High Court · 1999

to this Circular, the writ petitioner has enrolled in the said scheme on 19th July 2000 by subscribing an amount of Rs.8,264/- as membership fee. He was allotted membership No. 455/010134. On 13th November 2000, the writ petitioner’s wife had been admitted in L.V.Prasad Eye Institute for undergoing a surgery for her Cataract. It is not in dispute that the surgery for Cataract is one of the ailments covered by the scheme, dated 10th June 1999 of the respondent Bank. She has been discharged next day i.e. on 14th November 2000 and hospitalization charges came to Rs.22,351.39 ps. Immediately on 16th November 2000, the writ petitioner submitted his claim enclosing thereto all the medical bills. In response thereto, the writ petitioner has been served with a notice, dated 12th January 2001, disclosing that the Managing Committee constituted to manage the funds has settled the claim of the petitioner in a sum of Rs.8,586/- as per his eligibility and denying the payment of the rest of the hospitalization charges. This gave rise to the present Writ Petition. Sri S. Venkaeswara Rao, learned counsel for the petitioner submits that the Circular bearing No. 235, dated 23rd September 1999 issued by the respondent bank, which is in continuation of its earlier Circulars dated 10th June 1999 and 8th July 1999 specifies that the time limit for enrollment has been extended up to 30th November 1999 initially, but however, the same was not strictly adhered to. Hence, the subscription paid by the writ petitioner on 19th July 2000 has been accepted and he has been enrolled as a member. He is, therefore, entitled for payment of hospitalization charges spelt out in the scheme, dated 10th June 1999. Per contra, learned counsel for the respondent Bank, Sri M.S. Ramachandra Rao, has pointed out that as per the scheme announced by the respondent bank on 10th June 1999, the retired employees were required to join the scheme within three moths from the date of its introduction or within three months of his/her retirement. Since the petitioner has already retired by the date the said scheme came to be introduced, he was required to become a member of the said scheme before 10th September 1999, whereas on his own showing, the petitioner became a member of the scheme only on 19th July 2000. However, the Managers of the fund have taken a lenient view in the matter and condoned the delay in submitting the membership application by the writ petitioner, as the scheme is a beneficial scheme introduced for the benefit of the retired employees of the Bank and that several serving officers including the representatives of the staff as well as the officers association were made members of the Managing Committee for the purpose of managing the funds as effectively as it would be feasible to ensure that benefits of the claim are made available to a large section of the members. It is also contended that the overall limit of the hospitalization charges was to be at Rs.1 lac and the Managing Committee has also resolved that in case of claim, on account of treatment for spouses of employees/members of the scheme, it would be 75% of the eligible amount of the employee/member of the scheme. It is further pointed out that a member of a scheme should have obtained prior approval of the bank before receiving treatment at L.V. Prasad Eye Hospital, but however, taking a sympathetic view of the entire matter, a sum of Rs.8,586/- was sanctioned to the petitioner and the same was also paid by way of cheque No. 401933, dated 8th December 2000 to him. Importantly, the learned counsel for the respondent Bank has drawn my attention to the contents of paragraph 6 of the counter-affidavit filed by the Chief Manager (PPG) of the Bank, wherein it is specifically asserted that the said amount of Rs.8,586/- was paid to the petiotner on 1st January 2001. Though the learned counsel for the writ petitioner could not give any specific answer as to whether the writ petitioner has, in fact, received such an amount or not. The fact remains that this Writ Petition has been instituted on 7th February 2001 in this Court which is subsequent to 1st January 2001 and hence, it was for the petitioner to assert as to whether the said sum has been received by him or not. A perusal of the Retired Employees Medical Benefit Scheme introduced by the respondent Bank on 10th June 1999 made it clear that the said scheme has been introduced with a view to provide financial assistance in meeting partially or fully within specified limits, hospitalization expenses treatment of certain specified diseases/ailments to retired employees and their spouses where the expenditure so involved is fairly enormous. It was made clear that the treatment will have to be taken at the hospitals/nursing homes which have been approved by the bank for the said purpose. Paragraph 6 of the scheme listed out the various benefits under the scheme. At the initial stages of the scheme, the resources available for administering it will be very limited and the medical benefits under the scheme were intended to be extended on selective basis. Hence, hospitalization expenses for treatment of certain diseases and ailments, which have been listed out there under are sought to be initially covered. Of the six ailments, one that is relating to the ailments of eyes is described as under: “ Retinal Detachment or Cornea replacement” Strictly speaking, the Cataract surgery, which has been undergone by the spouse of the writ petitioner, does not fall either under the therapy or treatment for Retinal detachment or Cornea replacement, but however, as the learned counsel for the writ petitioner points out, Cataract surgeries have since been also covered under the said scheme through Circle letter dated 28th February 2000 issued by the PPG Department of the respondent bank, where Cataract and Glucoma surgery are also sought to be covered. Thus, the writ petiotner is justified in staking a claim for the hospitalization charges, but however, the procedure for raising claims specified in paragraph 8 of the Scheme dated 10th June 1999, in particular, paragraph 4 thereof, made it clear that as and when a member needs treatment, he will approach the designated officer personally or in case of emergency, through his relative, along with an identity card and an estimate of the treatment. In case of emergency, if prior intimation before hospitalization to the designated officer is not possible, he should be informed of the full particulars of the case as soon as possible after the patient has been admitted. In case hospital/nursing home, in such circumstances, is not approved by the Bank, the cost of the treatment in such hospital/nursing home may be approved for payment by the designated officer, subject to confirmation of the managing committee and it is stated that this procedure has not been adopted or followed by the writ petiotner. Further, it is made clear to the members that the entire hospitalization charges may not be borne, but only reasonable amounts of the hospitalization charges need be paid. In view of the contents of the scheme and in view of the fact that the writ petiotner has already been paid a sum of Rs.8, 586/- by the respondent bank, thought the claim is slightly more than that, I do not see any justifiable reason for interfering with the order passed by the respondent Bank. To my mind, Cataract surgery being essentially an optional surgery rather than an emergency surgery, the writ petiotner should have secured the prior approval or consent of the Managers of the Scheme before his spouse has been made to undergo treatment in L.V. Prasad Eye Institute. I, therefore, do not find any reason to interdict the order passed by the bank and direct them to remit the balance amount to the writ petitioner. Obviously, the fund is managed in such a way that it would be available to a larger number of members instead of confining it to a smaller section. Hence, perhaps, the compulsion thrust upon the writ petitioner to share nearly two-thirds of the hospitalization expenses incurred by him may not seriously warrant interference, inasmuch as, no circumstances, such as distressful financial condition of the writ petitioner are either pleaded or proved in this Writ Petition. For the aforementioned reasons, I do not find any merits in this Writ Petition and it is accordingly dismissed. However, if the writ petitioner can establish that he has not been paid the said sum of Rs.8,586/- on 1st January 2001 by the respondent Bank, he may produce appropriate evidence in this regard before the respondent Bank Managers of the Scheme by way of a written representation, which, I am sure will be redressed within a maximum period of 45 days from the date of receipt of such representation. No costs. ----------------------------------- (NOOTY RAMAMOHANA RAO, J) 8th December 2009