R.S. Bhanot v. Managing Director, Food Corporation of India and Ors

IN T

(108) R.S. BHAN MANAGIN ORS CORAM:

Present:

ALOK JAI

to the respo to reimburs amendments (Annexure P

¶2AGM, Foo Adenocarcin 2023. The p and was tre of the petiti THE HIGH COURT OF PUNJA CHANDIGAR NOT Versus

NG DIRECTOR, FOOD CORP HON'BLE MR. JUSTICEAL

**** Mr. Deepak Jindal, Advocate fo Mr. Ish Puneet Singh, Advocat

**** IN, J. (Oral) The present petition has been fi ondents to reimburse the medica e the medical bills to be subm s carried in Clauses 6.8 and 6.9 P-2). Briefly the facts of the matter od Corporation of India on 3 noma Right Lung Stage III B, c petitioner was initially admitted ated as an Indoor Patient, howe ioner was continued by conserv AB AND HARYANA AT RH CWP-14703-2024 (O&M) Date of Decision:-27.09.2024 ……Petitioner PORATION OF INDIA AND ……Respondents LOK JAIN for the petitioner. e for the respondents. filed inter alia seeking directions al bills of the petitioner and also mitted in future by invoking the 9 vide circular dated 15.12.2022 are that the petitioner retired as

31.10.2010 but suffered from chronic disease (cancer) in June, d on 22.06.2023 till 30.09.2023 ever, subsequently the treatment vative mode and was discharged

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from the h undergoing medicines to had purcha reimbursem by wrongly of the petitio

¶3that the P propounded FCI were gi benefits of w above said amendment ceiling of O Rs. 32,000/- time ceiling Clause 6.9 treatments Rs. 4,00,000

¶4authorities patient" wh which the c hospital with advice to take his medical treatment. The o the petitioner which were extr sed these medicines out of hi ment of the medical expenditure applying the incorrect clauses o oner. Learned counsel for the petiti ost-Retirement Medical Schem d on 30.12.2016, (Annexure R iven the benefits under the schem which the petitioner is admittedly scheme was amended from carried out on 15.12.2022 es OPD limit which was initially - and as per clause 6.8 of the sc g for specific disease was enhanc additional ceiling for exception was enhanced to Rs. 15,0 0/- and Rs. 3,00,000/- respective Learned counsel for the pe in their wisdom purposefully ile carrying out amendment in C ase of the petitioner would fall the medicine and, he is still Doctor has prescribed certain remely costly and the petitioner is pocket and later sought the which is not being reimbursed f the scheme in force to the case oner has opened his arguments me (PRMS for brevity) was R-1) whereby, the employees of me as part of the superannuation y a member. He submits that the m time to time and vide the specially in Clause 6.5 annual Rs. 18,000/- was enhanced to cheme the additional special life ced to Rs. 20,00,000/- and under nal cases of life saving indoor 00,000/- which was initially ly in the original scheme. etitioner has argued that the y took away the word "indoor Clause 6.8 and therefore, due to under Clause 6.8 of the scheme

l n r e d e s s f n e e l o e r r y e r o e

and the two recorded in treatment", further relie Jharkhand H Hon'ble Ap another Vs. that this has ambit of ben employees. Bench of th

(3) PLR 1 treatment" harmonious petitioner w the reimbu petitioner w maintains th hospitalizati therefore th indoor patie mere fact tha stand-alone r for which th o fold reasons and arguments rai n the amendment carried out in whereas, the said word was n es upon the judgment passed by High Court in LPA-194-2021 rely pex Court especially in the case . Sri Seetaram Rice Mill", [(20 s to be considered as purposive nevolent scheme which is only He also relies upon the judgme is Court in the case of "Ravi Ka 60 to impress upon his argu " and "outdoor treatment" sly. The present case does not was never admitted to the hospit ursement of treatment pertain was never admitted. The learn hat once the treatment is initiate ion it must be treated as a part o e petitioner, who was at one po ent then his entire treatment has at the petitioner has been discharge reason to deny the benefit of the sc he patient is discharged from th ised are that the authorities duly n Clause 6.9 the word "indoor not repeated in Clause 6.8 and the Hon'ble Division Bench of ying upon the judgements of the e of "Executive Engineer, and 012) 2 SCC 108] has submitted construction so as to widen the to protect the adversaries to the ent passed by Hon'ble Division ant Vs. State of Haryana", 1998 uments that the word "indoor will have to be construed concern a scenario where the tal, nor does it involved seeking ning to a condition for which ned counsel for the petitioner ed, even as an extension of prior of continuous treatment process oint of time, was admitted as an s to be treated collectively. The ed from the hospital would not be a cheme to the petitioner. The reason he hospital are manifold such as

y r d f e d d e e n r d e g h r r s n e a n s

high risk of keeping in waiting for a the petitio Nonetheless bifurcation "outdoor pa classificatio unreasonabl treatment un person whil person's rig are to be pro submits that citizens and scheme. He has to be co the larger as petitioner.

