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2024 DAILYLAW 2315 (CAL)

Lieutenant Governor v. Gupteshwar Lall

2024-08-12

Arijit Banerjee, Sugato Majumdar

body2024
JUDGMENT : ARIJIT BANERJEE, J. 1. The issue involved in this writ petition pertains to reimbursement of medical expenses of an employee in the Administration, on actual basis. 2. The respondent No. 1 was employed as Automatic Machine Man in the Govt. Press, Port Blair. In the early part of 2015 he was taken ill and was admitted in the G. B. Pant Hospital, Port Blair. Since his condition did not improve, the authorities in G. B. Pant Hospital referred him to M/s Billroth Hospital, Chennai, in the month of April, 2015. An amount of approximately Rs. 9 lakh was released by the Manager, Govt. Press, Port Blair on account of treatment of the respondent No. 1 and was paid to the hospital directly. 3. In November, 2017, an office order dated November 7, 2017, was issued by the office of the Manager, Govt. Press, Port Blair, showing that Rs. 9,22,135.36 had been paid by the Administration to Billroth Hospital but the total admissible amount was only Rs. 4,33,465.36. 4. A subsequent Memorandum dated November 30, 2018, was issued by the respondent authority and served on the respondent No. 1 calling upon him to deposit the sum of Rs. 4,66,535/-. 5. Challenging the Memorandum dated November 30, 2018, the respondent No. 1 herein filed an original application being OA No. 441/AN/2019 before the learned Central Administrative Tribunal (in short CAT). By an order dated March 27, 2019, CAT set aside the Memorandum dated November 30, 2018, on the ground of the same being too cryptic and directed the competent authority to pass a detailed reasoned order in response to the applicant’s representation dated November 22, 2017. The respondent authorities were restrained from recovering the amount of Rs. 4,66,535/- from the applicant till disposal of the applicant’s representation by a reasoned order. 6. Pursuant to the said order the office of the Manager, Govt. Press, Port Blair, passed an order dated May 15, 2019 rejecting the claim of the respondent No. 1 herein. The operative portion of the order reads as follows: “NOW THEREFORE, the undersigned is of the view that in such case, the possibility for re-imbursement of medical claim in full shape to the employee depends on the admissibility under Rule. Press, Port Blair, passed an order dated May 15, 2019 rejecting the claim of the respondent No. 1 herein. The operative portion of the order reads as follows: “NOW THEREFORE, the undersigned is of the view that in such case, the possibility for re-imbursement of medical claim in full shape to the employee depends on the admissibility under Rule. In such case, the reimbursed amount for medical treatment has been examined in consultation with Accounts Functionary of Directorate of IP & T and the admissibility for reimbursement of medical expenses incurred by the applicant during the course of treatment. With regards to 100% reimbursement, no such claim exist under CS (MA) Rules, the admissibility is governed by the CGHS rates only. However, in justified cases, relaxation of Ministry of Health & Family Welfare, Govt. of India shall have to be obtained for 100% re-imbursement. In this context, applicant shall have to refund Rs. 4,66,535/ to Govt. Press, Port Blair. The matter is accordingly disposed of.” 7. The respondent No. 1 herein challenged the said order before CAT by filing OA No. 351/691/2019. By an order dated June 4, 2019, CAT quashed the aforesaid order of the authority, dated May 15, 2019, primarily on the ground that the authority by passing such order failed to take into account the direction of the Calcutta High Court passed in WPCT No. 169 of 2013. The matter was remanded to the competent authority for fresh consideration of the issue in question in terms of the aforesaid decision of the Calcutta High Court. 8. By an order dated September 3, 2019, the Secretary (IP & T) again rejected the claim of the respondent No. 1 herein. The operative portion of the said order reads as follows:- “AND WHEREAS, As per CS (MA) Rules, 6(2) Where a Government Servant is entitled under sub-rule(1), free of charge, to treatment, any amount paid by him on account of such treatment shall, on production of a certificate in writing by the authorized medical attendant in their behalf, be reimbursed to him by the Central Government. AND WHEREAS, the Hon’ble Calcutta High Court while disposing the WPCT NO. 169 of 2013 directed the Administration to enter into tie up arrangements, with appropriate Hospital in mainland of its choice. AND WHEREAS, the Hon’ble Calcutta High Court while disposing the WPCT NO. 169 of 2013 directed the Administration to enter into tie up arrangements, with appropriate Hospital in mainland of its choice. The said order was in conformity with the CS(M.A) Rules, 1698, as the same allows to reimburse the medical claim of all recognised Hospital as per