to the Govt., Haryana & Ors. Vs. Vidya Sagar  INSC 1232 (16 July
SUPREME COURT OF INDIA CIVIL APPELLATE JURISDICTION CIVIL APPEAL NO. 4384 OF
2009 (Arising Out of SLP (C) No.25258 of 2004) The Secretary to the Government
of Haryana & Ors. ... Appellants Versus Vidya Sagar ... Respondent
The sole respondent was an employee of the State of 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.
He suffered an heart attack on 15.8.2002. He was treated in the
Post Graduate Institute of Medical Sciences and Research, Chandigarh. He 2
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.
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.
Aggrieved by the said order, the respondent filed a writ petition
before the High Court of Punjab and Haryana. The said writ petition was
have heard learned Counsel for the parties.
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-IHB-III 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
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 3 instructions issued by the Government vide
letter dated 25.8.2003.
Assistant Advocate General could not put forward any tangible argument to
controvert the submissions of Shri W.R. Dua.
considered the entire matter, we are convinced that the Petitioner is entitled
to reimbursement of the entire 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."
Mr. Manjit Singh, learned counsel appearing on behalf of the
State, contended that the High Court committed a serious 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.
Mrs. Nanita Sharma, learned counsel appearing on 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.
The Commissioner and Secretary of the state of Haryana, Health
Department, by a circular dated 30.11.1993 directed as under :
have been directed to invite your attention to the Haryana Government letter
No.2/296/86-H.R.II-III dated 19.11.1985 (sic 1986) and to say that the 4
decision for granting recognition to Nivedic Prosyek Centre Daulat Singh
Zirakpur (Punjab) Batra Hospital New Delhi for taking special treatment to
serving Haryana Govt.
pensioners and members of their family and dependants subject to the condition
that 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 (AIIMS) New Delhi/PGI. The 75%
of the excess expenditure in comparative to AIIMS will also be re-imbursed and
the rest of 25% will be borne by the 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.
has the concurrence of the finance department vide their memo No.56/80A/86-6
TT/229-1532-2297 dated 13.10.93.
order will come into force from the date of issue."
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 :
have been directed to draw your attention on the above subject to the memo
No.2/160/89-1 H.B. III dated 11.8.1992 whereby reimbursement on the out door
treatment of chronic diseases upto maximum of Rs.6,000/- to the Haryana Govt.
members of pensioners used to be allowed. The matter regarding removing the
maximum limit for reimbursement of expenses incurred on the 5 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 instructions dated
11.8.1992 reimbursement of all the expenses incurred on the treatment of
chronic diseases outdoor as well indoor shall be allowed.
other conditions issued on 11.8.92 shall remain in force.
instructions will take effect from the issue of this letter.
concurrence of the Finance Department has been obtained vide their endst.
No.70/20/2000-6 H.A. III/1450 dated 28.5.2003."
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, the respondent was entitled to
reimbursement of the medical bill in its entirety.
We see no
reason to differ with the views of the High Court.
the circular dated 28.5.2003 does not expressly supersede the circular letter
dated 30.11.1993, but the latter having been issued subsequent to the former
and in relation 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 6 expenses
incurred for the treatment of chronic disease outdoor but also indoor. In that
view of the matter, the impugned judgment must be sustained.
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 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.
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 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.
The question has also been considered by this Court in State of
Karnataka & Anr. v. R. Vivekananda Swamy [(2008) 5 SCC 328] in the
following terms :
In view of the aforementioned settled principles of law there cannot be any
doubt that the Rules regarding 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 7 to Article 309 of the
Constitution of India 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 State therefor would be
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).
............................J. [S.B. Sinha]
` .............................J. [Deepak Verma]