RCP KARN Vs. UNION OF INDIA

JUDGEMENT

(1.) MR . Bawa has brought to our notice the provisions of Rule 3 of the Central Services (Medical Attendance) Rules, 1944 (hereinafter referred to as "the Rules), which provides that on a certificates being issued by the Authorised Medical Attendant, the Government servant shall be entitled to reimbursement of the medical expenses incurred by the employee for his treatment. Further more, Rule 6 of the Rules, provides that a government servant shall be entitled to free of charge treatment which has been availed by the government servant in any hospital at or near the place where he falls ill as can in the opinion of the authorised medical attendant provide the necessary and suitable treatment This rule further provides that if no such hospital as referred to in Sub -clause (a) is available, the employee can avail medical treatment from such hospital other than a government hospital at or near the place where the employee falls ill. However, a proviso is added to Rule 3 as well as Rule 6 enabling the Controlling Officer to reject the claim for reimbursement if he is dis -satisfied with the genuineness of the claim. This proviso, enjoins on the Controlling Officer to take a decision after giving an opportunity to the claimant of being heard. This proviso also requires the Controlling Officer to communicate to the claimant his reasons, in brief, for rejecting the claim. After the communication of the order rejecting the claim, the employee (claimant) has a right to 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. It is not disputed that the claim of the petitioner relates to treatment which was taken from 14.07.2001 to 23.07.2001. The petitioner had undergone an operation of Coronary Artery By -pass Surgery, popularly known as "By -pass surgery", at the well known Escort Hospital, New Delhi. This hospital is stated to be recognised by the Government. The total claim of the petitioner was in the sum of Rs. 1,95,000/ -. According to Mr. Bawa, the claim of the petitioner would be over and above Rs. 1,95,000/ - as the aforesaid amount were spent by the petitioner only on the Bye -pass Surgery. The petitioner has, however, been refunded a sum of Rs. 89,700/ -. Not satisfied with the reimbursement, the petitioner had made a representation to the authorities which is dated 20.06.2002 (Annexure P -6) No decision has been taken by the respondents on the aforesaid representation.

(2.) WE are of the considered opinion that the respondents were duty bound to comply with the proviso to Rules 3 and 6 of the Rules, even if, the respondents were going to reject the claim of the petitioner, it was necessary for the Controlling Officer to give an opportunity of hearing to the petitioner. Since Mr. Bawa has argued the matter on merits, it is not necessary to remand the matter to the respondents for taking a decision on the representation which has been submitted by the petitioner. We proceeded on the basis that the representation, Annexure P -6, made by the petitioner has been rejected by the authorities.

(3.) MR . Sharma, appearing for the respondents has submitted that the claim of the petitioner is liable to be rejected as he would be entitled to reimbursement only at the approved rates which have been prescribed in a decision taken by the Union of India's letter No.G.I.M.H. & F.W., O.M. No.S -14025/55/92 -MS, dated the 19th August, 1993 and S -14025/45/94 -MS, dated the 31st October, 1994. It is not denied that the hospital from which the petitioner took treatment is a recognised hospital. According to approved rates given, the petitioner would be entitled to the amount already reimbursed. He further submits that the writ petition is liable to be dismissed on the short ground that the petitioner has concealed the material facts from this Court. In support of the submission with regard to approved rates, Mr. Sharma has relied on a judgment of the Supreme Court in the case of State of Punjab and Ors. v. Ram Lubhaya Bagga etc. etc. A.I.R. 1998 Supreme Court 1703 and Union of India and Ors. v. S.K. Rampal . Learned counsel has made particular reference to paragraph 11 of the judgment in S.K. Rampal's case (supra).