MUKESH TIWARI Vs. STATE OF M P

JUDGEMENT

(1.) Being aggrieved by partial reimbursement of Medical expenses meted out by the petitioner for Coronary Artery By-Pass Surgery underwent at Escorts Hearts Hospital, New Delhi, present petition is filed seeking direction to respondents to make good the difference of amount paid and the amount reimbursed. The petitioner an employee of School Education Department, Government of M.P. was detected of Coronary heart disease in May 2004. He was treated at Government MGM College, Indore, whereupon he was referred to Escorts Heart Hospital, New Delhi for Coronary Angiography and further treatment. The petitioner on the basis of referral certificate applied for permission from the Director, Public Instruction for treatment at Escorts Heart Hospital, New Delhi. The permission was duly accorded. Petitioner after preliminary treatment underwent surgery and was relieved on 8.6.2004. Petitioner had to incur Rs. 2,19,473/- for the entire treatment. Thereafter, he applied for reimbursement of the said amount. The respondents instead of entire amount of Rs. 2,19,473/-reimbursed only Rs. 1,15,000/- on the anvil that it was the maximum amount which tis reimbursable as per circular issued by the Medical Education Department No. F 18-58/2000/55/vish/1 dated 15/20-3-2001 for an open heart surgery.

(2.) The facts being not controverted, nor the entitlement of the petitioner for medical reimbursement having undergone surgery at Escorts Heart Hospital, New Delhi, the question which arises for consideration is whether the petitioner is entitled for the reimbursement of entire amount spend to meet out the expenses of surgery or are the respondents justified in limiting the same as per circular dated 15/20-3-2001.

(3.) Medical attendance and treatment of Government servant is regulated by the Rules framed by Governor in exercise of powers conferred by proviso to Article 309 of the Constitution of India, viz., Madhya Pradesh Civil Services (Medical Attendance) Rules 1958 (hereinafter to be referred as Rules of 1958)'. Since it is not disputed, that the petitioner underwent treatment in the Hospital as per sanction by the Competent Authority. It is Rule 4 which is relevant in the context as to the entitlement of Government servant of medical reimbursement. Rule 4 stipulates-