Sumer Singh Rajpurohit vs Union of India

Sunil Ambwani, Actg. C.J.—We have heard appellant-petitioner appearing in person and Mr. M.R. Singhvi, Sr. Advocate, assisted by Mr. Mohit Singhvi, appearing on behalf of the respondents.

This intra Court Special Appeal is directed against the judgment of the learned Single Judge dated 15.04.2014 by which he had disposed-of the writ petition with liberty and direction to appellant-petitioner to approach the Director (HR and BD), Oil India Limited, Noida-respondent No. 3 and the Group General Manager (RP), Oil India Limited-respondent No. 4 to get his claim for reimbursement of medical expenses for treatment of his wife decided. The authorities were directed to decide the representation/claim of appellant-petitioner locally at the first instance and, thereafter, at the Director''s level at Noida, after giving an opportunity of hearing to appellant-petitioner within three months.

The Executive Director (RP), Oil India Limited, has in pursuance to the order dated 14.07.2014 of the learned Single Judge, impugned in this appeal, decided the representation, vide an order annexed to the affidavit, in support of the compliance report, of Shri Narendra Vashisht, Head (Admn. and E.R.), Oil India Limited, Jodhpur.

The appellant-petitioner was reimbursed the medical expenses, claimed by him for his wife''s treatment upto the year 2006. He was aggrieved by the non-consideration and rejection of reimbursement of the medical bills for the treatment of his wife in AIIMS, New Delhi for which it is alleged that the medical bills totalling more than about Rs. four lacs are pending reimbursement.

In the order dated 04.10.2014 deciding appellant-petitioner''s representation, the Executive Director (RP), Oil India Limited has quoted the relevant Medical Attendance Rules of the Company as follows:

"The Medical Attendance Rules of the Company stipulates as under:

i) If in the opinion of Competent Authority certain essential specialized investigations/treatment of an illness is not available in the authorized hospital (local), the Competent Authority can refer the case to any nearest hospital providing such investigations/treatment.

ii) Medical treatment availed outside without prior approval will not be considered except in cases of emergent situations requiring immediate hospitalization.

iii) Every subsequent visit/consultation from the date of referral should have approval from the Competent Authority.

iv) The employee shall submit all bills in original including hospitalization, travel medical test, boarding and lodging charges etc., within 30 days from the date of resumption of duty to the Head of Administration/IR as the case may be."

The order dated 04.10.2014 further states that since June, 2007, the appellant-petitioner has made several applications to Oil India Limited Management requesting for permission for medical treatment of his wife at AIIMS, New Delhi. He, however, did not submit the required documents i.e. original medical card/prescription of the attending doctors of AIIMS, New Delhi alongwith his application, which was essential to enable the competent authority to assess the need for outside treatment and decide the request. The appellant-petitioner was advised from time to time vide Note dated 01.09.2007 and the letters of the Corporation dated 21.06.2007 and 05.09.2007, to follow the medical rules, which were not complied with. The required documents and the original bills were not submitted. It is further stated in the order that the appellant-petitioner availed his wife''s treatment at AIIMS, New Delhi without prior approval of the competent authority for which no reimbursement can be allowed as per the Medical Attendance Rules. The treatment of his wife was locally available in Jodhpur vide certificate dated 28.06.2013 of Dr. Anand Goyal, Director, Goyal Hospital and Research Center, Jodhpur and the letter dated 01.10.2014 from GM (Admin.), Medipulse Hospital, Jodhpur, which shows that the treatment for the said ailment was available in Jodhpur.

The order further states that the appellant-petitioner was repeatedly advised to consult Dr. S.K. Vohra, Company''s authorized Medical Attendant at New Delhi, alongwith all the records of the case. The appellant-petitioner did not visit him. The available medical records were forwarded to Dr. S.K. Vohra, who opined vide his letter dated 13.10.2014 that the patient can avail the treatment from an Endocrinologist at Jodhpur for routine examination and, thereafter, his wife can be referred to AIIMS, New Delhi, if it was necessary.

On the aforesaid facts, the competent authority was of the opinion that having violated the Medical Attendance Rules, the claim of the appellant-petitioner will set a wrong precedence leading to unmanageable administrative situation in the Company and, thus, the post facto permissions can also not be given and settlement of the reimbursement of claims cannot be agreed.

