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Judgment
Heard Smt. R.K. Emily, the learned counsel appearing for the petitioner; Shri S. Suresh, the learned CGC appearing for the respondent Nos. 1, 2 and 3 and Shri L. Atembi, the learned counsel appearing for the respondent No. 4.
By the instant writ petition, the petitioner has prayed for issuing a direction to the respondents to reimburse and release the medical expenses incurred by him.
The facts of the case as narrated in the petition are that the petitioner initially joined the Central Industrial Security Force (referred to hereafter as "the CISF") in the year 19-05-2001 and was transferred and posted at different CISF Units and is presently posted at CISF Unit, Imphal Airport vide an order issued in the month of June, 2015. While the petitioner was suffering from Right Knee ACL Tear with Lateral and Medial Meniscus Tear, he was treated at Ganga Medical Centre & Hospitals Pvt. Ltd., Coimbatore for which the petitioner submitted a medical bill of Rs. 80,214/- (Rupees eighty thousand two hundred and fourteen) only to the Airport Authority of India (hereafter referred to as "the AAI"). However, the said bill was returned by the AAI vide its letter dated 27-10-2014 and in response thereto, the office of the CASO/Dy. Commandant, CISF, Coimbatore issued an office order dated 09-06-2015 directing that the individuals concerned be informed and the claims made by them be handed over to them. On 21-07-2015 the petitioner submitted a representation to the Deputy Commandant, CISF Unit, ASG, Coimbatore, Tamil Nadu explaining as to how the said expenses was incurred by him towards his treatment and requested that his medical bill be reimbursed as per the CGHS rates as soon as possible. Even though the petitioner is entitled to, his medical bill has not yet been reimbursed and accordingly, the petitioner has filed the present writ petition.
An affidavit-in-opposition on behalf of the respondent Nos. 1, 2 and 3 has been filed wherein it has been stated that the CISF being an armed force unit of the Union of India, is governed by the rules and regulations framed by the Government of India from time to time. While the petitioner was posted at CISF Unit, Coimbatore, he submitted an application dated 28-08-2014 seeking prior permission for indoor medical treatment in Ganga Hospital, Coimbatore which was forwarded to the AAI but without awaiting approval from the APD, AAI, Coimbatore, the petitioner underwent medical treatment but the AAI vide its letter dated 09-09-2014 informed the respondent No. 3 that prior permission could not be given as the Ganga Medical Centre and Hospital is not in the panel of AAI, Coimbatore. However, the medical bills were forwarded to the AAI which returned the same vide its letter dated 02-12-2014 stating that the Ganga Hospital is non-panelled and as such, the request was not acceded to. Since the names of the empanelled hospitals were not provided by the AAI, medical bills were again forwarded to the AAI with the request that reimbursement could be made at the CGHS rates. Thereafter, the office of the respondent No.4 was persuaded to reimburse the medical bill of the petitioner as has been done earlier in the case of SI/Exe. M. Surendera Reddy.
An affidavit on behalf of the respondent No. 4 has been filed wherein it has been stated that when prior permission was sought for by the petitioner, the same could not be granted as the Ganga Hospital is not in the panel of AAI. As per the policy of the AAI communicated vide letter dated 16-04-2010, all CISF employees wherever they are posted, should take treatment from AAI empanelled hospitals and make use of the CGHS facilities. The treatment in non-panelled hospitals is not permissible except in cases of emergency. The application of the petitioner did not indicate any assertion of or existence of an emergency which required him to get himself treated at Ganga Hospital, Coimbatore. The ailment as seen from the medical prescription, was not an ailment of an emergent nature which required him to be immediately rushed to casualty or emergency service. The petitioner has acted in violation of the policy of the AAI at his own peril and the AAI cannot be made to act contrary to its own policy. There is no averment made by the petitioner that the ailment from which he was suffering, cannot be treated in the empanelled hospital in Coimbatore. Therefore, the petitioner is not entitled to reimbursement of the medical expenses incurred by him.
