Govt Can't Deny Medical Reimbursement because Hospital Charged patient more than approved Rates: Delhi HC

New Delhi: The Delhi High Court bench has recently clarified that State cannot deny medical reimbursement under Central Government (Medical Attendance) Rules, 1944 merely on the ground that the hospital had charged an excessive amount than the approved rates.

While considering a plea in this regard, the HC bench expressed its shock regarding the fact that only Rs 51, 824 remained pending for last 16 years and the State had vehemently contested the same. 

"It is therefore observed by this Court that the Petitioner cannot be faulted or penalised to pay the excess amount that was charged from him from the Rajiv Gandhi Cancer Institute, when Petitioner in the first instance did not even choose the Hospital but was referred there," observed the HC bench of Justice Chandra Dhari Singh.

The matter concerned the petitioner, who was employed in the Tis Hazari Courts, Delhi as a Reader in the Court of the Metropolitan Magistrate. Since the petitioner was a government employee, he was covered by the Central Government (Medical Attendance) Rules, 1944. Back in 2003, his son was diagnosed as suffering from Madulloblastoma (Postop). For the treatment, initially the petitioner's son was taken to Sir Ganga Ram Hospital and later was referred to Rajiv Gandhi Cancer Institute and Research Centre for further treatment like radiation and chemotherapy.

It was submitted in the plea, that the petitioner was not fully reimbursed against the medical expenditure of his son’s ailment and further, he was issued a letter dated 6th August, 2004 from Drawing & Disbursing Officer, Officers of District and Sessions Judge, Delhi asking him to deposit a sum of Rs. 51,854/- against the medical advance of Rs 2,34,000 granted to him from time to time for the medical treatment of his son in Rajiv Gandhi Cancer Institute.

After receiving the letter, the petitioner requested the Disbursing Officer to provide him the details of deductions. Considering his representation, the Drawing & Disbursing Officer sought the opinion of the Director, Directorate of Health Services as to why the Petitioner should not be fully reimbursed for the medical expenses incurred for his son’s treatment.

Also Read: Gujarat: HC directs authorities to reimburse medical expenses of Retired teacher of Grant-In-Aid Primary School

However, representation of the petitioner was rejected and subsequently the learned District & Session Judge, Delhi passed the order dated 17th January 2006 for recovery of amount of Rs. 51,854/- from the pay of the Petitioner. Thereafter, the petitioner approached the High Court bench seeking relief.

The counsel for the petitioner submitted to the court that the authorities have acted arbitrarily by making unreasonable deductions from the medical claims submitted by the Petitioner for his son’s treatment from the Government recognised hospitals and also by not informing the reasons for such deductions to the Petitioner despite his several reminders and representation. Referring to this, the petitioner's counsel argued that the actions of the respondents suffer from gross illegality and violation of principles of law.

On the other hand, the counsel for the Government submitted that the Petitioner is entitled for medical reimbursement only in terms of CS (MA) Rules as well as the instructions issued by the Government of NCT of Delhi from time to time and accordingly, the Petitioner was sanctioned medical advances summing up to Rs. 2,34,000/- from time to time against the billing amount of Rs. 2,28,429/-, i.e., less than the amount advanced.

It was further submitted that after scrutinizing the bills and calculating his entitlement as per applicable CS(MA) rules, he was found to be entitled for a grant of Rs. 1,82,146/- against the bills submitted by him for Rs. 2,28,429/-. Therefore, he was directed to deposit the excess amount of Rs. 51,854/- sanctioned to him vide letter dated 6th August 2004.

The Counsel for the petitioner argued on the other hand that right to health is a constitutional right protected under Article 21 of the Constitution of India and therefore, the Government is under a constitutional mandate to reimburse the Government Servant, for the legitimate expenses incurred by him for the medical attention received by him or his dependants.

Further, the petitioner's counsel submitted that Government Servant is entitled to reimbursement of the full amount of the medical expenses and not only at the rates specified in the circulars issued by the Government from time to time. Therefore, it was argued that the petitioner cannot be denied full reimbursement if the hospital has charged from him a rate exceeding the package deal rate and it is for the Government to effect recovery from the hospital rather than issuing a demand in favour of the Petitioner.

Referring to CS (MA) Rules, 1944, the Court noted that the medical treatment availed by the medical treatment availed by the government servant or his dependants has to be free of charge, and any amount that is paid by him on account of such medical attention or treatment has to be fully reimbursed to him.

"This Court is of the opinion that the medical attendance rules formulated by Central and State Governments are not merely the rules relating to medical attendance, but are the beneficiary piece of legislation to facilitate good and sound health for all the government employees and their families. It does not stand to reason as to why any impediments are read in the rules which have the tendency to defeat the cherished Constitutional rights for which this Court has always stood as a custodian," noted the Court.

The bench also referred to the counter affidavit filed by the State and noted, "I am unable to figure out even a single provision of law which has been taken in support by the Respondents to justify the deductions made in the claim of the Petitioner. Merely making a statement that calculations have been made in accordance with the relevant rules as applicable to the Petitioner will not help the case of the Petitioner."

"The claims in dispute in the instant petition are the claims arising from the bills given by Rajiv Gandhi Cancer Institute and Research Centre for the amount of Rs.2,28,429/-. It is not denied by the Respondents that the Petitioner on his own, did not chose this hospital but he was referred there for the further treatment of his child," further noted the Court.

Holding that the petitioner was entitled full reimbursement for the expenses incurred by him for the treatment of his minor child, the bench mentioned the judgment, "The Respondents are directed to fully reimburse the Petitioner to the extent of bills raised by both the Hospitals, and to release the amount retained in the FDR, along with interest accrued from time to time, deducted from the salary or allowances of the Petitioner as soon as possible, but positively within a period of four weeks from the date of this judgment."

"Before parting, this Court expresses its deep dismay that as to how a petition seeking reimbursement for only Rs. 51, 824/- has been pending since 16 years, and is being vehemently contested by the GNCTD," the Court further noted.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/delhi-hc-medical-reimbursement-197670.pdf

Also Read: Medical Claims cannot be denied only because hospital not mentioned in Govt order: HC