Supreme Court of India
SECRETARY, TO THE GOVT. OF HARYANA & ORS.versusVIDYA SAGAR
- Citation
- 2009 INSC 919
- Decided
- 16 July 2009
- Disposal
- Dismissed
- Bench
- S B SINHA
Holding
The later 2003 circular specifically covering chronic diseases overrides the earlier 1993 circular, obligating the State to reimburse the full medical expenses for heart disease treatment.
Summary
The appellant, the Secretary to the Government of Haryana, appealed against a High Court order that directed full reimbursement of medical expenses incurred by a retired employee (respondent) for heart bypass surgery. The respondent, a pensioner, submitted a claim of Rs.1,87,907.65, but the State paid only Rs.1,62,298 based on a 1993 circular limiting reimbursement to 75% of excess costs. The respondent filed a writ petition, and the High Court held that heart disease, classified as a chronic ailment, entitled him to full reimbursement under a 2003 circular. The Supreme Court examined whether the later 2003 circular superseded the earlier 1993 circular and affirmed that the specific later circular governing chronic diseases prevailed, obligating the State to reimburse the full amount. Relying on precedents that a State may change its policy and is bound by its own subsequent orders, the Court dismissed the appeal, upholding the High Court's decision.
Issues considered
- Whether the 2003 circular regarding reimbursement for chronic diseases supersedes the 1993 circular limiting reimbursement to 75% of excess costs.
- Whether a pensioner is entitled to full reimbursement of medical expenses for treatment of heart disease classified as a chronic ailment.
- Whether the State of Haryana is bound by its later policy decision to reimburse the entire medical bill.
Subjects
service lawmedical reimbursementpensionerchronic diseasecircular policystate liabilitymedical expenses
Judgment
[2009] 10 S.C.R. 584
.,..
A SECRETARY, TO THE GOVT. OF HARYANA & ORS.
v.
VIDYA SAGAR
(Civil Appeal No. 4384 of 2009)
JULY 16, 2009
B
[S.B. SiNHA AND DEEPAK VERMA, JJ.]
•
Service Law - Medical reimbursement - To pensioner
- Medical Claim for treatment of heart disease -
c Reimbursement not done in its entirety placing reliance on a
Circular of the year 1993 - Writ petition - High Court holding
him entitled to full reimbursement in view of Circular of the
year 2003 - On appeal, held: In view of the changed policy
of the State by Circular of the year 2003, the claimant was •
D entitled to full reimbursement.
Respondent, a retired employee of the appellant-
State, underwent a bye-pass surgery in a hospital which
was on recognized panel of the State. He submitted a bill
for medical reimbursement. State, relying on its Circular
E
dated 30.11.1993, did not make full reimbursement.
Respondent filed writ petition. High Court allowed the
same, holding that heart disease having been treated to
be one of the chronic ailments, the respondent was
entitled to reimbursement of medical bill in its entirety in
F terms of instructions issued vide Circular letter dated
25.8.2003. Hence, the present appeal.
Dismissing the appeal, the Court
HELD: The High Court, was right in holding that
G
heart disease having been treated to be one of the
chronic ailments the respondent was entitled to
reimbursement of the medical bill in its entirety. Although
the Circular dated 28.5.2003 does not expressly
H 584
SECRETARY, TO THE GOVT. OF HARYANA & ORS. 585
v. VIDYA SAGAR
't supersede the Circular letter dated 30.11.1993, but the A
latter having been issued subsequent to the former an-1
in relation to a particular category of disease, namely, the
chronic diseases, shall prevail over the earlier general
Circular letter. The Circular letter dated 28.5.2003 brings
within its umbrage not only the expenses incurred for the- B
treatment of chronic disease outdoor but also indoor.
State can change its policy decision from time to time.
Once the State in its magnanimity adopted a decision that
the medical bills in their entirety in connection with the
heart diseases shall be reimbursed, the authorities of the c
State being bound thereby were obligated to comply
therewith. [Paras 9 and 1 O] [589-B-F]
State of Punjab and Ors. v. Ram Lubhaya Bagga and
Ors. (1998) 4 sec 117 and State of Kamataka and Ant. v.
