1. In effect, the present petition has been filed with the prayer to quash the order dated 29.09.2016 passed by Senior Superintendent of Police, Lucknow and also to command the respondents to pay the remaining amount of medical reimbursement of Rs.8,84,879.60 against the expenses at Apollo Indraprasth Hospital, New Delhi and Rs.53,027/- against the expenses at KGMU, Lucknow along with 18% interest including the amount of Rs.3,30,000/- against the expenses of Air Ambulance and also the amount spent against the private rooms of hospital.
2. Brief facts of the case are that the petitioner met with an accident during late hours of night at 1.45 am on 26.07.2010 while he was posted as Station Officer, Police Station Gosainganj and was on patrolling. The petitioner sustained severe injuries and he was brought to Trauma Centre in King George Medical University, Lucknow. At a later point of time, looking to the condition of the petitioner, he was referred to Indraprasth Apollo Hospital New Delhi for further treatment. The petitioner was Airlifted and he was remained in the hospital up to 22.08.2010. On 23.08.2010, the petitioner was sent to Lucknow and he remained under treatment at King George Medical University till 08.04.2011. On 09.04.2011, the petitioner joined his services on the advise of the doctors. The petitioner submitted his all bill vouchers amounting to Rs.98,406/- spent in KGMU and Rs.10,99,219.60 spent in Apollo Hospital, New Delhi to the D.I.G. Police, Lucknow Range who referred the matter to the Director General Medical Health, Lucknow (opposite party no.2). The opposite party no.3 sanctioned only an amount of Rs.1,48,340/- against the expenses at Indraprasth Apollo Hospital New Delhi and Rs.45,479/- against the expenses at K.G.M.U., Lucknow. The amount of Rs.3,30,000/- against the bill of Air Ambulance was not sanctioned.
3. Being dissatisfied with the meager amount, so sanctioned, the petitioner preferred a representation to the Additional Director, Medical and Health, Lucknow (opposite party no.3) on 18.04.2011. Thereafter the petitioner has filed a writ petition No.6092 (SS) of 2012 praying therein to reimburse the amount so incurred on the medical treatment. The said writ petition was disposed of vide order dated 01.08.2016 giving liberty to the petitioner to approach the respondent no.4-Senior Superintendent of Police, Lucknow for ventilation of his grievance by making a representation which shall be considered and decided by the respondent no.4 in accordance with law. It was also observed that the Senior Superintendent of Police, Lucknow while considering the matter under this order shall also give finding as to whether provisions of Uttar Pradesh Government Servant (Medical Attendance) Rules, 2011 are applicable to the case of the petitioner or not. The petitioner preferred a representation in compliance to the order of this Court dated 01.08.2016, which has been rejected by impugned order dated 29.09.2016 on the ground that the claim has been settled before issuance of the U.P. Government Servants (Medical Attendance), Rules, 2011. Hence, this petition.
4. Learned counsel for the petitioner has submitted that respondent no.3 in a very illegal and arbitrary manner without applying his mind sanctioned only an amount of Rs.1,48,340/- against the claim of Rs.10,33,219.60 and Rs.45,479/- against the claim of Rs.98,406/-. Learned counsel submits that the actual claim of the petitioner was verified by the competent authorities of the K.G.M.U, and the Appollo Hospital New Delhi, but the authorities did not sanction the entire amount and no reason has been assigned. It is submitted that the petitioner cannot be denied the payment of entire amount of medical reimbursement as he met with an accident and sustained serious injuries while he was on official duty. Learned counsel submits that as per the earlier Government Orders and the Uttar Pradesh Government Servants (Medical and Attendance) Rules, 2011 (for short 'Rules 2011'), the petitioner is entitled for the expenses of the private room or special room during the treatment as his basic salary was Rs.22,370/- and 'Rules 2011' also provides for the expenses of Air Ambulance in case of emergency but despite of the admitted fact of emergent situation, the fee of Air Ambulance was not paid to the petitioner. It has also been submitted that the opposite parities have illegally denied the benefit of the 'Rules 2011' to the petitioner. Learned counsel for the petitioner has submitted that the representation of the petitioner has been rejected without application of mind. The denial of medical reimbursement is not only violate the legal right of the petitioner but also violative of fundamental rights of the petitioner. Learned counsel for the petitioner submits that the impugned order is liable to be quashed and the petitioner is entitled for the payment of medical reimbursement.