other conditions stipulated therein. AND WHEREAS, as per CS(MA) Rules, 6 Provided that the Controlling Officer shall reject any claim if he is not satisfied with its genuineness of facts and circumstances of each case, after giving an opportunity to the claimed of being heard in the matter. While doing so, the Controlling Officer shall communicate to the claimant the reasons, in brief, for rejecting the claim and the claimant may submit an appeal to the General Government within a period of forty-five days of the date of receipt of the order rejecting the claim. NOW THEREFORE, Keeping in mind aforesaid facts, the undersigned is constraint not to consider the prayer of the applicant for re- imbursement of medical claim in full shape to the employee depends on the admissibility under Rule, With regards to 100% reimbursement, no such claim exist under CS (MA) Rules, the admissibility is governed by the CGHS rates only. However, in justified cases, relaxation of Ministry of Health & Family Welfare, Govt. of India shall have to be obtained for 100% re-imbursement. In this Context, applicant shall have to refund Rs. 4,66,535/-.” 9. The respondent No. 1 herein challenged the aforesaid order dated September 3, 2019, before CAT by filing OA No. 351/670/AN/2020. At this point, it may be noted that in the meantime the respondent No. 1 had retired from service and the sum of Rs. 4,66,535/- had been withheld from his retiral benefits. 10. By an order dated March 7, 2024, CAT allowed the original application, quashed the impugned orders dated September 3, 2019, and November 7, 2017 and the impugned Memorandum dated November 30, 2018. The respondent authorities were directed to release the withheld amount of retiral benefit of the applicant therein to the tune of Rs. 4,66,535/-. 11. Being aggrieved, the Administration has filed this writ petition challenging the aforesaid order of CAT. 12. Learned advocate for the petitioner submitted that the applicable rules do not permit full reimbursement of the medical expenses of the respondent No. 1. 4,66,535/-. 11. Being aggrieved, the Administration has filed this writ petition challenging the aforesaid order of CAT. 12. Learned advocate for the petitioner submitted that the applicable rules do not permit full reimbursement of the medical expenses of the respondent No. 1. To the extent permissible, the respondent No. 1 has been extended the benefit. Therefore, it was not open to CAT to direct the Administration to reimburse to the respondent No. 1 herein, the entire medical expenses, on actual basis. 13. We have not called upon the respondent No. 1 to make submission. 14. The operative portion of the order of CAT reads as follows : - “5. Heard Learned Counsel for the parties and perused the record. From perusal of Annexure A/% i.e. the order dated 10.12.2015, it is evident that office order NO. 1295 was issued and copy of the same was served to Shri Gupteshwar Lall, the applicant, after examination of demand claimed by M/s Billroth Hospita, Chennai. The said office order was not communicated to M/s Billroth Hospital, whom the advance amount was directly paid. The assessment of the medical bill is to be made as per CGHS prescribed rate and if any CGHS empanelled hospital filed to abide, strict action may be taken against the empanelled hospital. Since the advance payment has already been made by the respondents directly to the M/s Billroth Hospital, Chennai, therefore, it appears that the Billroth Hospital is a CGHS empanelled hospital. However, no action has been taken against the hospital to whom the advance payment was made. Therefore, any action against the applicant on the basis of medical bill prepared by M/s Bilroth Hospital is not justified for recovery of huge amount. 6. Therefore, we are of the opinion that the respondents have clearly admitted that payment was directly made to the Billroth Hospital, Chennai as per the estimates given by them. Therefore, it is crystal clear that the applicant has not taken any advance from the respondents. If the applicant was not entitled to the amount as claimed by the concerned hospital for his treatment, the respondent should have raised that point before making payment to the hospital. Therefore, it is crystal clear that the applicant has not taken any advance from the respondents. If the applicant was not entitled to the amount as claimed by the concerned hospital for his treatment, the respondent should have raised that point before making payment to the hospital. Only after examination by the Internal Accounts of Directorate of IP & T, the respondents realized that excess payment was made to the hospital and demanded the excess amount from the applicant which is not good and bad in law. But the applicant was in no way responsible for such fault on the part of the respondents. 