CWP No.5865 of 2007 -1- IN THE HIGH COURT OF PUNJAB AND HARYANA AT CHANDIGARH CASE NO.: CWP No.5865 of 2007 DATE OF DECISION: October 16, 2008 COL. HARBANS SINGH (RETD.) ...PETITIONER VERSUS THE UNION OF INDIA & ANOTHER ...RESPONDENTS CORAM: HON'BLE MR. JUSTICE ASHUTOSH MOHUNTA. HON'BLE MR. JUSTICE RAJAN GUPTA. PRESENT: MR. AMIT RAWAL, ADVOCATE FOR THE PETITIONER. MR. G.K.S. TAANK, CENTRAL GOVT. STANDING COUNSEL FOR THE RESPONDENTS. ASHUTOSH MOHUNTA, J. The petitioner is aggrieved of the orders dated 23.02.2006 (Annexure P-15) and 18.10.2006 (Annexure P-17) vide which the request of the petitioner for reimbursement of medical expenses amounting to Rs.2,12,687/- incurred on account of Angiography and Angioplasty carried by the petitioner has been rejected. Briefly the facts of the case are the petitioner retired as Colonel from the Indian Army. Thereafter, the petitioner became a registered beneficiary/member of Army Group Insurance Fund (AGIF) for life. To provide better medical facilities to the Ex-servicemen, in addition to AGIF, a new Scheme called 'Ex-Servicemen Contributory Health Scheme' (ECHS) was formulated of which the eligible persons was only ex-serviceman drawing pension/disability pension or widows who are drawing family pension. On 21.6.2003, the petitioner got himself registered with the Station Headquarters, Chandigarh under the ECHS after depositing an CWP No.5865 of 2007 -2- amount of Rs.18000/-. As per Clause 10 of the Instructions of the said Scheme, to avail of any medical treatment from the Polyclinics/empanelled hospital, it was mandatory for the Members to first report to the nearest polyclinic alongwith their ECHS Membership Card. On the intervening night of 30.6.2003 and 1.7.2003, the petitioner suffered a massive attack of Angina which was reported to Cardiologist at Command Hospital, Chandigarh on 2.7.2003 and was advised to get Angiography done. As there was no provision of Angiography at the Command Hospital, Chandigarh, therefore, the petitioner got his Angiography done from Fortis Heart Institute of Multi Speciality Hospital. An amount of Rs.11,887/- was incurred on Angiography. Further the report of Angiography was shown to the Cardiologist at Command Hospital, Chandigarh who advised the petitioner to undergo Angioplasty and referred the case of the petitioner to R.R. Hospitals, New Delhi. On 21.7.2003, when the petitioner was at Delhi and was en-route again suffered an attack of Angina and was removed to Batra Hospital in emergency which was the nearest hospital. On 23.7.2003, the petitioner underwent Angioplasty at Batra Hospital and was discharged on 24.7.2003. A total amount of Rs.2,95,766/- was incurred on Angioplasty out of which Rs.2,00,766/- was paid by the petitioner himself (Annexure P- 8) and payment of Rs.95,000/- was undertaken to be paid by the Army Group Insurance Fund (AIGF) of which the petitioner was also a member. The petitioner submitted the bills for reimbursement towards the amount spent on Angiography at Fortis Hospital and Angioplasty at Batra Hospital under the ECHS vide letter dated 27.10.03 (Annexure P-9). However, the claim of the petitioner regarding reimbursement of medical bill was rejected by the respondents vide letter (Annexure P-10) by stating that ECHS CWP No.5865 of 2007 -3- procedure was not followed as all the cases for treatment of ECHS members needs to be routed through Service Hospitals. Learned counsel contends that the action of the respondents in not reimbursing the medical bills submitted by the petitioner is wholly illegal. Learned counsel contends that the petitioner got done his Angiography from Fortis Hospital as there was no such facility at the Command Hospital, Chandigarh and further the Angioplasty was got done from Batra Hospital as it was an emergency case. It was not possible for the petitioner to get examined himself at Service Hospital at that point of time. Learned counsel has further contended that at the time when the petitioner was operated upon, no hospital was empanelled by the ECHS for the said purpose. It has further been contended that now the ECHS has empanalled Fortis Hospital and Batra Hospital and as such there should not any legal impediment in reimbursing the medical bills of the petitioner. It is contended that when ECHS Scheme was floated, the respondents were specifically asked to empanel recognized/established hospitals of the country immediately and as such the petitioner cannot be made to suffer at the hands of the respondents. Learned counsel further submitted that even the Command Hospital, Chandigarh which is the Service Hospital recommended the case of the petitioner for reimbursement (Annexure P-12). Reply has been filed on behalf of the respondents wherein the averments made by the petitioner are controverted by stating that interim procedure was not followed by the petitioner while undergoing Angioplasty. It has been averred that no document was shown regarding the petitioner's consultation with the Cardiologist at Command Hospital, Chandigarh for undergoing Angiography at Fortis Hospital. CWP No.5865 of 2007 -4- We have heard learned counsel for the parties at length. The petitioner was beneficiary of Army Group Insurance Fund (AGIF) for life. He has got himself registered on 21.6.2003, with Station Headquarters at Chandigarh under the Ex-Servicemen Contributory Health Scheme' (ECHS), after depositing an amount of Rs.18,000/- and as such the petitioner became entitled to avail of all the medical treatment. A perusal of the case file shows that the petitioner suffered an Angina attack on the intervening night of 30.6.2003 and 1.7.2003 and his case was reported to the Cardiologist at Command Hospital at Chandigarh wherein he was advised to undergo Angiography. As there was no provision for Angiography at the Command Hospital, therefore, the petitioner got his Angiography done from Fortis Heart Institute of Multi Speciality Hospital. Thereafter the petitioner also underwent Angioplasty at Batra Hospital on 23.7.2007 and was discharged on 24.7.2007. The petitioner submitted bills amounting to Rs.2,95,766/- which was incurred in Angioplasty for reimbursement, out of which Rs.95,000/- was reimbursed to the petitioner by the AIGF.. However, no reimbursement has been given to the petitioner under the ECHS. A perusal of Annexure P-16 shows that the petitioner incurred expenses totalling to Rs.2,95,800/- for undergoing Angioplasty. The petitioner being a member of ECHS is entitled to the reimbursement of medical bills submitted by him. The rejection of the case of the petitioner is absolutely arbitrary because the petitioner had received the treatment as an emergency case for undergoing Angioplasty. It is pertinent to mention here that Batra Hospital has been empanelled by the ECHS subsequent to the medical treatment taken by the petitioner. CWP No.5865 of 2007 -5- In view of the above, we quash the orders (Annexures P-15 and P-17) and allow the writ petition with a direction to the respondents to reimburse the petitioner his medical bills at the AIIMS rates within a period of four months from the date of receipt of certified copy of this order. (ASHUTOSH MOHUNTA) JUDGE October 16, 2008 (RAJAN GUPTA) Gulati JUDGE