¶5arguments t same has to He further contribution f infection overcrowding of hosp mind that patient more seriou admission in the hospital and their oner has left the hospita s once it is established that it is drawn, as to whether the patie atient" would lose its sheen. He on of "indoor patient" and le classification and the only ap nder OPD is separate from the le being an indoor patient. He h ghts as enshrined under Article otected and they are sacrosanct m t it is the duty of the state to pro d that is the basic objective of p submits that the scheme being onstrued widely rather than narro spect of the matter also, the reli Per contra, learned counsel for that only the amendment canno be read with the original schem submits that the scheme w n as detailed in Clause 5 of the sc pital, stability of the patient and us than the petitioner could be treatment. It is not the case where al against medical advice. a continuous treatment then the ent is an "indoor patient' or an e has also argued that any other "outdoor patient" would be pparent classification is that the e ailment being suffered by the has raised an argument that the 21 of the Constitution of India much less to save one's life. He ovide and secure the health of its propounding such a benevolent a beneficial piece of legislation owing its approach. Therefore, in ief deserves to be granted to the r the respondents has opened his ot be read in isolation and the e propounded by the authorities. was based on the employer's cheme and therefore, expanding

d e e . e n r e e e e a e s t n n e s e . s

the arena o accumulated the amendm amounts und from time t incurred by fall under C and reiterat expenses of admitted in his being a Rs. 32,000/ which still immediately case of the p being propo

¶6ready refere

6.8 and 6.9 f the applicability of the schem d fund available with the respo ments are with respect to the up der various heads which the auth to time to accommodate the c the beneficiaries. He further su Clause 6.5 as he is seeking an o tes the above-said Clause. He f the petitioner as "indoor patient the hospital, have already been an indoor patient and even su - available to him under Clause Rs. 17,000/- is available in y released. He submits that the p petitioner does not fall under the ounded by the petitioner. Heard learned counsel for the ence, the relevant provisions of t are reproduced herein below:

6.5 The members should als of outdoor treatment in India for self, spouse and disabl maximum ceiling of Rs 18000 p of certificate from a sp Hospital/empanelled hospital/ me would be detrimental to the ndents. He further submits that pgradation in the ceiling of the horities undertake as an exercise change in the cost of expenses ubmits that the petitioner would outdoor treatment of his ailment e further submits that all the t" which he incurred while being n reimbursed as to the extent of ubsequent thereto, the limit of e 6.5 has been extended, out of n his account which can be petitioner is not entitled and the e ambit of Clauses 6.8 and 6.9 as e parties at length and for the the scheme i.e. Clauses 6.5, 6.6, so be eligible for reimbursement of specified prolonged diseases led depended children uptoa per annum subject to production pecialized doctor of Govt. /FCI Medical Officer for the

e t e e s d t e g f f f e e s e , t s a n

e

specified diseases approved by held on 12.6.2012 viz. i. Heart ailments and FCU ii. Diabetes mellitus iii. Paralysis / Cerebrovascu iv FUC Thyroid disorder v. Kidney disorders vi. Bronchial Asthma vii. Cancer/Malignant Tumo viii. Haemolytic Disorder ix. Tuberculosis x. Rheumatoid Arthritis & ( xi. Osteoporosis xii. Thalassemia xiii. Chronic Liver Disease

6.6 The ceiling for indoor treatment shall be Rs. 1 lakh financial year per member co and dependent disabled childr without any linkage between th

6.8 An additional special life be applicable to a memb self/spouse/dependent children the following specified major d is done at a Govt. hospital or a such other hospital of nationa CMD, FCI for this purpose:

(a) Bypass surgery of heart/a

(b) Pacemaker implant

(c) Neuro Surgery

(d) Kidney/renal/liver/bone-

(e) Joint replacement and su

(f) Pulmonary valvotomy/su

(h) Cancer

A member would be abl one go or on multiple occasion limit.

y the Board in its 347thmeeting U Hypertension ular attack ors

(OA) Osteo Arthritis r (IPD) and outdoor (OPD) and Rs. 18000 respectively per omprising of employees, spouse ren, to be considered separately e two. fetime ceiling of Rs 4,00,000 will ber for indoor treatment of (as specified in this scheme) for diseases, provided the treatment at a FCI empanelled hospital or al repute as may be notified by /angioplasty/valve replacement -marrow/otherorgantransplant urgery urgical treatment of lung le to avail this option either at ns subject to the overall lifetime

g ) r e y l f r t r y t e

¶7out by the au

¶8that the aut

6.9 In addition, for exceptio treatments, irrespective of the may grant special additional r of Rs. 3,00,000 (over and abov and 6.8 above) provided the hospital or at a FCI empan forwarded through the GM (Re alongwith specific recommend have the recommendation of Zone/Hqrs. This option would b specified at (6.6, 6.7 and 6.8 have been utilized by the memb

It would also be relevant to re uthorities on 15.12.2022 which r "6.5 a) The annual ceiling prolonged diseases shall be R thousand only) b) Modified list of p enclosed as Annexure I.