It is not in dispute that the petitioner was suffering from Right Knee ACL Tear with Lateral and Medial Meniscus Tear for which he was treated at Ganga Medical Centre & Hospitals Pvt. Ltd., Coimbatore, without prior approval, which is not in the panel of the AAI and since he spent a sum of Rs. 80,214/- (Rupees eighty thousand two hundred and fourteen) only towards it, he submitted a medical bill thereof to the AAI for reimbursement. When the AAI returned the bill, his only prayer was that his medical bill be cleared at the rate fixed by the CGHS. The short question that arises for consideration by this court is as to whether the petitioner is entitled to reimbursement of the medical expenses incurred by him at the rate admissible as per norms of the CGHS. The contention of the learned counsel appearing for the petitioner is that the petitioner is entitled to reimbursement of his medical expenses at the rate admissible as per norms of the CGHS in terms of the decision rendered by the Hon''ble Supreme in Court in Surjit Singh Vs. State of Punjab & ors., (1996) 2 SCC 336 as well as the decision of this court in Smt. Kshetrimayum (O) Hemolata Devi Vs. State of Manipur in WP(C) No. 85 of 2014. In support of his contention, the learned counsel appearing for the respondent No. 4 has not cited any decision.
In Surjit Singh''s case, he got himself admitted and operated upon in Humana Hospital, Wellington, London spending a sum of Rs.3 lakhs and submitted a bill for medical reimbursement which was not sanctioned by the Department. The appellant filed a writ petition before the High Court and during the course of hearing, the Asstt. Advocate General made a statement to the effect that the State was ready to pay the expenses incurred for bypass surgery and angiography on the rates prevalent in the AIIMS. The writ petition stood disposed of accordingly and an appeal preferred before the Hon''ble Supreme Court by way of special leave was allowed with the direction that the appellant be paid towards his medical expenses at the rate admissible as per Escorts. While allowing the said appeal, the Hon''ble Supreme Court held that self-preservation of one''s life is the necessary concomitant of the right to life enshrined in Article 21 of the Constitution of India and therefore, the appellant had the right to take steps in self-preservation. Para 12 of the judgment and order is as under:
"12. The appellant therefore had the right to take steps in self-preservation. He did not have to stand in queue before the Medical Board, the manning and assembling of which, barefacedly, makes its meetings difficult to happen. The appellant also did not have to stand in queue in the government hospital of AIIMS and could go elsewhere to an alternative hospital as per policy. When the State itself has brought Escorts on the recognised list, it is futile for it to contend that the appellant could in no event have gone to Escorts and his claim cannot on that basis be allowed, on suppositions. We think to the contrary. In the facts and circumstances, had the appellant remained in India, he could have gone to Escorts like many others did, to save his life. But instead he has done that in London incurring considerable expense. The doctors causing his operation there are presumed to have done so as one essential and timely. On that hypothesis, it is fair and just that the respondents pay to the appellant, the rates admissible as per Escorts. The claim of the appellant having been found valid, the question posed at the outset is answered in the affirmative. Of course the sum of Rs. 40,000 already paid to the appellant would have to be adjusted in computation. Since the appellant did not have his claim dealt with in the High Court in the manner it has been projected now in this Court, we do not grant any interest for the intervening period, even though prayed for. Let the difference be paid to the appellant within two months positively. The appeal is accordingly allowed. There need be no order as to costs."
Relying upon the said decision of the Hon''ble Supreme Court, this court allowed the W.P. (C) No. 85 of 2014, Smt. Kshetrimayum (O) Hemolata Devi directing the respondents therein to reimburse the medical expenses incurred by the petitioner therein to be calculated on the rates approved by the State Government or at the rate being charged by the private hospitals approved by the State Government.
In the present case, the petitioner, in exercise of his right to self-preservation as held by the Hon''ble Supreme Court, took steps and got himself treated at Ganga Medical Centre & Hospitals Pvt. Ltd., Coimbatore and therefore, he submitted a medical bill of Rs.80,214/-(Rupees eighty thousand two hundred and fourteen) only to the Airport Authority of India. It may also be noted that his case was that his medical expenses be reimbursed at the rate admissible as per norms of the CGHS. In view of the decision of the Hon''ble Supreme Court referred to hereinabove as well as the facts of the present case, this court is of the view that the instant writ petition ought to be allowed.
For the reasons stated hereinabove, the instant writ petition is allowed with the direction that the respondents and in particular, the respondent No.4 shall reimburse the medical expenses incurred by the petitioner by calculating the amount at the rate admissible as per norms of the CGHS and shall pay the amount so calculated to the petitioner within sixty days from the date of receipt of a copy of this judgment and order, failing which it will carry an interest @ Rs.9% per annum till the date of payment. There shall be no order as to costs.