5. Per contra, learned counsel for the State has vehemently opposed the submissions made by the learned counsel for the petitioner and submitted that in compliance to order dated 01.08.2016 passed in W.P. 6092 (SS) of 2012, the representation of the petitioner has been decided in accordance with law by the impugned order. Learned Standing Counsel has submitted that all admissible amounts have been reimbursed to the petitioner after due consideration and as per the relevant rules and the Government Orders applicable at the relevant time. The incident was taken place on 26.07.2010 and the 'Rules 2011' came into existence w.e.f. 02.09.2011 and therefore the same is not applicable in the case of the petitioner. It is submitted that the department has proceeded with the matter and after following the procedure prescribed in the relevant rules and the Government Orders, amounts have been reimbursed to the petitioner. Learned counsel for the State has submitted that the writ petition has no merit and it is liable to be dismissed.
6. Heard learned counsel for the parties and perused the record. Pleadings have already been exchanged.
7. It is admitted fact that the petitioner met with an accident during discharging of his official duties. He was admitted in the Hospital at King George Medical University and thereafter looking to his condition, he was referred to the Appollo Indraprasth Hospital, New Delhi on the advise of the doctors for the specialized treatment. After the treatment, he has submitted his medical bills duly verified by the doctors and there is no dispute regarding the genuineness of the medical bills, which have been submitted to the department for the reimbursement.
8. In the petition, it is contended that this Court may exercise its jurisdiction under Article 226 of the Constitution of India so that the fundamental rights of the petitioner under Article 14 and 21 of the Constitution are protected and promoted by reimbursing his medical expenditure already incurred by him under genuine emergency.
9. In the case of State of Punjab and others vs. Ram Labhaya Bagga and others reported at (1198) 4 SCC 117 Hon'ble the Apex Court in para 23 and 27 the following has held that :
"23. When we speak about a right, it corelates to a duty upon another, individual, employer, Government or authority. In other words, the right of one is an obligation of another. Hence the right of a citizen to live under Article 21 casts obligation on the State. This obligation is further reinforced under Article 47, it is for the State to secure health to its citizen as its primary duty. No doubt Government is rendering this obligation by opening Government hospitals and health centers, but in order to make it meaningful, it has to be within the reach of its people, as far as possible, to reduce the queue of waiting lists, and it has to provide all facilities for which an employee looks for at another hospital. Its up-keep; maintenance and cleanliness has to be beyond aspersion. To employ the best of talents and tone up its administration to give effective contribution. Also bring in awareness in welfare of hospital staff for their dedicated service, give them periodical, medico-ethical and service oriented training, not only at the entry point but also during the whole tenure of their service. Since it is one of the most sacrosanct and valuable rights of a citizen and equally sacrosanct sacred obligation of the State, every citizen of this welfare State looks towards the State for it to perform its this obligation with top priority including by way of allocation of sufficient funds. This in turn will not only secure the right of its citizen to the best of their satisfaction but in turn will benefit the State in achieving its social, political and economical goal. For every return there has to be investment. Investment needs resources and finances. So even to protect this sacrosanct right finances are an inherent requirement. Harnessing such resources needs top priority."
However, having regard to the fact that the medical facilities continued to be given and an employee was given free choice to get treatment from any private hospital in India but the amount of payment for reimbursement was regulated, it was opined :-
"27. No State or any country can have unlimited resources to spend on any of its project. That is why it only approves its projects to the extent it is feasible. The same holds good for providing medical facilities to its citizen including its employees. Provision of facilities cannot be unlimited. It has to be to the extent finance permit. If no scale or rate is fixed then in case private clinics or hospitals increase their rate to exorbitant scales, the State would be bound to reimburse the same. Hence we come to the conclusion that principle of fixation of rate and scale under this new policy is justified and cannot be held to be violative of Article 21 or Article 47 of the Constitution of India."
The aforesaid principle was reiterated in the case of State of Punjab vs. Mohan Lal Jindal reported at 2001 (9)SCC 217.