The appellant-petitioner has sent a reply to the letter dated 04.10.2014 of which he has reiterated the contents of the writ petition and the grounds of appeal alleging that all the original bills were submitted and that, he had taken leave from the competent authority before proceeding to Delhi for getting the treatment of his wife at AIIMS, New Delhi. He had submitted the original bills and the certificates, issued by the doctors at Jodhpur, including the competent authority in the Medical College at Jodhpur that the Endocrinology Department is not available in the Medical College at Jodhpur and that the required treatment was available in AIIMS, New Delhi. It is submitted that the original bills submitted, were returned by the competent authority to him and, thus, they may not be available with the respondents. The appellant-petitioner can produce them as and when required. He has also stated in his reply that he had submitted the original prescriptions of AIIMS, New Delhi, from which the medical treatment and cost of medicines can be verified. The appellant-petitioner has not taken any decision for visiting AIIMS, New Delhi on his own. He had pursued the treatment of his wife on the medical advice and the non-availability of the required medical treatment at Jodhpur.

We have considered the respective submissions and find that appellant''s wife was not suffering with any life threatening disease nor required immediate hospitalization in any emergency. She required specialized treatment from an Endocrinologist, who was not available at any attached hospitals of Dr. S.N. Medical College, Jodhpur. The appellant continued with the treatment of his wife in AIIMS at New Delhi without permission of the competent authority in the Company and claimed reimbursement of his bills. His explanation for absence of original medical bills with the respondents was not acceptable.

We are informed by the learned counsel appearing for the respondents that appellant''s wife is an employee of the State Government. She is serving as a Teacher and is still claiming the bills for medical treatment from the respondent-Company on the ground that she can claim medical bills only from one source.

The medical reimbursement can be claimed by any employee strictly in accordance with the Medical Attendance Rules of the Company. In the present case, the Oil India Limited is a Government of India enterprises and has its own Oil India Employees Medical Attendance Rules, 2001. These Rules provide for specialized investigations/treatment of an illness, in case, it is not available in the authorized hospital (local). In such cases, the competent authority may refer the case to any nearest hospital providing such investigations/treatment. Any treatment taken outside without approval is not to be considered for reimbursement of expenses, except in a case of emergent situation and life threatening condition requiring immediate hospitalization. Every subsequent visit/consultation for outstation treatment from the date of referral should receive approval from the competent authority. An employee must, in all cases of reimbursement, submit all bills in original, including hospitalization, travel, medical test, boarding and lodging charges within 30 days from the date of resumption of duty.

In the present case, the conditions of the Medical Attendance Rules were violated by the appellant-petitioner. The reimbursement was made to him upto the year 2006, as the appellant-petitioner had established that the investigations and the treatment were not available at Jodhpur and that it was necessary for him to visit AIIMS, New Delhi for treatment of his wife and for which he was referred and permission was given to him by the competent authority. He, however, did not produce the referral letters by which he was required to visit AIIMS, New Delhi, after 2006 for the treatment of his wife. Dr. S.K. Vohra, the consulting physician and child specialist, engaged by the Company, has opined in his letter dated 13.10.2014, that perhaps in the year 1996, there was no Senior Endocrinologist available in Jodhpur for treatment of disease relating to pituitary glands, which results in extra growth of hair on the body. He had learnt that there is one now, who can keep check on patient''s condition and refer her to AIIMS, if it was absolutely necessary. After the original diagnosis was made, which was quite complex, the follow up would be easier. It would have reduced the frequent travelling with its own problems. The AIIMS could see her once a year, while Endocrinologist at Jodhpur can see her for routine examinations. She could be sent to AIIMS if at any point, a surgery is required. The repeated travelling and tests at AIIMS, New Delhi, for all times, was not found absolutely necessary by the doctors, consulted by the respondents. The necessity for each visit for routine check up or treatment was, in the opinion of the doctor of the Company, was uncalled-for.

We are of the view that since the appellant-petitioner had not followed the Medical Attendance Rules, 2001, made by the Oil India Limited for its employees, he was not entitled to reimbursement of the medical bills for the treatment of his wife at AIIMS, New Delhi.

In view of the aforesaid facts and circumstances of the case, the Special Appeal, after the appellant-petitioner''s representation has been considered and decided against him, is dismissed. The stay petition is also dismissed.