6.6 Annual ceiling of IPD (Rupees one lakh seventy thous

6.8 Additional special life-tim shall be Rs. 20,00,000/- (Rupee

"Macular Degeneration list of specified diseases.

6.9 Additional Ceiling for e indoor treatments shall be R lakhs only)." A perusal of the amendment c thorities in their wisdom, did onal cases of life-saving indoor disease, the Managing Director reimbursement upto a maximum ve the limits specified at 6.6, 6.7 treatment is done at a Govt. nelled hospital. Such cases be egion) and ED (Zone) concerned dation. Such cases should also f the Medical Officer of the be available only after the limits above) to the extent available ber. eproduce the amendment carried reads as under: g of OPD limit for specified Rs. 32,000/- (Rupees thirty two prolonged diseases for OPD is limit shall be Rs. 1,70,000/- sand only). me ceiling for specified diseases es twenty lakhs only). " has been added in the existing exceptional cases of life saving Rs. 15,00,000/- (Rupees fifteen carried out clearly demonstrates not include the word "indoor

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treatment" medication suffering fr requirement person is su being treate disease as a carried out f

¶9patient" or larger aspec as an indoo disease, the the hospital would fall u better under have got h discharged t the ambit o health and w the hospital a ground to Clause. The in Clause 6.8. The Courts can and the increasing complexitie rom such a disease face many ts that evolve over the time w uffering. It cannot be said with c ed for a particular disease canno an outcome or an offshoot of the for the said purpose. The distinction between trea "outdoor patient" has to be adj ct. Once it is established that a p or patient for a considerable lo treatment continued for the said l cannot be simplicitor be dec under the category of an outdoo rstanding for the case hypothe himself admitted in the hospit the next day, the case of the peti of Clauses 6.8 and 6.9 and just weakness, if the petitioner is un and is taking a conservative tre o not consider the case of the e claim has to be considered ha nnot ignore the rising cost of es of ailments today. A person other difficulties and medical which are due to the ailment a conviction that a person if he is ot contract any other subsequent e medication or treatment being ating a person as an "indoor judicated and considered in the person has undergone treatment ong time for a life-threatening d disease post his discharge from clared to be a treatment which or treatment. For the purpose of etically, if the petitioner would al to take one tablet and got itioner would have fallen within because of his age and the ill-nable to get himself admitted in atment being at home cannot be e petitioner under the relevant armoniously and positively with

f n l a s t g r e t g m h f d t n - n e t h

intent to sup the departm

amendment to be taken purposefully amending th in the amen authorities h positive stan support to i binding effe At thi to secure hi Hon'ble Jha Hon'ble Ap view, the au Clauses 6.8 treatment. A the verificat The petition medicinesar

¶10has sought pport the employee who has disc ment. At the outset the issue needs carried out vide Annexure P-2 as purposive construction. The a y removed the word "indoor t he same although the word "ind ndment carried out for Clause 6 have exercise and deliberated u nd to amend clause 6.8 so as to w its employees. Therefore clause ect or rider of it being applicable is juncture of life, he cannot be is medical treatment. Consideri arkhand High Court, wherein, t pex Court have also been consid uthorities are directed to consider and 6.9 and reimburse the bil Accordingly, the present petition tion and veracity of the medical b ner shall also file an appropr re not available at the Ayush Cen As regard the CM-14355-CWP directions to atleast release a su charged his duties all his life for s to be decided is whether the of the scheme Annexure R-1 is authorities have in their wisdom treatment" in Clause 6.8 while door treatment" finds mentioned

6.9 which demonstrate that the upon the issue and have taken a widen the scope of the financial

6.8 has to be read without the only for "indoor patient" made to run from pillar to post ing the judgment passed by the the entire law laid down by the dered, and having a harmonious r the case of the petitioner under lls of the petitioner towards his n stands disposed of, subject to bills submitted by the petitioner. riate undertaking that the said ntre. P-2024, whereby, the petitioner um of Rs. 3,00,000/- during the

r e s m e d e a l e t e e s r s o . d r e

pendency o petitionercan per Clause accepted in would be ap therefore, ti extend the r scheme the petitioner w by invoking today.

11.

27.09.2024 Parul

f the writ petition.The responde nnot be granted the amount as th

6.5 of the scheme.The stand n light of the findings returned pplicable but clause 6.8 and 6.9 ill the time the Authorities take relief to the petitioner by invok e respondents shall release a within 15 days from today and d g Clauses 6.8 and 6.9 of the sc Pending CM also stands dispos

Whether speaking/reasone Whether Reportable:-

ents have taken a stand that the here is ceiling of Rs. 32,000/-, as of the respondents cannot be above as not only Clause 6.5 9 shall also come into play and, a decision as directed above to king Clauses 6.8 and 6.9 of the sum of Rs. 3,00,000/- to the decide the case of the petitioner cheme within four months from sed of accordingly.

(ALOK JAIN)

JUDGE ed:-

e s e , o e e r m