10. In the case of Paschim Banga Khet Mazdoor Samity v. State of W.B. reported at (1996) 4 SCC 37 Hon'ble the Apex Court has held that "The Constitution envisages the establishment of a welfare State at the federal level as well as at the State level. In a welfare State the primary duty of the Government is to secure the welfare of the people. Providing adequate medical facilities for the people is an essential part of the obligations undertaken by the Government in a welfare State. The Government discharges this obligation by running hospitals and health centres which provide medical care to the person seeking to avail of those facilities. Article 21 imposes an obligation on the State to safeguard the right to life of every person. Preservation of human life is thus of paramount importance. The government hospitals run by the State and the medical officers employed therein are duty-bound to extend medical assistance for preserving human life. Failure on the part of a government hospital to provide timely medical treatment to a person in need of such treatment results in violation of his right to life guaranteed under Article 21."
11. In the case of Surjit Singh vs. State of Punjab and others reported at (1996) 2 SCC 336 Hon'ble the Apex Court has held as under :
"In a case where the appellant therein while in England fell ill and being a case of emergency case was admitted in Dudley Road Hospital, Birmingham. After proper medical diagnosis he was suggested treatment at a named alternate place. He was admitted and undergone bypass surgery in Humana Hospital, Wellington, London. He claimed reimbursement for the amount spent by him.
In the peculiar facts of that case it was held :-
"11. It is otherwise important to bear in mind 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, fundamental in nature, sacred, precious and inviolable. The importance and validity of the duty and right to self-preservation has a species in the right of self defence in criminal law. Centuries ago thinkers of this Great Land conceived of such right and recognised it. Attention can usefully be drawn to verses 17, 18, 20 and 22 in Chapter 16 of the Garuda Purana (A Dialogue suggested between the Divine and Garuda, the bird) in the words of the Divine :
17. Vinaa dehena kasyaapi canpurushaartho na vidyate Tasmaaddeham dhanam rakshetpunyakarmaani saadhayet Without the body how can one obtain the objects of human life? Therefore protecting the body which is the wealth, one should perform the deeds of merit.
18. Rakshayetsarvadaatmaanamaatmaa sarvasya bhaajanam Rakshane yatnamaatishthejje vanbhaadraani pashyati One should protect his body which is responsible for every thing. He who protects himself by all efforts, will see many auspicious occasions in life.
20. Sharirarakshanopaayaah kriyante sarvadaa budhaih Necchanti cha punastyaagamapi kushthaadiroginah The wise always undertake the protective measures for the body. Even the persons suffering from leprosy and other diseases do not wish to get rid of the body.
22. Aatmaiva yadi naatmaanamahitebhyo nivaarayet Konsyo hitakarastasmaadaatmaanam taarayishyati If one does not prevent what is unpleasent to himself, who else will do it? Therefore one should do what is good to himself."
We may, however, notice that in that case, before the Court, Rules framed under the proviso to Article 309 of the Constitution of India, were not in force. What were in force were the Policies regarding reimbursement of medical expenses framed by the State of Punjab on 25th January, 1991 and 8th October, 1991."
12. The right to life of a citizen of the country is the obligation on the part of the State to reimburse the Medical Expenses incurred by the employees. Article 21 of the Constitution says that no person shall be deprived of his life or personal liberty except according to procedure established by law. Right to life enshrined in this Article has been held to mean something more than survival or animal existence. This right would include right to live with human dignity, a right to minimum subsistence allowance during suspension. This right would include all those aspects of life, which go to make a man's life meaningful, complete and worth living. This principle was laid down by Hon'ble the Apex Court in the case of Menika Gandhi v. Union of India, AIR 1978 Supreme Court 597. An aspect which alone can make it possible to live must be declared to be an integral component of right to life. Right to livelihood would also be a facet of right to life. Even right to good health has been held to be inclusive of right to life. That being the wide scope and ambit of this Article, right of the petitioner to seek reimbursement of medical expenses incurred by him to ensure his right to health would fall within the ambit of right to life. The responsibility of the Government towards government employees can not be left at the whims of the officials. The Government can not be permitted to escape from responsibility to reimburse the medical expenses of the employees incurred on the support of some technicalities.
