Genuine Case For Relaxation: J&K High Court Directs Govt To Reconsider Employee's Claim For Reimbursement Of Medical Expenses Incurred Outside State

The Jammu & Kashmir High Court has ruled in favour of a contractual government employee, stating that medical expenses incurred by her for her husband's treatment outside the erstwhile State should be reimbursed.

The court emphasized that the government's power to relax rules should be used genuinely, not just to decorate the "Rule Book," and should be exercised in cases where strict adherence to the rules would unfairly burden the beneficiary.

A bench comprising Justice Rajnesh Oswal was hearing a petition assailing the rejection of the claim by the respondents prompting the petitioner to approach the court through a writ petition, seeking not only the quashing of the communication rejecting her claim but also reimbursement of Rs. 14,99,511/- along with interest.

The petitioner, a contractual employee with government, found herself in a distressing situation when her husband fell seriously ill during a private visit to Nagpur in 2009. He had to undergo emergent treatment, including chemotherapy and radiotherapy. The petitioner claimed to have spent over Rs. 25 lakhs on her husband's treatment, but she retained bills totalling Rs. 12,31,711/- for reimbursement.

Upon submitting the bills, the petitioner received only Rs. 1.5 lakhs in March 2011. She continued to incur medical expenses as her husband's treatment extended beyond 2010 and submitted additional bills of Rs. 2,67,000/-. The respondents sought verification of the treatment from the Director of Health Services, who confirmed its genuineness. Despite this, the claim was rejected by respondents on two grounds: (i) treatment was received outside the State without prior permission from authority; and (ii) hospital where the treatment has been obtained is not covered under the J&K Civil Services (Medical Attendance and Allowance) Rules 1990. 

The petitioner argued that she did not deliberately seek treatment outside the State but rather had to deal with the sudden illness of her husband while on a private visit. She further contended that the respondent had the power to relax the rules under which her claim was rejected.

After hearing both parties, the court observed that the petitioner's case fell under Rule 6(5) of the aforementioned rules, which allows reimbursement in emergent situations where obtaining prior permission may not be feasible.

"The Rule 6(5) envisages an emergent situation when it may not be possible for an employee-beneficiary to get a sanction for treatment outside the State. In view of this, this Court is of the considered view that the respondents could not have rejected the claim of the petitioner just because the petitioner had got her husband treated outside the State without prior permission of the respondents", the bench maintained.

The court noted that the respondents did not dispute the petitioner's claim that her husband's illness was sudden and not pre-existing. Therefore, rejecting her claim solely on the grounds of lack of permission was unjust, it said.

The court also considered Rule 8(2), which empowers the government to relax the rules in cases of undue hardship and held that the respondents had the authority to relax the rules and reimburse the petitioner's medical expenses, particularly given the circumstances of her case.

"The power of relaxation of the Rules has been vested with the Government not for the purpose of adorning the" Rule Book‟ only but for its exercise in genuine cases, where the strict adherence to the Rules would operate harshly against the beneficiary", the bench underscored.

Consequently, the court quashed the communication rejecting the petitioner's claim and directed the officials to reconsider the claim in accordance with the spirit of the rules and judicial precedents within two months.

Case Title: Monica Pathania Vs State of J&K

Citation: 2023 LiveLaw (JKL) 167

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