The Central Board of Trustees vs Manjunath Rao T.

Mohan M. Shantana Goudar, J.—The order dated 21.4.2015 passed by the Central Administrative Tribunal (''CAT'' for short), Bangalore Bench, in O.A. No. 334/2014 is called in question in this writ petition.

The records reveal that the respondent being the employee working in Employees'' Provident Fund Organisation (''EPFO'' for short) at Mysore, underwent heart surgery at Vikram Hospital, Mysore on 22.8.2012; three stents were implanted during the course of heart operation. After completion of operation successfully, the respondent submitted his claim for reimbursement of the amount spent by him towards medical expenses. The respondent has received Rs. 1,00,000/- (Rupees One Lakh Only) as advance from the petitioner. Since the petitioner did not reimburse the full medical charges as claimed by the respondent, he approached the CAT in O.A. No. 334/2014, which came to be allowed with a direction to the petitioner to pay full amount of the bill within one month.

Smt. Sumangala Swamy, learned Advocate appearing on behalf of the petitioner taking us through the material on record, submits that the respondent is not entitled to the cost incurred by him for the implantation of third stent; the respondent is entitled for the actual cost incurred by him to the maximum of two stents; since the respondent had claimed the medical bills relating to three stents which were implanted in the heart, the Department has rightly not reimbursed such cost. To support the aforementioned contention, she relies upon Annexure-R1 dated 19.8.1993. The said Annexure is annexed to (i.e., part of) O.M. No. S.14025/55/92-MS, wherein it is specified that the ceiling limit for reimbursement of the cost of Coronary Stents is maximum of two stents per patient.

The question as to whether the respondent is entitled to the reimbursement of full amount or not including even the cost of third stent is fully covered by the Division Bench of this Court in the case of THE REGIONAL PROVIDENT FUND COMMISSIONER AND OTHERS v. C.K. NAGENDRA PRASAD, in W.P. No. 8995/2013 (S-CAT) disposed of on 13.6.2013, wherein this Court relying upon Rule 6 of CS(MA) Rules, 1944, (''Rules'' for short) concluded that the Office Memorandum cannot regulate the Rules or restrict the operation of the Rule. Rule 6 is a beneficial provision, which should be interpreted to give its full effect and not to restrict or to deprive of the benefits to the employee. The Rules are applicable to all the Central Government servants when they are on duty, leave or foreign service in India or when under suspension. The said Rules are applicable to the EPFO. Rule 6 of the Rules reads thus:

"6. (1) A Government servant shall be entitled, free of charge, to treatment -

(a) in such Government hospital at or near the place where he falls ill as can in the opinion of the authorized medical attendant provide the necessary and suitable treatment; or

(b) If there is no such hospital as is referred to in subclause (a) in such hospital other than a Government hospital at or near the place as can in the opinion of the authorized medical attendant, provide the necessary and suitable treatment.

(2) Where a Government servant is entitled under sub-rule (1), free of charge, to treatment in hospital, any amount paid by him on account of such treatment shall, on production of a certificate in writing by the authorized medical attendant in this behalf, be reimbursed to him by the Central Government;

Provided that the Controlling Officer shall reject any claim if he is not satisfied with its genuineness on facts and circumstances of each case, after giving an opportunity to the claimant of being heard in the matter. While doing so, the Controlling Officer shall communicate to the claimant the reasons, in brief, for rejecting the claim and the claimant may submit an appeal to the Central Government within a period of forty-five days of the date of receipt of the order rejecting the claim."

(emphasis supplied)

The bare reading of the said Rule makes it amply clear that the Government servant shall be entitled to free of charge, to treatment in such Government hospital at or near the place where he falls ill as can in the opinion of the authorized medical attendant provide the necessary and suitable treatment. If there is no such Government hospital is available nearby, the Government servant may take medical help from nearby hospital, which provides the necessary and suitable treatment. The Government servant is entitled to free of charge, treatment in hospital and any amount paid by him on account of such treatment shall, on production of a certificate in writing by the authorized medical attendant in this behalf, be reimbursed to him by the Central Government.

Hence, Rule 6 makes it amply clear that the Government servant is entitled to treatment free of charge and any amount paid on account of such treatment shall, on production of a certificate in writing, in this behalf, be reimbursed to him by the Central Government.

However, as aforementioned, in Annexure-R1, which is annexed to O.M. No. S.14025/55/92-MS dated 19.8.1993 relied upon by the learned Counsel for the petitioner, it is stated that the patient would be entitled to the cost of maximum of two stents (Rs. 60,000/- per stent). But, the said Annexure further makes it clear that however, in exceptional circumstance, when the use of more than two stents becomes necessary to bail out the patient, prior permission of Director-General of Health Services, will have to be obtained. In this matter, the prior permission of Director-General of Health Services is not obtained by the respondent. In that context, the learned Advocate for the petitioner submits that the respondent is not entitled for the reimbursement in respect of the cost of third stent. Such submission cannot be accepted.

The Official Memorandum cannot displace the beneficial provision contained in Rule 6 of the Rules. The Official Memorandum cannot regulate the Rules or restrict the operation of the Rules. Moreover under exceptional circumstances, it is open for the Director-General of Health Services to give consent for the third stent also. But in case of emergency, the Doctor has to decide on the operation table as to how much stents should be implanted in the heart. In that regard, it will not be possible to get consent of the concerned authority, when the patient is on the operation table.

As has been held by the Division Bench of this Court in W.P. No. 8995/2013 (S-CAT) disposed of on 13.6.2013, mentioned supra, the Government servant is entitled to free of charge, treatment in hospital and any amount paid by him on account of such treatment shall, on production of a certificate in writing by the authorized medical attendant in this behalf, be reimbursed to him by the Central Government as per Rule 6 of the Rules. The Official Memorandum relied upon by the petitioner''s counsel cannot restrict or deprive the benefits to the employee provided under Rule 6 of the Rules.

Hence, no interference is called for. Accordingly, petition fails and the same stands dismissed.

We hope and trust that the Central Government shall amend its O.M. No. S.14025/55/92-MS dated 19.8.1993 in consonance with Rule 6 of the Rules, keeping in mind the observations made supra and having regard to the present day cost of stents.