A bench of The Chief Justice of Tripura, Mr. Akil Kureshi has observed that one cannot be denied medical reimbursement only on the ground that the employee did not obtain prior referral order from the Medical Board before taking treatment outside the state.
Brief facts of the case
Kali Sankar Baidya, the Petitioner under took the full treatment for his nasal cancer, at Vellore Hospital.
The petitioner had consulted the local ENT specialist and skin specialist. However his condition deteriorated despite treatment. He wished to consult the doctor at a hospital at Vellore for which he also applied to the authority on 30th November, 2019 seeking a referral order for taking treatment outside the State.
He applied for medical reimbursement but his application for total expenditure of Rs.3,72,031 was rejected on the ground that he did not obtain a prior referral order from the Medical board. Thereafter he moved the High Court challenging the rejection order while pleading that as per the Government rules the same is to be reimbursed and that he had applied for a referral order before taking treatment outside the state and since his condition was deteriorating he couldn't wait for a response from the board for too long. It was much later that the Medical Board conveyed to the petitioner that as per the prevailing norms there is no provision for referring the patients outside the State without appearing before the Medical Officer and since he had already started his journey, he could not present himself for a referral order.
The Respondent Government objected on two grounds stating
1. That there was no referral order allowing the petitioner to take the treatment from outside the State.
2. There were no extraordinary urgent grounds for the petitioner to have travelled outside the State for his treatment without presenting himself before the Medical Board.
The Hon'ble Court while relying on the judgement, W.P(c) No.830/2019 in case of Sri Samar Bhusan Chakraborty Vrs. The State of Tripura & others, with a similar factual matrix ruled in favour of the Petitioner and observed that:
Both the objections of the Government need to be overruled. Firstly, as noted the petitioner was struggling with aggressive infection on his nose which did not get cured despite his treatment at the hands of ENT specialist and skin specialist. The petitioner therefore desired to have further investigations and opinion from the experts. He, therefore, approached the authorities for permission to travel outside State. His request dated 29th November, 2019 met with no immediate response. He could not wait any longer. He started his travel on 5th December, 2019. It was only thereafter that the Medical Board conveyed to him that unless and until he is present a referral order cannot be issued in his favour. On 7 th December, 2019 the hospital at Vellore detected that the petitioner was suffering from cancer. Under such circumstances it was not expected for the petitioner to have waited for the Medical Board to call him for personal appearance for grant of referral order which would delay his treatment. As things turned out, having gone to Vellore for investigations, the petitioner ended up the undergoing entire treatment even without Page 4 of 9 returning home for which purpose his leave was sanctioned by the employer. [6] Under such circumstances to expect the petitioner to wait for the referral order is unreasonable. It is not even the case of the respondents that the specialized treatment needed for such cancer is readily available within the State. In other words going by the stand of the respondents if the petitioner had presented himself before the Medical Board and waited for long enough for the Medical Board to respond to his request for grant of referral order, the same would have been granted. Only on that ground to deny the benefit of reimbursement of medical expenditure would be interpreting the policy of the Government too rigidly. Further, the ground that there was no urgency in the petitioner departing for treatment, also must be rejected. After having waited for long enough for the treatment prescribed by the local doctors to have effect and the treatment having failed to have desired effect, the petitioner had to have a proper diagnosis and line of treatment. It is not as if the petitioner departed immediately without informing the employer or even the Medical Board. The petitioner did approach the Medical Board but could not give too long a time for Medical Board to respond. The petitioner had to take a calculated risk of departing without prior referral order.
Therefore the case was disposed of and the Government was directed to process the medical reimbursement bills of the petitioner and release the same to the extent as per the Government policy the same are payable within a period of eight weeks.
Read Judgement here