Govt can't deny medical reimbursement if hospital charges higher rates: Delhi HC

The Delhi High Court has declared that, in cases where the patient is referred to such a hospital, reimbursement of medical expenses under the Central Government (Medical Attendance) Rules, 1944 cannot be denied on the grounds that the hospital charged a sum in excess of the allowed rates.

The beneficiary employee cannot be blamed or punished to pay the excess amount that was charged from him by the Rajiv Gandhi Cancer Institute, when he in the first instance did not even choose the hospital but was referred there, Justice Chandra Dhari Singh said, expressing dismay at how a petition seeking reimbursement of only Rs 51,824 remained pending for the past 16 years and was vehemently contested by Delhi government.

Mahendra Kumar Verma, the petitioner, was a reader in the Tis Hazari Court, Delhi, Metropolitan Magistrate's Court. The petitioner argued that medical advancements had made it possible to treat his little child's brain tumour. The Drawing & Disbursing Officer, Officers of District and Sessions Judge, Delhi, sent the petitioner a letter asking him to deposit a sum of Rs. 51,854 against the medical advance of Rs. 2,34,000 that had been periodically granted to him for the treatment of his son at the Rajiv Gandhi Cancer Institute.

The petitioner's arguments for why he shouldn't receive full reimbursement for the medical costs he incurred for his son's treatment were disproved. The District & Session Judge subsequently issued an order authorising the deduction of the sum from the petitioner's wages. In 2006, Verma filed a writ case challenging both the deductions from his pay and the order requesting the money back.

The petitioner is only entitled to medical reimbursement under the terms of the Central Services (Medical Attendance) Rules, 1944 (CS (MA) Rules) and the directives occasionally issued by the Government of NCT of Delhi, according to the government's argument before the High Court.

The State added that it was determined that the petitioner was only eligible for a payment of Rs. 1,82,146 after carefully examining the medical bills that the petitioner had supplied and computing his entitlement in accordance with the CS(MA) guidelines. He was therefore instructed to deposit the extra Rs. 51,854 that had been granted to him, according to the State.

The legal representative for Verma argued that Article 21 of the Indian Constitution protects the right to health as a constitutional right. Therefore, he claimed that the government has a constitutional obligation to cover the government employee's justified out-of-pocket costs for the medical care he or his dependents received.

He asserted that a government employee is entitled to full reimbursement and that it cannot be limited to the rates listed in the government's circulars. The petitioner further asserted that even if the hospital charged him a fee higher than the package deal pricing, he could not be denied full payment. Thus, the petitioner argued that he was qualified to receive full reimbursement for all medical costs he incurred under the CS (MA) Rules.

Referring to the CS (MA) Rules, 1944, the Court noted that any medical care received by a government employee or his dependents must be provided free of charge, and any money paid by the employee for such care must be fully refunded to him.

"This Court believes that the medical attendance requirements developed by the Central and State Governments are a beneficial piece of legislation that will help all government employees and their families maintain excellent and sound health. The court stated, "It does not make sense why any restrictions are interpreted in the regulations that have the propensity to thwart the cherished constitutional rights for which this Court has always stood as a protector.

The bench noted the State's Counter Affidavit in holding that not a single legal provision had been mentioned to support the deductions made in the petitioner's claim.

deciding that the petitioner was entitled to full reimbursement for the costs he paid in taking care of his minor child's medical needs.

According to the court, "The Respondents are directed to fully reimburse the Petitioner to the extent of bills raised by both Hospitals, and to release the cash maintained in the FDR, along with interest collected from time to time, taken from the Petitioner's income or allowances."