This post is case digest on Medical Reimbursement Writ High Court Chandigarh where the claim of the petitioner for medical reimbursement has been rejected as petitioner was not able to submit bills within stipulated 30 days. The insurance company was directed to pay the payment @9% from the date of bills received in the deputy commissioner office. In case the bills are not paid, state will pay the bills and recover the money from the insurance office.
Let’s have the judgment.
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Maninder Singh Patwari vs State of Punjab And Ors
4 March, 2020
CWP-17694-2017
THE HIGH COURT OF PUNJAB AND HARYANADate of Decision: 4.3.2020Petitioner- Maninder Singh PatwariRespondent- State of Punjab and Ors Also Read- Manoj Jain vs State Of Haryana And Ors on 3 December, 2018
The petitioner filed CWP-17694-2017 for setting aside the order dated 7.4.2017 issued by the India Health Systems Corporation-respondent wherein the claim of the petitioner for medical reimbursement has been rejected.
Also Read- Hari Chand vs State Of Punjab & Ors on 6 January, 2016
Facts of CWP-17694-2017
- That the petitioner was suffering from kidney ailment.
- That the treatment was genuine. Even the bills are not disputed.
- That the respondents are liable to pay.
- That the case of the petitioner is rejected by saying that as per the terms and conditions of the contract, the bills have to be submitted within 30 days.
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Timeline of events:
- On 19.9.2017 i.e. approximately 2½ years ago he following order was passed:-
“Inter-alia, learned counsel for the petitioner contented the medical reimbursement claim of the petitioner has been declined simply on the ground that medical bills have not been submitted within prescribed period of 30 days from the date of discharge from the hospital.”
- Petitioner could not submit medical bills within prescribed period of 30 days.
- The respondents have adopted stubborn attitude and instead of paying the amount towards medical reimbursement, the stand that the bills have not been submitted within 30 days was repeated
- The matter was adjourned for today on request of learned counsel for respondents No.6 and 9 to seek instructions with respect to the payment forthwith along with interest @ 9% per annum.
- The respondents 3 of 6 CWP-17694-2017 are not supposed to reject the claim simply on the said ground, in case, the treatment has been taken and they have been paid premium for that.
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Judgments Cited:
- Baljinder Kaur vs. State of Punjab and ors., 2008(2) SCT 820
- Rajwant Kaur vs. State of Punjab, 2001 (2) SCT, 1035
Findings of the Court:
- Instead of reimbursing the medical bills, the petitioners are being made to run from one authority to another.
- As per the Department, the employee has to apply directly Oriental Insurance Company as per the procedure.
- There is nothing to show that the copy of the Insurance Scheme was ever circulated or brought to the notice of their respective employees or they were made aware of the procedure for claiming the medical reimbursement.
- The petitioner being an employee of the respondent-department, it was incumbent upon the respondent-department to forward the medical claim to respondents No.6 and 9 instead of reimbursing the bills.
- There is negligence on the part of the respondent-State for not forwarding the same to the Oriental Insurance Company in case the bills had been received by the Department.
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- It is actually the duty of the respondent-State to ensure that medical bills of their employees are reimbursed taking into account that the agreement is between the State and the Oriental Insurance Company.
- It is for the respondent-State to procure the medical reimbursement from the Oriental Insurance Company and to deposit the amount in the accounts of their employees.
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- Respondents No.6 and 9 too on their part cannot reject the medical reimbursement only on the ground of delay i.e. beyond 30 days without examining the problem/difficulty of an employee, who is recovering 5 of 6 CWP-17694-2017 or may be seeking reimbursement on account of his family member covered under the scheme and who is either trying to cope up with his or her ailment or may be even death in certain cases.
- It is not denied that the respondent-State has already paid the premium. Therefore, the respondents No.6 and 9 under no circumstances can deny the medical reimbursement on the ground of delay.
- The medical reimbursement is the right of the petitioner, which should have been granted immediately on receipt of the medical bills.
Also Read- WRIT JURISDICTION OF PUNJAB HARYANA HIGH COURT
Order:
- The writ petitions are allowed.
- The Oriental Insurance Company shall reimburse the medical bills to the petitioners as per the policy ignoring the already delay, if any, along with interest @ 9% per annum from the date the bills received in the office of the Deputy Commissioner till it is paid within a period of one month from the receipt of certified copy of this order.
- In case, the same is not paid within the period as mentioned above, the Insurance Company shall be liable to pay interest @ 12% per annum from the expiry of the period of one month.
- In case the Oriental Insurance Company does not make the payment as directed, the State shall be held liable to make the payment towards the medical bills and recover the same subsequently from the Oriental Insurance Company.
Also Read- WRITS IN PUNJAB HARYANA HIGH COURT CHANDIGARH
For case specific advice, please contact, best/top/expert writ lawyers advocate of Punjab Haryana High Court Chandigarh regarding Medical Reimbursement issue in State Government departments.
This post is written by Rashika Garg.
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