BALDAU PRASAD KAUSHIK Vs. STATE OF C.G.

JUDGEMENT

(1.) The petitioner is aggrieved by the order dtd. 24/9/2022, whereby respondent No. 3 has rejected his claim for medical reimbursement amounting to Rs.54,848.00. The petitioner, serving as Assistant Grade-II in the Secretariat Services, Mantralaya, Raipur, had sought reimbursement for the treatment and surgery of his minor son for Hypospadias at Makhija Pediatric and Neonatology Surgery Center, Bilaspur--an empanelled hospital. Despite due intimation and compliance with all procedural formalities, the claim was rejected arbitrarily on the ground of lack of urgency, and the subsequent representation was also dismissed without valid reason. Hence, this petition seeking following reliefs :

(2.) Facts of the case, in a nutshell, are that the petitioner is serving as an employee of the Secretariat Services under the Government of Chhattisgarh, in the General Administration Department, Mantralaya, Raipur. He is presently posted as Assistant Grade-II in the Department of Women and Child Development, Mantralaya, Mahanadi Bhavan, Nava Raipur, Atal Nagar, District Raipur (C.G.). During the year 2018 2019, the minor son of the petitioner, namely Master Devansh Kaushik, aged about 2 years and 4 months, was diagnosed with Hypospadias (Urinary Difficulty), a congenital condition requiring specialized surgical treatment. The child was under regular medical supervision and treatment at Makhija Pediatric and Neonatology Surgery Center, Bilaspur, where the attending physician advised surgical intervention. The surgery for Hypospadias was to be conducted in two stages. The first stage of the operation was successfully performed in the months of SeptemberOctober 2018. Thereafter, it was medically advised that the second stage of surgery be carried out at the same hospital to ensure continuity of care and medical safety. In November 2019, the child again developed complications and urinary difficulty, and upon medical examination, was advised immediate admission. Consequently, the second stage of the surgery was performed on 15/11/2019 at Makhija Pediatric and Neonatology Surgery Center, Bilaspur. It is pertinent to mention that Makhija Pediatric and Neonatology Surgery Center, Bilaspur is a hospital duly recognized and enlisted by the State Government of Chhattisgarh for providing medical treatment to State Government employees and their dependent family members. As per the provisions of the Chhattisgarh Civil Services (Medical Attendance) Rules, 2013, it is mandatory that in cases of emergency treatment, the concerned employee must intimate the Director, Medical Education, Chhattisgarh, Raipur and the Head of the Department within 48 hours of the commencement of treatment, and post facto approval may thereafter be obtained. The petitioner duly complied with the aforesaid requirement and intimated the concerned authorities within 48 hours of the admission of his son for emergency surgery. After the successful completion of the treatment and recovery of his child, the petitioner submitted an application for Medical Reimbursement in the prescribed format on 16/12/2019, enclosing all requisite documents and medical certificates. Respondent No. 2, upon due consideration, forwarded the application filed by petitioner along with supporting documents to the Civil Surgeon, Bilaspur, for verification vide letter dtd. 17/12/2019. The Civil Surgeon, after due verification of the documents, issued a certificate on 9/1/2020 certifying that an amount of Rs.54,848.00 was payable to the petitioner as medical reimbursement. Under the Chhattisgarh Civil Services (Medical Attendance) Rules, 2013, respondent No. 3 is the competent authority to sanction reimbursement claims exceeding Rs.25,000.00. Accordingly, the claim of the petitioner was forwarded to respondent No. 3 for necessary consideration and sanction. However, respondent No. 3, without proper application of mind and without appreciating the circumstances of the case in their correct perspective, rejected the medical reimbursement of petitioner claim vide order dtd. 23/3/2021, assigning the remark "Not Emergency , " The action of respondent No. 3 is arbitrary, unjust, and contrary to the spirit of the Medical Attendance Rules.

(3.) It is further submitted that the minor son of the petitioner was barely two and a half years old and was suffering from a serious congenital urological disorder. The surgery performed was a life-saving and medically urgent procedure. The petitioner had duly informed the authorities within 48 hours and availed treatment at an authorized and empanelled hospital under the State Government. It is submitted that the life and health of a two-year-old child are matters of utmost emergency to a parent, and therefore, rejection on the ground of "no emergency" is unreasonable and insensitive to the humanitarian and legal principles involved. Being aggrieved by the arbitrary rejection, the petitioner preferred a detailed representation on 24/12/2021 requesting reconsideration of his reimbursement claim. In his representation, the petitioner specifically explained that the treatment was continued under the same doctor and hospital where the first stage of surgery had been performed and that the second surgery became urgently necessary owing to the recurrence of complications and pain. The choice of the same empanelled hospital was both reasonable and medically justified. The said representation was duly forwarded by respondent No. 2 to respondent No. 3 for appropriate action. However, once again, respondent No. 3, without assigning any valid or reasoned basis, rejected the claim vide order dtd. 24/9/2022, merely recording the word "". The rejection order was subsequently communicated to the petitioner on 8/2/2023 by respondent No. 4. The rejection of the genuine medical reimbursement claim of petitioner by respondent No. 3 is arbitrary and unreasonable. Hence, the petitioner is constrained to approach this Court.