7. In view of the aforesaid circumstances, we quash the impugned orders dated 03.09.2019, 07.11.2017 and Memorandum dated 30.11.2018. The respondents are directed to release the withheld amount of retirement benefits of the applicant to the tune of Rs. 4,66,535/- within 3 months. Accordingly the O.A. stands allowed. No order as to costs.” 15. We find no apparent infirmity in the aforesaid order. The Administration directly remitted to the concerned hospital the entire medical expenses incurred on account of treatment of the respondent No. 1, without any reservation or caveat. 16. The respondent No. 1 was not informed contemporaneously or within a reasonable time period that such payment to the hospital was being made by the Administration subject to its right to recover any payment made in excess of the maximum admissible medical benefit, that the respondent No. 1 may be entitled to. 17. In our view, the Tribunal rightly held that if any excess payment was made by the Administration on account of medical treatment of the respondent No. 1 herein, the same was not the fault of the employee. The employer could not recover the alleged excess payment subsequently. 18. We have to keep in mind that while exercising high prerogative writ jurisdiction under Article 226 of the Constitution of India, the High Court does not act as an appellate court. The Court is not concerned with the merits of the decision impugned before it but with the decision making process. So long as the Tribunal passes an order within its jurisdiction, supported by reasons and after observing the principles of natural justice, the High Court in exercise of its power of judicial review will generally not interfere with the order of the Tribunal. So long as the Tribunal passes an order within its jurisdiction, supported by reasons and after observing the principles of natural justice, the High Court in exercise of its power of judicial review will generally not interfere with the order of the Tribunal. Of course, the intervention of the High Court may be warranted if the order is arbitrary, unreasonable, patently illegal and/or otherwise perverse. 19. We do not find that in the present case, the order of the Tribunal has any of those vices. It is a well reasoned and logical order, fair and just. 20. There is a stronger reason as to why interference with the Tribunal’s order is not called for. In an identical fact scenario, an order of the Central Administrative Tribunal directing the Administration to reimburse the entire medical expenses of an employee was carried to a Division Bench of this Court by the Administration by filing WPCT No. 169 of 2013. While not interfering with the Tribunal’s order under challenge, the Division Bench issued the following directions:- “(a). The Administration shall enter into tie up arrangement with the appropriate hospitals of its choice in the mainland. (b). The beneficiaries shall have a choice to have the treatment at anyone of the hospitals with which the State has its tie up arrangement. (c). The beneficiaries shall not be liable to pay any amount on account of such treatment and the cost will be directly borne by the Administration. (d). So long as the aforesaid arrangements are not made by the Administration, the treatment of a referred patient can be availed from an appropriate hospital and costs to be incurred on actual basis shall be reimbursed by the government upon usual verification. (e) IT is clarified that in case any beneficiary, after the tie up arrangements are made by the State, chooses to obtain medical assistance from a hospital other than the one with which the State has its tie up arrangement the reimbursement shall only to be made in accordance with the Central Government Health Service Scheme and Central Services Medical Attendance Rules. (f). After the tie up arrangements are made necessary information shall be circulated by the Administration to tall the departments so that the beneficiaries can have cashless treatment at the appropriate place.” 21. (f). After the tie up arrangements are made necessary information shall be circulated by the Administration to tall the departments so that the beneficiaries can have cashless treatment at the appropriate place.” 21. In view of the directions in sub-paragraphs (c) and (d) above, it is incumbent upon the Administration to reimburse the full medical expenses of the respondent no. 1 herein. The aforesaid order of the Divisions Bench was not assailed before any competent forum either by way of review or appeal. The directions in that order have become final and are binding on the Administration. It is also not that the directions were passed for the purpose of only that matter. They were general directions issued to the Administration for the benefit of all its employee who are entitled to medical benefits. 22. In view of the aforesaid, we find no merit in the writ application. The application stands dismissed. 23. However, there shall be no order as to costs. 24. Urgent certified server copies, if applied for, be issued to the parties upon compliance of due formalities. I agree. Sugato Majumdar, J.