Petitioner challenged refusal of balance medical reimbursement, claiming prior order was complied with. Court found petitioner treated at non-referred hospital before Medical Board reference and excluded expenses pre-reference.
No order as to costs.
This page shows the compact analysis of this judgement. The full analysis — procedural history, issue-by-issue holdings with ratio and obiter, advocates, and paragraph-level evidence for every claim — is being added to the record in batches and will appear here when this judgement has been through it.
THE HIGH COURT OF TRIPURA AGARTALA
WP(C) 327 of 2017
Sri Himangshu Ghosh, son of late Harendra Ch Ghosh, resident of Vill - Natunnagar (Deshbandhu Para) P.O. Natunnagar (Cooperative) Airport Road, Agartala, Tripura West, PIN-799009.
………… Petitioner
…….Respondents
BEFORE
THE HON’BLE MR. JUSTICE S. TALAPATRA
For the petitioner : Mr. P Maishan, Advocate For the respondents : Mr. TD Majumdar, Advocate Date of hearing & delivery of judgment &order : 09.11.2017 Whether fit for reporting : No .
JUDGMENT AND ORDER (ORAL)
Heard Mr. P Maishan, learned counsel appearing for the
petitioner as well as Mr. TD Majumdar, learned counsel appearing for the
TTAADC respondents.
2. By means of this writ petition, the petitioner has challenged the
decision of the respondents declining to pay/reimburse the sum of WP(C) 327 of 2017 Page 1 of 3
Rs.72,862/- with interest @ 9% per annum from the date of submission of the original bills till the date of reimbursement.
3. The petitioner has submitted that by the memorandum dated 23.05.2016 (Annexure-II to the writ petition), the Principal Officer (Education) Khumulwng, TTAADC should have sanctioned a sum of Rs.2,90,411/- in lieu of Rs.2,17,545/- withholding a sum of Rs.72,866/-. It is to be noted that the petitioner had earlier approached this Court by filing the writ petition being WP(C)443/2015 for medical reimbursement wherein this Court had observed
as follows:
“This court further finds sufficient force in the submission of Mr. T.D. Majumder, learned counsel appearing for the TTAADC and as such the respondents are directed to make reimbursement of the medical bills as raised by the petitioner at the rate what the petitioner would have incurred if he was treated in the ILS Hospital as a referred patient, meaning at par the settled rate between the Government of Tripura and the ILS Hospitals, Agartala. However, it is made clear that the petitioner will not get any reimbursement of his travel expenses as he has travelled for a hospital which is not a referral hospital of the state. Hence, the petitioner will not be entitled to get such reimbursement on account of the travelling expenses.
The respondents are directed to make such payment within a period of 3(three) months from the date of resubmission of the medical reimbursement bills which were returned to the petitioner by the authority before filing of the writ petition else the amount shall carry interest @ 9% till the payment is made.”
4. The petitioner submitted those bills but by the said memorandum dated 23.05.2016 the respondents sanctioned the medical reimbursement for a sum of Rs.2,17,545/-. For not paying the entire bill amount to the extent of Rs.2,90,411/- as mentioned, the petitioner has approached this Court by filing a fresh writ petition.
5. The respondents by filing their reply have categorically stated in paragraph 6 that they have paid the amount which the petitioner is entitled to. They have further contended that the petitioner was admitted in the hospital on 15.11.2014 and thereafter, he was referred by the Medical Board
WP(C) 327 of 2017 Page 2 of 3
to the ILS Hospitals on 21.11.2014. But he did not take admission or report to the referral hospital. From the bill submitted by the petitioner it is revealed that he was admitted in the Medica Super Specialty Hospital, Kolkata on 17.11.2014, but he was referred on 21.11.2014 by the Standing Medical Board. Therefore, it is evident that the Medical Board has issued the certificate of reference without physical examination of the patient. Therefore, the petitioner is not entitled to the treatment cost as incurred at Kolkata during the period from 17.11.2014 to 20.11.2014 for private treatment which was available at Agartala. The authority has made reimbursement erroneously. Moreover such cost of the treatment availed at Agartala before being referred is not reimbursable as he was then getting fixed medical allowance being a Group-C employee. It has been further asserted as follows:
“He was paid the bill for an amount of Rs.217545/- against the bill raised by him. The differences of the rate of the bill of the petitioner and the CGHS rate is Rs.38085/-. The amount of Rs.34631/- was not paid to him for treatment at Agartala before being referred at ILS Hospital. Simply this is the reason for not paying Rs.72,716/- against the bill raised.”
6. Having appreciated the submissions made, this Court is satisfied that the judgment and order dated 26.02.2016 delivered in WP(C)433/2015 has been complied as the petitioner is not borne in the reimbursable establishment and therefore, he is not entitled to get reimbursement of the medical expenses that he had incurred before he was referred by the Medical Board for better management of his illness.
7. Hence, this writ petition being bereft of substance is dismissed. There shall be no order as to costs.
JUDGE
WP(C) 327 of 2017
Page 3 of 3
lodh
2 issues framed by the court
Whether the petitioner is entitled to reimbursement of medical expenses incurred at a non-referred hospital before being advised to refer to ILS Hospital?
Whether the Medical Board's reference certificate was issued without physical examination justifying the claim?
Himangshu Ghosh
Tripura Tribal Areas Autonomous District Council
S. Talapatra
As recorded by the court registry
Judgements on the same questions, provisions and authorities, from every court