R. Vivekananda Swamy (2008) 5 SCC 328 - relied on. D
Case Law Reference:
(1998) 4 sec 111 Relied on. Para 10
(2008) s sec 328 Relied on. Para 11 E
CIVIL APPELLATE JURISDICTION : Civil Appeal No.
4384 of 2009 .
•
From the Judgment & Order dated 22.7.2004 of the High
Court of Punjab & Haryana at Chandigarh in Civil Writ Petition F
No. 19081 of 2003.
'
T.V. George for the Appellant.
Nanita Sharma for the Respondent.
G
' The Judgment of the Court was delivered by
S.B. SINHA, J. 1. Leave granted.
2. The sole respondent was an employee of the State of H
586 SUPREME COURT REPORTS [2009) 10 S.C.R.
A Haryana. He has since retired. He was serving in the 'Health ~
Department' of the State having joined services on 26.11.1961.
He retired on 7.9.1988 on health grounds.
3. He suffered an heart attack on 15.8.2002. He was
treated in the Post Graduate Institute of Medical Sciences and
B
Research, Chandigarh. He underwent a bye-pass surgery at
Fortis Heart Institute and Multi-Speciality Hospital, Mohali. It is
on the recognized panel of the hospitals of the State of Haryana.
He submitted a bill for a sum of Rs.1,87,907.65 towards
medical expenses borne by him for its reimbursement.
c
Relying on or on the basis of a circular issued by the State
of Haryana dated 30.11.1993, the Department sanctioned
payment for a sum of Rs.1,62,298/- only.
D 4. Aggrieved by the said order, the respondent filed a writ •
petition before the High Court of Punjab and Haryana. The said
writ petition was allowed, holding:
"We have heard learned Counsel for the parties.
E Shri W.R. Dua, learned counsel for the petitioner drew our
attention to the Punjab Services (Medical Attendance)
Rules 1940, as applicable to the Haryana employees/
pensioners and the instructions issued by the Haryana •
Government vide circular letter No. HD.HR. No.2/82/98-
F IHB-111 dated 31.10.2002 to show that Fortis Hospital,
Mohali has been recognized by the Haryana Government
for the treatment of Haryana Government employees/
Pensioners/Family Pensioners. He then referred to the
instructions issued vide letter dated 11.8.1992 (Annexure
G P.5/A) to show that heart disease has been treated as one
of the chronic ailments and argued that the petitioner is
entitled to full medical reimbursement in terms of the
instructions issued by the Government vide letter dated
25.8.2003.
H
.~
SECRETARY, TO THE GOVT. OF HARYANA & ORS. 587
v. VIDYA SAGAR [S.S. SINHA, J.]
"'· Learned Assistant Advocate General could not put forward A
any tangible argument to controvert the submissions of Shri
W.R. Dua.
Having considered the entire matter, we are convinced that
the Petitioner is entitled to reimbursement of the entire
B
expenses incurred by him in his treatment at Fortis
Hospital, Mohali and the decision of the Respondents to
pay only 75% thereof is legally unsustainable."
5. Mr. Manjit Singh, learned counsel appearing on behalf
of the State, contended that the High Court committed a serious c
error in so far as it failed to give effect to the circulars issued
by the State laying down the norms for reimbursement of the
medical bill.
> 6. Mrs. Nanita Sharma, learned counsel appearing on D
behalf of the respondent, on the other hand, urged that the heart
disease having been considered to be one of the chronic
diseases, the circular letter dated 28.5.2003 would prevail.
7. The Commissioner and Secretary of the state of
Haryana, Health Department, by a circular dated 30.11.1993 E
directed as under :
• "I have been directed to invite your attention to the Haryana
Government letter No.2/296/86-H.R.ll-lll dated 19.11.1985
(sic 1986) and to say that the decision for granting F
recognition to Nivedic Prosyek Centre Daulat Singh
Zirakpur (Punjab) Batra Hospital New Delhi for taking
special treatment to serving Haryana Govt. officers/
officials/pensioners/family pensioners and members of
their family and dependants subject to the condition that G
the conditions that the officers/officials/pensioners who
would undergo for treatment in those approved institutions
will get reimbursement at the rates of All India Institute of
Medical Sciences (AllMS) New Delhi/PG I. The 75% of the
excess expenditure in comparative to Al/MS will also be
H
588 SUPREME COURT REPORTS [2009] 10 S.C.R. .
A re-imbursed and the rest of 25% will be borne by the ·r
claimant himself. If a Patient avails extra comfort as single
room instead of double occupy room facilities, as such the
whole expenditure will be borne by the claimant himself.
