Petitioner sought medical bill reimbursement denied because the hospital was not on the approved panel. The Court held that under the pre-1993 policy, reimbursement should be based on actual expenses incurred.
Petitioner held entitled to reimbursement of actual medical expenses incurred under the policy prevailing before the year 1993.
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IN THE HIGH COURT OF PUNJAB AND HARYANA AT CHANDIGARH
Civil Writ Petition No.14352 of 1994
Date of decision: 25th August, 2010
K.C. Verma
… Petitioner
Versus
Punjab State Electricity Board
… Respondent
CORAM: HON'BLE MR. JUSTICE KANWALJIT SINGH AHLUWALIA
Present: Petitioner in person. Mr. Rajat Khanna, Advocate for the respondent.
KANWALJIT SINGH AHLUWALIA, J. (ORAL)
Petitioner, in the year 1991, was posted as a Chief Engineer Civil (New Projects), Research and Consultancy, Punjab State Electricity Board. He proceeded on casual leave from 9th to 11th and then from 16th to 18th September, 1991. The petitioner had received a message from his daughter, who was settled at Delhi, that she was suffering from acute kidney pain. At Delhi, the petitioner had a severe attack of chest pain accompanied by vomiting in the evening of September 17, 1991. As an emergency measure, he was rushed to Aashlok Hospital, Safdarjang, New Delhi for treatment. The petitioner was diagnosed to be a case of gall bladder and the stones had moved from the gall bladder towards the gut. That was the reason of severe chest pain and vomiting. As an emergency measure, the petitioner had to be operated upon on 25th September, 1991 and he was discharged from hospital on 20th October, 1991. The petitioner resumed his duties and submitted his medical bills
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Civil Writ Petition No.14352 of 1994
for reimbursement. He had raised a bill of Rs.52,184.50. The petitioner was denied payment of the medical reimbursement on the ground that the policy, which was prevailing in the year 1991, had not recognized Aashlok Hospital, Safdarjang, New Delhi, as one of the hospitals, where an employee of the respondent-Board could take treatment.
Mr. Rajat Khanna, Advocate appearing for the respondentBoard, has submitted that in the year 1991, the Board had approved Escorts Heart Institution, New Delhi; Christian Medical College, Ludhiana; and Appolo Hospital, Madras, along with various other private hospitals for open heart surgery, where an employee could undertake his treatment. According to the Board, Aashlok Hospital, Safdarjang, New Delhi was not on the panel of hospitals approved by it. In the year 1993, the Board adopted a policy regarding medical reimbursement issued by the State of Punjab. In the policy of 1993, it was stated that an employee can take treatment from any private hospital but the medical expenses shall be reimbursed at the rates, which were prevailing at AIIMS Delhi or PGIMER Chandigarh. Mr. Khanna has submitted that according to the PGIMER Chandigarh, the petitioner was entitled to payment of Rs.18,385/-.
The question, which arises for consideration of this Court, is that before the policy of 1993, at what rates the petitioner was entitled to reimbursement of medical expenses?
The petitioner-K.C. Verma, aged about 75 years, appearing in person has stated that before the year 1993, other employees of the Board were made payment as per the actual expenses incurred. He has further relied upon a decision of this Court rendered in ‘Sadhu R. Pall v. State of Punjab’ 1994(1) RSJ 335.
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Civil Writ Petition No.14352 of 1994
This Court, in ‘Gurmail Singh v. State of Punjab and others’ (Civil Writ Petition No.10640 of 1994, decided on 26th July, 2010), has held as under:
“Now the question which arises for consideration of this Court is as to at what rates medical expenses are to be reimbursed to the petitioner.
- Whether the policy dated 13.02.1995 upheld by Hon'ble Apex Court in State of Punjab versus Ram Lubhaya Bagga, 1998 AIR (SC) 1703 will apply retrospectively or not?
In case, the policy is held to apply with retrospective effect, petitioner shall not be entitled to reimbursement of actual expenses and this Court had to hold that the payment of medical bills as per AIIMS rate is valid. Cue can be taken from the words of wisdom in State of Punjab versus Ram Lubhaya Bagga's case (supra) wherein in Para 17 it was observed as under:-
‘17. That was a case where the petitioner got heart attack being in England and was hospitalised and operated in Burminghom hospital and this Court held that inasmuch as Escorts' was one of the designatted hospitals under the old policy of the reimbursement permissble to the appellant would be at the rate as that of Escorts and not of AIIMS as ordered by the State.’
Taking clue from the above observation, this Court can hold that the medical claims of petitioner is to be decided in terms of the old policy prevalent before the year 1995. Therefore, petitioner shall be entitled to reimbursement of actual medical expenses incurred by him under the old policy (before 1995) in accordance with the norms prevalent at that time.”
The objection raised that since Aashlok Hospital, Safdarjang, New Delhi was not on the panel of the hospitals approved by the Board
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Civil Writ Petition No.14352 of 1994
for reimbursement, therefore, the petitioner is not entitled for the same, cannot be accepted because in emergency, the first anxiety of the relations of a patient is to get immediate help and if at the hospital where the help is sought, it is opined that operation is the only answer and condition of the patient is life-threatening, then the family members of the patient have to act to save his life and at that stage, the relations cannot evacuate the patient to move from one hospital to another. Therefore, considering the fact that before the year 1993, payment was made by the Punjab Government on the basis of actual expenses incurred, this Court is of the opinion that petitioner cannot be denied the relief sought.
Accordingly, in view of the discussion made above and the view formulated by this Court in Gurmail Singh’s case (supra), present petition is allowed and the petitioner is held entitled to reimbursement of actual medical expenses incurred by him, under the policy prevailing before the year 1993. The needful shall be done within a period of two months from the date of receipt of a certified copy of this order. However, there will be no order as to costs.
[KANWALJIT SINGH AHLUWALIA] JUDGE
August 25, 2010 rps
1 issue framed by the court
Before the 1993 policy, what rates are employees entitled to for medical expense reimbursement?
Colour shows how this judgement treated each authority
Sadhu R. Pall v. State of PunjabReferred¶18
Sadhu R. Pall v. State of Punjab 1994(1) RSJ 335
Gurmail Singh v. State of Punjab and othersApplied¶21
Gurmail Singh v. State of Punjab and others (Civil Writ Petition No.10640 of 1994)
State of Punjab versus Ram Lubhaya BaggaExplained¶24
State of Punjab versus Ram Lubhaya Bagga, 1998 AIR (SC) 1703 · Who else cites this
K.C. Verma
Punjab State Electricity Board
Kanwalsingh Ahluwalia
As recorded by the court registry
Judgements on the same questions, provisions and authorities, from every court
