-1- Civil Writ Petition No.6559 of 2006. IN THE HIGH COURT FOR THE STATES OF PUNJAB & HARYANA AT CHANDIGARH ... Date of Decision: March 13,2008. Mohinder Singh ... Petitioner VERSUS Union of India and others ... Respondents CORAM : HON'BLE MR.JUSTICE HEMANT GUPTA. HON'BLE MR.JUSTICE MOHINDER PAL. 1. Whether Reporters of Local papers may be allowed to see the judgment ? 2. To be referred to the Reporters or not ? 3. Whether the judgment should be reported in the Digest ? Present: Ms. Sonia G. Singh, Advocate, for the petitioner. Mr.Hemen Aggarwal, Advocate, for the respondents. -.- MOHINDER PAL, J. The petitioner retired as Upper Division Clerk (for short `U.D.C') from the respondent-Department on April 30, 2001. On July 03, 2005, he was got admitted in Daya Nand Medical -2- Civil Writ Petition No.6559 of 2006. College & Hospital, Ludhiana (for short `D.M.C') for heart ailment. He underwent Coronary Angiography after necessary tests. It has also been mentioned in the petition that the petitioner was further advised to undergo PTCA with stenting to LAD. However, he was in acute shortage of money and, therefore, did not go for PTCA with stunting to LAD. He was discharged from D.M.C, Ludhiana, on July 06, 2005. His treatment is still continuing. He had incurred Rs.18645/- on his treatment. He sent representation dated September 07, 2005 (Annexure P-2) to the respondent-Department for reimbursement of Rs.18645/- on account his treatment from D.M.C, Ludhiana. His claim was returned as un-actioned vide letter dated September 27, 2005 (Annexure P-5) with the remark that as Rs.100/- per month was taken by the petitioner as medical allowance, he was not entitled for reimbursement of medical expenses as there was no provision for it. In this petition filed under Articles 226/227 of the Constitution of India, the petitioner has prayed for issuance of a writ in the nature of certiorari, thereby quashing the order dated September 27, 2005 (Annexure P-5). He has further prayed for issuance of a writ in the nature of mandamus directing the respondents to make reimbursement of the medical expenses of Rs.18645/- and further sanction Rs.20,000/- for follow up treatment. In the written statement filed by the respondents, it has been pleaded that as per the provisions contained in the -3- Civil Writ Petition No.6559 of 2006. Central Services (Medical Attendance) Rules, 1944 (for short `the Rules'), the pensioners who are not residing in the areas covered by the Dispensaries of Central Government Health Scheme (for short `CGHS') are entitled to medical allowance at the rate of Rs.100/- per month. This fixed medical allowance of Rs.100/- per month could be drawn by the pensioner on the basis of an undertaking given by him and a certificate from CGHS authorities that the area is not covered by any CGHS dispensary. The petitioner had given his option for fixed medical allowance of Rs.100/- per month vide Annexure R-1 as he was residing in an area where no CGHS facilities were available. His option was forwarded to P.C.D.A (P), Allahabad, along with his pension claim papers and the same had been sanctioned by P.C.D.A (P), Allahabad, vide Pension Payment Order dated February 13, 2001. It has been pleaded that case of the petitioner for reimbursement of medical expenses was returned as un-actioned as there was no provision for reimbursement of medical expenses once he had retired from service and was receiving Rs.100/- per month as medical allowance along with his monthly pension since he was residing in an area where CGHS facilities were not available. We have Ms. Sonia G. Singh, Advocate, appearing for the petitioner and Mr.Hemen Aggarwal, Advocate, appearing for the respondents and have gone through the records of the case. Learned counsel for the petitioner has argued that the petitioner cannot be deprived of medical reimbursement on -4- Civil Writ Petition No.6559 of 2006. account of his hospitalization in D.M.C, Ludhiana, merely on the ground that he had opted to claim fixed medical allowance of Rs.100/- per month as he was residing in an area where no CGHS facilities were available. According to the learned counsel, the fixed medical allowance of Rs.100/- is given to the employees/pensioners for treatment from Out Patient Department (for short `OPD') and when an employee is hospitalized he is entitled to full reimbursement of medical expenses for the period he remains hospitalized. For getting best treatment, the petitioner had got himself admitted in D.M.C, Ludhiana. He had no other option because, admittedly, no CGHS facilities are available in the area where the petitioner is residing. In the Nabhi's Compendium of Orders under Central Government Health Scheme texts of various orders passed by the Central Government have been incorporated. At page 206 of this book, text of DOP & PW. O.M. No.45/57/97-P & OW dated December 19, 1997 has been given which is as under:- “ The undersigned is directed to state that in pursuance of Government's decision on the recommendations of the 5th Central Pay Commission announced in this Department's resolution No.45/86/97-P & P.W. (A) dated 30-9-1977, sanction of -5- Civil Writ Petition No.6559 of 2006. the President is hereby accorded to the grant of fixed medical allowance @ Rs.100 p.m to Central Government pensioners/family pensioners/residing in areas not covered by Central Government Health Scheme administered by the Ministry of Health & Family Welfare and corresponding Health Schemes administered by other Ministries / Departments for their retired employees for meeting expenditure on day-to-day medical expenses that do not require hospitalization.” A perusal of the above text makes it clear that fixed medical allowance @ Rs.100/- p.m is given to the Central Government pensioners residing in areas not covered by CGHS for meeting day-to-day medical expenses which do not require hospitalization. Therefore, we hold that the petitioner being a resident of the area not covered by CGHS and getting fixed medical allowance of Rs.100/- per month for meeting day-to-day medical expenses that do not require hospitalization, is entitled to reimbursement of medical expenses for his heart ailment for which he remained hospitalized in D.M.C, Ludhiana. At page 41 of the Nabhi's Compendium of Orders text of MH & FW. O.M. No. S. 14025/7/2000-MS dated March 28, -6- Civil Writ Petition No.6559 of 2006. 