B 2. This has the concurrence of the finance department vide
their memo No.56/80A/86-6 Fin. Deptt. TI/229-1532-2297
dated 13.10.93.
3. This order will come into force from the date of issue."
c 8. However, it appears that on or about 28.5.2003, the
same authority, referring to an earlier memo dated 11.8.1992,
directed as under :
"I have been directed to draw your attention on the above
subject to the memo No.2/160/89-1 H.B. Ill dated
D 11.8.1992 whereby reimbursement on the out door
treatment of chronic diseases upto maximum of Rs.6,000/
- to the Haryana Govt. employees/officers/pensioners/
family members of pensioners used to be allowed. The
matter regarding removing the maximum limit for
E reimbursement of expenses incurred on the treatment of
chronic diseases has been under consideration of the
Government keeping in view the interest of employees and
pronouncements delivered by the Courts in this respect. •
Now the Government has decided that in view of
F instructions dated 11.8.1992 reimbursement of all the
expenses incurred on the treatment of chronic diseases
outdoor as well indoor shall be allowed.
All the other conditions issued on 11.8.92 shall remain in
G force.
These instructions will lclke effect from the issue of this
letter.
The concurrence of the Finance Department has been
H obtained vide their ends!. No.70/20/2000-6 H.A. 111/1450
SECRETARY, TO THE GOVT. OF HARYANA & ORS. 589
v. VIDYA SAGAR [S.B. SINHA, J.]
1 dated 28.5.2003." A
...,-} 9. The High Court, as noticed hereinbefore, was of the
opinion that heart disease having been treated to be one of the
chronic ailments in terms of the circular letter dated 11.8.1992,
-i
·' the respondent was entitled to reimbursement of the medical
B
bill in its entirety.
We see no reason to differ with the views of the High Court.
1 Although the circular dated 28.5.2003 does not expressly
"'<' supersede the circular letter dated 30.11.1993, but the latter
I
having been issued subsequent to the former and in relation c
to a particular category of disease, namely, the chronic
diseases, shall prevail over the earlier general circular letter.
The said circular letter dated 28.5.2003 brings within its
umbrage not only the expenses incurred for the treatment of
> chronic disease outdoor but also indoor. In that view of the D
matter, the impugned judgment must be sustained.
10. Mr. Singh had relied upon a decision of this Court in
State of Punjab & Ors. v. Ram Lubhaya Bagga & Ors. [(1998)
4 SCC 117] to urge that obligation on the part of the State to
E
foot the medical bill of its employee can be restricted by framing
appropriate rules and/or by issuance of requisite circular. No
exception to the dicta laid down therein can be taken. However,
.. the said decision is itself an authority for the proposition that
the State can change its policy decision from time to time. Once
the State in its magnanimity adopted a decision that the F
medical bills in their entirety in connection with the heart
diseases shall be reimbursed, the authorities of the State being
bound thereby were obligated to comply therewith.
11. The question has also been considered by this Court G
in State of Karnataka & Anr. v. R. Vivekananda Swamy [(2008)
5 sec 328] in the following terms :
"24. In view of the aforementioned settled principles of law
there cannot be any doubt that the Rules regarding
H
590 SUPREME COURT REPORTS [2009] 10 S.C.R.
A reimbursement of medical claim of an employee when he
obtains treatment from a hospital of his choice can be
made limited. Such Rules furthermore having been framed
the proviso to Article 309 of the Constitution of India
,_
B
constitute conditions of service in terms whereof on the
one hand the employee would be granted the facility of
.
medical aid free of cost from the recognized government
hospital and on the other he, at his option, may get himself
treated from other recognized hospitals/institutions subject
of course to the condition that the reimbursement by the ',
c State therefor would be limited."
12. For the reasons aforementioned, there is no merit in
the appeal. It is dismissed accordingly with costs. Counsel's
fee assessed at Rs.10,000/- (Rupees ten thousand only).
K.K.T. Appeal dismissed. •
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