Saji K v Union of India and others

## IN THE HIGH COURT OF KERALA AT ERNAKULAM ## PRESENT THE HONOURABLE MR.JUSTICE BASANT BALAJI THURSDAY, THE 1[ST] DAY OF FEBRUARY 2024 / 12TH MAGHA, 1945 ## WP(C) NO. 27621 OF 2021 ## PETITIONER: SAJI K AGED 64 YEARS, W/O. LATE K. MURALEEDHARAN, SOUPARNIKA, TKSRA 41, SRINIVASAKOVIL ROAD, KANNANKULANGARA, TRIPUNITHURA. BY ADV L.RAJESH NARAYAN ## RESPONDENTS: - 1 UNION OF INDIA REP. BY ITS PRINCIPAL SECRETARY TO GOVERNMENT, MINISTRY OF CONSUMER AFFAIRS FOOD AND PUBLIC DISTRIBUTION, DEPARTMENT OF FOOD AND PUBLIC DISTRIBUTION, KRISHIBHAVAN, NEW DELHI-110001. - 2 FOOD CORPORATION OF INDIA REP. BY THE CHAIRMAN AND MANAGING DIRECTOR, 16-20, BHARAKAMBA LANE, NEW DELHI-110001. - 3 THE CHAIRMAN AND MANAGING DIRECTOR, FOOD CORPORATION OF INDIA 16-20, BHARAKAMBA LANE, NEW DELHI-110001. - 4 THE EXECUTIVE DIRECTOR, FOOD CORPORATION OF INDIA (SOUTH ZONE), ZONAL OFFICE NO.3, HADDOS ROAD, CHENNAI-600006. - 5 THE GENERAL MANAGER (KERALA REGION), FOOD CORPORATION OF INDIA KERALA REGIONAL OFFICE, KESAVADASAPURAM, PATTOM P.O., THIRUVANANTHAPURAM-695004. - 6 DIVISIONAL MANAGER, FOOD CORPORATION OF INDIA, DIVISIONAL OFFICE, KOCHI, 4TH FLOOR, KANDOMKULATHY TOWERS, OPP. MAHARAJA'S COLLEGE GROUND, MG ROAD, ERNAKULAM-682011. WPC 27621/2021 -2- 7 AMRITA INSTITUTE OF MEDICAL SCIENCES, KOCHI, PONEKKARA P.O., KOCHI-682041, REP. BY ITS CHAIRMAN. BY ADVS. NAVANEETH.N.NATH JOSE KURIAKOSE (VILANGATTIL) K.SRIKUMAR (SR.) K.MANOJ CHANDRAN THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION ON 01.02.2024, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING: WPC 27621/2021 -3- ## JUDGMENT (Dated this the 1[st] day of February 2024) Petitioner’s husband late K.Muraleedharan who retired from the Food Corporation of India, was admitted to the Lourdes Hospital, Ernakulam for treating Carcinoma Distal Esophagus, and from there he was referred to the 7[th] respondent-hospital since the facilities in Lourdes Hospital were limited. Thereafter, he was passed away on 12.02.2021. 2. It is the case of the petitioner that the petitioner’s husband was a member of FCI Post Retirement Medical Scheme (PRMS). The petitioner submitted an application as Ext.P4 for reimbursement of medical expenses incurred. It is also the case of the petitioner that her husband is eligible for an additional special lifetime ceiling of Rs.4 lakhs for WPC 27621/2021 -4- indoor treatment as provided in Ext.P5 Circular. The claim of the petitioner is based on Clauses 6.8 and 6.9 of Ext.P5. The claim was rejected by Exts.P6 and P7. Therefore, the petitioner filed this writ petition for setting aside Exts.P6 and P7 and for a declaration that the petitioner is eligible for an additional special lifetime ceiling of Rs.4 lakhs and reimbursement of the medical expenditures incurred. 3. A counter-affidavit is filed on behalf of respondents 2 to 6, wherein it is contended that the respondents are not aware of the lack of treatment facilities in the Lourdes hospital, Ernakulam. Clause 6.8 of Ext.P5 says that the lifetime ceiling of Rs.4 lakhs would be applicable to a member provided the treatment is done at a Govt. Hospital or at an FCI empanelled hospital or such other hospital of national repute as may be notified by WPC 27621/2021 -5- CMD, FCI for this purpose. Since the 7[th] respondent is not an empaneled hospital, nor a hospital of national repute, the claim was not honored. 4. Heard the counsel for the petitioner as well as the counsel for respondents 2 to 6. 5. The counsel for the petitioner relies on Ext.P8 judgment of the Apex Court in W.P.(C) No.694/2015 in which a similar issue was considered regarding the nonpayment of the benefits under the CGHS Scheme. The Apex Court, in paragraph 15, held as follows: “15. In the present view of the matter, we are of the considered opinion that the CGHS is responsible for taking care of healthcare needs and well being of the central government employees and pensioners. In the facts and circumstances of the case, we are of opinion that the treatment of the petitioner in non-empanelled hospital was genuine because there was no option left with him at the relevant time. We, therefore, direct the respondent-State to pay the balance amount of Rs.4,99,555/- to the writ petitioner. We also make it clear that the said decision is confined to this case only.” WPC 27621/2021 -6- 6. Taking into account the above decision of the Apex Court, a learned Single Judge of this Court in W.P.(C) No.33449/2018 also directed the competent authority to take up the issue and pass appropriate orders. It is also brought to the notice of this Court that another learned Single Judge of this Court in Prakash R.(Dr.) v. State of Kerala and Others. (2022(6) KHC 592) has also taken such a view. 7. Therefore, there will be a direction to the petitioner to file a detailed representation pointing out all these facts before the 4[th] If such a respondent. representation is filed within a period of two weeks from today, the 4[th] respondent or any competent authority authorized by him shall take up such representation and pass appropriate orders, taking into consideration Ext.P8 and P9 judgments The petitioner shall produce the copy of the WPC 27621/2021 -7- Writ Petition along with this judgment before the 4[th] respondent for further orders. The said exercise shall be completed within a period of two months from the date of receipt of a copy of the judgment. Sd/- BASANT BALAJI JUDGE JS -8- ## WPC 27621/2021 ## APPENDIX OF WP(C) 27621/2021 ## PETITIONER EXHIBITS Exhibit P1 TRUE COPY OF THE RELEVANT PAGES OF THE IDENTITY CARD. Exhibit P2 TRUE COPY OF THE DEATH SUMMARY. Exhibit P3 TRUE COPY OF THE BILL DATED 12.2.2021. Exhibit P4 TRUE COPY OF THE APPLICATION FOR REIMBURSEMENT OF MEDICAL EXPENDITURE. Exhibit P5 TRUE COPY OF THE CIRCULAR NO.EP-12-2016-23 DATED 30.12.2016 ISSUED BY THE 2ND RESPONDENT. Exhibit P6 TRUE COPY OF THE REPLY DATED 10.2.2021 NO. IR(S) 18(11)/2020-21/PRMS. Exhibit P7 TRUE COPY OF THE COMMUNICATION DATED 12.2.2021 NO.IR.18(1)/2020/MHS/VOL-II/500. Exhibit P8 TRUE COPY OF THE JUDGMENT DATED 13.4.2018 IN WRIT PETITION (CIVIL) NO.694/2015. Exhibit P9 TRUE COPY OF THE JUDGMENT DATED 25.10.2018 IN WPC NO.33449/2018.