1998 JTR(SC) 1087
2001 9 SCC 217 ; 2002 SCC(L&S) 189 ; 2001 7 SLR 77 ; 2002 7 SLR 77 ; 2001 KHC 3937
SUPREME COURT OF INDIA
J.Jagannadha Rao : S.B.Majmudar
State Of Punjab
Versus
Mohan Lal Jindal
Case No. : 5206 of 1998
Date of Decision : 10/26/98
Medical reimbursement for employees is limited to the rates prescribed by the prevailing policy. Entitlement cannot exceed these rates based on emergency treatment at other hospitals or claims that the policy was not sufficiently published.
(A) Service Law - Medical Reimbursement - Entitlement to reimbursement under a specific policy - When an employee requires medical treatment after a new policy has come into operation, the entitlement to medical reimbursement is based on the rates prescribed under that policy - Reimbursement is limited to the prescribed rates even if the employee sought treatment at another hospital due to emergency or long queues at the designated government hospital - The contention that a policy was not sufficiently published to justify reimbursement beyond prescribed rates is unsustainable. (Para 2)
Facts of the case:
An employee suffered a heart attack and underwent bypass surgery. Due to long queues at the designated government hospital, the employee sought treatment at another hospital. The employee claimed medical reimbursement exceeding the rates prescribed by the policy dated 13-2-1995. The lower court had granted the additional amount on the ground that the new policy was not sufficiently published.
Findings of Court:
The medical reimbursement available to the employee is limited to the prescribed rates of the designated government hospital. The view of the lower court regarding the insufficient publication of the policy cannot be sustained.
Issues: Whether an employee is entitled to medical reimbursement exceeding the rates prescribed by the governing policy on the grounds of emergency or insufficient publication of the policy.
Ratio Decidendi: Once a policy prescribing specific reimbursement rates is in operation, employees are entitled to reimbursement only at those rates, regardless of the necessity to seek treatment at a different facility.
Result: Appeal allowed.
Facts of the case:
An employee suffered a heart attack and underwent bypass surgery. Due to long queues at the designated government hospital, the employee sought treatment at another hospital. The employee claimed medical reimbursement exceeding the rates prescribed by the policy dated 13-2-1995. The lower court had granted the additional amount on the ground that the new policy was not sufficiently published.
Findings of Court:
The medical reimbursement available to the employee is limited to the prescribed rates of the designated government hospital. The view of the lower court regarding the insufficient publication of the policy cannot be sustained.
Issues: Whether an employee is entitled to medical reimbursement exceeding the rates prescribed by the governing policy on the grounds of emergency or insufficient publication of the policy.
Ratio Decidendi: Once a policy prescribing specific reimbursement rates is in operation, employees are entitled to reimbursement only at those rates, regardless of the necessity to seek treatment at a different facility.
Result: Appeal allowed.
Medical Reimbursement - The court held that employees requiring medical treatment after the new policy of 13-2-1995 are entitled to reimbursement at AIIMS rates.
(1) LEAVE granted.
(2) WE have heard learned counsel for the parties. The questions involved in the present proceedings are squarely covered by a judgment of three-Judge Bench of this Court in the case of State of Punjab v. Ram Lubhaya Bagga. The view taken in the said decision is that when an employee requires medical treatment after the new policy dated 13-2-1995 had come into operation, he will be entitled to medical reimbursement on the basis of the new policy at AIIMS rate. It is not in dispute between the parties that the respondent suffered a heart attack on 20-7-1995 and underwent bypass surgery on 29-7-1995. According to learned counsel for the respondent as there was a long queue of patients at AIIMS Hospital for bypass surgery and his case was of emergency, he had to go to other hospital. It may be so. However, in the light of the reported decision, the medical rembursement available to the respondent will that the AIIMS rates, which has already been paid to him. The additional amount which he has claimed was granted by the High Court on the ground that the new policy was not sufficiently published. The said view of the High Court cannot be sustained. Consequently, the appeal is allowed by observing that the respondent will be entitled to medical reimbursement in the light of the new policy i.e. at AIIMS rates. It was however, vehemently submitted by learned counsel for the respondent that exception deserves to be made in this case as the respondent who was a Teacher could not afford such huge medical expenses which had to be incurred by him due to long queue for bypass surgery in the AIIMS Hospital and he had to go to other hospital. It is further submitted by learned counsel for the respondent that the appellants may consider his grievance. He may submit such a representation on compassionate grounds. We have no doubt that such a representation will be sympathetically considered by the appellant authorities on its own merits. The judgment of the High Court will stand modified to the extent indicated herein. No costs.