13. In the instant case, the accident taken place during discharge of official duties. The petitioner was admitted in the Government Hospital in emergency condition and thereafter referred for the further treatment which was the requirement and necessity for survival of his life. Once the accident and the medical bills are undisputed, the medical reimbursement cannot be denied on technical grounds. The respondents have clearly misdirected themselves by disallowing the petitioner's reimbursement of his medical bills under the pretext of Rules. The Rules do not disentitle the petitioner from getting reimbursement of his medical bills, if otherwise are found genuine. The State and its officials being public functionary are supposed to discharge their duties for larger benefit of its citizens. It is welfare State. The respondents were expected to perform their duties in a more responsible, reasonable and passionate manner so as to visualize the problem and hardship faced by the government employees.
14. It is settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. A very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the expenditure incurred was excess to his entitlement. The right to medical claim cannot be denied on technical grounds. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds.
15. It is admitted fact that the medical bills which have been submitted by the petitioner were duly verified by the concerned hospitals. The petitioner was discharged from the Indraprasth Apollo Hospital on 22.08.2010. Thereafter, he was sent to Lucknow and further he remained under treatment at King George Medical University, Lucknow till 08.04.2011. On the advise of the doctor, he joined his duties on 09.04.2011. The petitioner submitted all medical bills to the D.I.G. Police Lucknow Range for reimbursement, however, only Rs.1,48,340/- was sanctioned against the claim of Rs.10,33,219/- and Rs.45,479/- was sanctioned against the claim of Rs.98,406/-. On 18.04.2011, the petitioner made representation to opposite party no.2 for reconsideration but no order was passed by the competent authority. In the year 2012, the petitioner filed a writ petition No.6092 (SS) of 2012 before this Court which was disposed of vide order dated 01.08.2016 with direction to the S.S.P. Lucknow to reconsider the claim of the petitioner. So, the matter regarding bill of medical reimbursement never finally settled and in the meantime the U.P. Government Servant (Medical Attendance) Rules 2011 came into force and made applicable w.e.f. 02.09.2011.
16. Now the question which is for consideration is whether the duly verified medical bills by the concerned hospitals may be reimbursed to the petitioner as per the Rules 2011 or not ? It is also relevant to take into consideration that if the petitioner was not sent by the Air Ambulance, then he would certainly have died for want of better medical treatment.
17. Apparently and avowedly, the Medical Attendance Rules providing for reimbursement of the medical expenses to the Government servant and retired pensioners, is a beneficial and welfare legislation meant for the welfare of the Government servants and, therefore, a liberal, sympathetic and objective interpretation for the applicability of these Rules, has to be made by the Courts and not a pedantic or narrow approach of the matter would subserve the interest of justice.
18. In the aforesaid facts and circumstances the case in hand, it is admitted fact that the bills which were submitted for reimbursement were duly verified by the concerned hospitals and it is also not disputed by the State - respondents that the condition of the petitioner was critical and he was required specialized treatment under the advise of the doctors of K.G.M.U., so he was shifted to Appollo Hospital New Delhi by Air Ambulance. The only objection on behalf of the State is that Rules 2011 is not applicable in the case of the petitioner as the incident took place prior to the commencement of the Rules 2011 but it is admitted fact that till the commencement of the Rules, 2011, medical bills of the petitioner was not settled by the competent authority and this Court vide order dated 01.08.2016 passed in writ petition No.6092 (SS) of 2012 has directed to consider the claim of the petitioner for the reimbursement of the medical bills.
19. Since the amount of medical bills of the petitioner was not settled and pending for reimbursement before the competent authority after the commencement of the Rules 2011, I am of the view that the claim of the petitioner requires consideration as per the Rules 2011. Thus, the impugned order dated 29.09.2016 passed by Senior Superintendent of Police, Lucknow is liable to be set aside.
20. Accordingly, the writ petition is allowed. Impugned order dated 29.09.2016 is hereby set aside. A writ of mandamus is issued directing the respondents - competent authority to re-consider the claim of the petitioner for the reimbursement of the medical bills in terms of the Uttar Pradesh Government Servants (Medical and Attendance) Rules, 2011. Whatever amount the petitioner is entitled, the same be released. The said exercise shall be completed within two months from the date of receipt of a certified copy of this order.
No costs. Pending applications, if any stands disposed of.
Order Date :- 25.1.2021 VNP/-