, learned Counsel for respondent no. 2 states that he does not wish to file any further affidavit. Admit.

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Heard Mr. S.P. Mishra, learned Counsel for the petitioner and Mr. Ridham Gupta, Advocate holding brief of Mr. Kaushalendra Nath Singh, learned Counsel for respondent no. 2.

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The petitioner has filed this writ petition seeking a mandamus directing the Executive Engineer, Western Electricity Distribution Division Ist/City Electricity Distribution Division, Bulandshahar, to consider the petitioner’s grievance for medical reimbursement.

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This Court issued a wider Rule asking the Executive Engineer to justify denial of medical reimbursement. In paragraph no. 5 of the affidavit, it is averred that a sum of Rs. 2,25,000/- has been availed by the petitioner from a private insurance company i.e. Star Health Bima Company and there is no rule in the respondent-Corporation permitting the petitioner to claim

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reimbursement of medical expenses in part from a private insurance company as well as the respondent-Corporation, his employer.

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The petitioner has clearly come out with a case that he holds a medical insurance policy and on that basis a medical reimbursement claim form has been submitted to the Corporation, where it is indicated that out of the total medical expenses of Rs. 7,00,341/-, he had received a sum of Rs. 2,25,000/- from the Star Health Insurance Company, the private medical insurance company. The petitioner has claimed the balance sum of Rs. 4,75,341/- from the Corporation.

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The respondents have denied this claim saying that there is no rule enabling the Corporation to pay the medical expenses of an employee who holds a medical insurance policy.

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Upon the Court asking learned Counsel for the respondentCorporation as to which is that rule that prohibits the payment of medi-claim to an employee, otherwise eligible to it under the Rules, if he has with him a private medical insurance policy, learned Counsel for the Corporation states that there is no rule prohibiting the reimbursement of such medical expenses.

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Learned Counsel for the respondent-Corporation submits that the stand taken by the Corporation is based on the general principle understood by the Corporation that the employee cannot be permitted to take benefit of a medical insurance policy and also claim reimbursement from the employers. This kind of an approach can be understood in a case where the medical insurance company reimburses the entire medical expenses or a very substantial part of it. But, where the medical insurance cover is a limited one that reimburses the medical expenses as regards a part of the total expenditure, it would require a positive rule in the employer establishment to prohibit

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reimbursement of medical expenses claimed by the employee to the extent that these have not been paid by the medical insurance company.

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The reason is that unless, reimbursement of medical expenses for the balance that the private medical insurance company had not paid is prohibited by a statutory prescription or rule, the general principle that would be attracted is that the law permits all that to be done, which is not expressly prohibited. If medical reimbursement is permissible for an employee, there is no reason to infer prohibitions of a part of it, if he depends on his insurance cover to make it good. Rather, it lightens the employers burden to the extent that he would otherwise have to bear according to Rules a particular percentage far more than what he would have to bear now. Therefore, the stand taken in paragraph no. 5 of the counter affidavit is not at all tenable and is rejected.

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The other stand taken in paragraph no. 6 of the counter affidavit to deny the petitioner’s claim is that she has not filed her medical bills in original which is mandatory according to the Rules of the Corporation.

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Now, the difficulty appears to be that the medi-claim bills in original have already been submitted to the private medical insurance company, and, on that basis a part of the claim has been reimbursed by them.

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In the circumstances, the Indian Spinal Injuries Centre, SectorC, Vasant Kunj, New Delhi, where the petitioner has been treated, shall issue a complete duplicate set of copies of the bills, vouchers and receipts, including in-house purchase bills of medicines etc., which upon production before the respondentCorporation shall be accepted in lieu of the original. At the same time, acting on copies of cash memos etc. of medicines

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purchased from outside, of course, after due verification, the respondent shall pass necessary orders on the petitioner’s claim for reimbursement of the sum of Rs. 4,75,341/-, in accordance with Rules within two weeks.

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The writ petition is allowed in terms of the aforesaid orders. Let this order be communicated to the Executive Engineer, Western Electricity Distribution Division Ist/City Electricity Distribution Division, Bulandshahar by the Registrar (Compliance) by Tuesday i.e. 03.10.2023. Order Date :- 26.9.2023 / K.K. Maurya

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Digitally signed by :- KAMLESH KUMAR MAURYA High Court of Judicature at Allahabad

Pratibha Bhati v. U.P. Power Corporation and Another

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Pratibha Bhati v. U.P. Power Corporation and Another

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