2000 has been given. Its relevant portion reads as under:- “ xx xx xx. It has now been decided that the Central Government employees and the members of their families may be permitted to avail of medical facilities in any of the Central Government, State Government Hospitals and the hospitals recognized by the State Government/CGHS Rules/CS (MA) Rules, 1944, as well as the hospitals fully funded by either Central Government or the State Government subject to the condition that they will be reimbursed the medical expenditure at the rages fixed by the Government under the CGHS Rules/CS (MA) Rules, 1944 or the actual expenditure incurred, whichever is less. In other words, the permission can be granted by the Head of the Ministry/Department/Office to the Central Government employees/members of their families to obtain medical services from any of the private hospitals recognized under CGHS in the 18 CGHS covered cities also.” -7- Civil Writ Petition No.6559 of 2006. The above-quoted order was made effective from March 28, 2000 and the petitioner having retired on April 30, 2001, is entitled to avail its benefit. As stated above, the petitioner took treatment for heart ailment from D.M.C, Ludhiana, a renowned hospital. He had to undergo Coronary Angiography. This being a private hospital, is not recognized by the Central Government for purposes of reimbursement of medical expenses incurred by its pensioners/employees. However, in view of the above-quoted text of MH & FW. O.M. No. S. 14025/7/2000-MS dated March 28, 2000, he is held entitled to reimbursement of the medical expenditure at the rates fixed by the Central Government under the Rules or the actual expenditure incurred, whichever is less. While concluding the matter, we may also refer, to the Text of M.H. & F.W.O.M. No.S-14025/4/96 M.S dated June 05, 1998, regarding extension of the Rules to pensioners residing in areas not covered by CGHS, which is at page 215 of the Nabhi's Compendium of Orders. For facility of reference, it is reproduced as under:- “ The undersigned is directed to refer to the Department of Pension and Pensioners' Welfare O.M. No.45/74/97-PP & PW ( C ) dated 15.4.1997 on the above subject and to say that it has been decided by the Ministry that the pensioners should not be -8- Civil Writ Petition No.6559 of 2006. deprived of medical facilities from the Government in their old age when they require them. This Ministry has, therefore, no objection to the extension of the CS (MA) Rules to the Central Government pensioners residing in non CGHS areas as recommended by the Pay Commission. However, the responsibility of administering the CS (MA) Rules for pensioners cannot be handled by CGHS. It should be administered by the respective Ministries / Departments as in the case of serving employees covered under CS (MA) Rules, 1944. The Department of Pension and Pensioners Welfare would need to have the modalities worked out for the implementation of the rules in consultation with the Ministries/Department prior to the measure being introduced to avoid any hardship to the pensioners. The pensioners could be given a one-time option at the time of their retirement for medical coverage under CGHS or under the CS (MA) Rules, 1944. In case of a pensioner opting for CGHS facilities he/she would have to get himself/herself registered in -9- Civil Writ Petition No.6559 of 2006. the nearest CGHS city for availing of hospitalization facilities. In such cases, the reimbursement claims would be processed by the Additional Directors, CGHS of the concerned city. For those opting for medical facilities under the CS (MA) Rules, the scrutiny of the claims would have to be done by the parent office as in the case of serving employes and the payment would also have to be made by them. The list of AMAs to be appointed under CS (MA) Rules would be decided Ministry/Department-wise as provided under the rules. The beneficiaries of the CS (MA) Rules, 1944 would be entitled to avail of hospitalization facilities as provided under these rules. The Departments of Pension and Pensioners' Welfare are requested to take further necessary action in the matter accordingly.” In the written statement, it has been specifically mentioned by the respondents that as per the provisions contained in the Rules, the pensioners who are not residing in the areas covered by the CGHS, are entitled to medical -10- Civil Writ Petition No.6559 of 2006. allowance at the rate of Rs.100/- per month; meaning thereby that the petitioner had to perforce opt fixed medical allowance as the area where he was residing was not covered by the CGHS. As per text of M.H. & F.W.O.M. No.S-14025/4/96 M.S dated June 05, 1998, reproduced above, in order to avoid any hardship regarding availing of medical facilities by the pensioners in their old age, the Central Government decided to extend the implementation of the Rules to its pensioners residing in non CGHS areas as recommended by the Pay Commission. However, the responsibility of administering the Rules has been left to the respective Ministries /Departments as in the case of serving employees covered under the Rules. For those opting fort medical facilities i.e fixed medical allowance of Rs.100/- under the Rules, as is in the case of the petitioner, the scrutiny of the claims for medical reimbursement is to be done by the parent office as in the case of serving employes and the payment would also have to be made by them. It has also been clearly mentioned in the above-quoted text that the beneficiaries of the Rules would be entitled to avail of hospitalization facilities as provided under these rules. For the aforesaid reasons, this writ petition is allowed and the order declining reimbursement to the petitioner is quashed. The respondents are directed to reimburse the medical expenses incurred by the petitioner during his treatment in D.M.C, Ludhiana, at the rates fixed by the Central Government under the Rules or the actual expenditure incurred, whichever is -11- Civil Writ Petition No.6559 of 2006. less. The request of the petitioner for sanction of Rs.20,000/- for follow- up treatment be also considered by the respondents under the Rules. ( HEMANT GUPTA ) ( MOHINDER PAL ) JUDGE JUDGE March 13, 2008. ak