Shyam Shanker Mishra v. State Of U.P. Thru. Prin. Secy. Kar Evam Nibandhan, U.P. Lucknow And

1. Heard Mr. Abhishek Mishra, learned counsel for petitioner and learned State Counsel for opposite parties.

2. Petition has been filed seeking a direction to concerned authority for making actual payment of Medical Reimbursement Bills of petitioner pertaining to treatment undertaking in Government Hospitals in terms of Rule 19 of the U.P. Government Servants (Medical Attendance), Rules 2011 as amended from time to time. Further prayer has been sought for a direction not to send the Medical Reimbursement claims of petitioner to the Chief Medical Officer for Technical Examination.

3. On 13.08.2025, following order had been passed:- "1. Heard learned counsel for petitioner and learned State Counsel appearing on behalf of the opposite parties.

2. Primary grievance of petitioner is that medical bills submitted for out door treatment duly verified/technically examined by Medical Superintendents of Government Hospital are being sent for further verification to Chief Medical Officer concerned. It is submitted that there is no such provision under U.P. Government Servants (Medical Attendance) Rules, 2011[hereinafter referred to as the Rules of 2011] as even amended in year 2021 for such dual verification. He has adverted to amended Rules of 2011 notified on 05.01.2022 to submit that the provision which substituted previous Rule 10 of Rules of 2011 pertained only to indoor treatment and to be specifically verified/technically examined by Medical Superintendents and such Bills need not be technically re-examined by any Chief Medical Officer or any other authority. the Bills are required indicates 2 WRIA No. 5533 of 2023

3. In such circumstances, learned State Counsel is granted two weeks' time to file a short affidavit particularly adverting as to whether there are any specific provisions under the Rules or Government Order(s) pertaining to reimbursement of medical bills submitted by an employee as an outdoor patient and whether such dual verification is required?

4. List this case on 29.08.2025 at 02:15 P.M"

4. In pursuance thereof, a short counter affidavit has been filed on behalf of State.

5. Learned counsel for petitioner has drawn attention to Part V of the Rules of 2011 pertaining to procedure required to be adopted for purposes of reimbursement of Medical Claims. It is submitted that in terms of Rules 16 and 17, the Sanctioning Authority of the head of office as the case may be, is required to send the claim for reimbursement to the competent authority for Technical Examination. He has thereafter alluded to Rule 19 of the Rules of 2011 which indicates the Competent Authority. It is therefore submitted that it is only the Medical Superintendent of the Hospital concerned who is indicated as the competent authority for evaluation and examination of bills pertaining to Medical Reimbursement and therefore the bills of petitioner after verification by the Medical Superintendent of the Government Hospital are being incorrectly sent to the Chief Medical Officer concerned. It is submitted that this amounts to dual verification of Medical Reimbursement Bills of petitioner which are the primary reason for delay in Reimbursement Claims of petitioner.

6. Learned State counsel placing reliance on the counter affidavit as well as the supplementary affidavit dated 25.09.2025 submits that as per Rules of 2011, the competent authority no doubt has been indicated in Rule 19 of the Rules of 2011 but also submits that even after verification of bills by the Medical Superintendent, the same are being sent to Chief Medical Officer concerned only for purposes of further verification and examination of the bills as a matter of abundant caution and custom.

7. Upon consideration of submissions advanced by learned counsel for parties and perusal of material on record, it is admitted that petitioner is undergoing treatment in a Government Hospital and his Medical Bills were verified by the Medical Superintendent concerned whereafter it was 3 WRIA No. 5533 of 2023 being sent to the Chief Medical Officer concerned.

8. Part V of the Rules of 2011 specifically pertained to procedure required to be adopted for reimbursement purpose, the same are as follows:- PART-V REIMBURSEMENT

16. The beneficiary shall submit the reimbursement claim in prescribed proforma as given in Appendix "C" to the sanctioning authority as soon as possible but not later than three months after the completion of the treatment: Provided that the reimbursement claim of a pensioner shall be submitted to the Head of Office of the district from where he/she is drawing pension or place of residence. Where there is no such office, the District Magistrate of the concerned district shall be the Head of Office and also the Head of Department for this purpose.

17. (a) The sanctioning authority or the Head of Office in case of the pensioner shall send the claim to the competent authority for technical examination within ten days from the date of its submission. The concerned authority shall return back the claim to sanctioning authority or the Head of Office, as the case may be, after due technical examination indicating the actual reimbursable amount within fifteen days. (b) Unless certain objections have been raised and communicated, the reimbursement order shall be issued within one month from the date of receiving the technical examination report from the sanctioning authority and the Drawing and Disbursing Officers shall ensure its actual payment within the next fifteen days. If in the case of the pensioners, the Head of Office is not the sanctioning authority, he shall forward the reimbursement claim alongwith the technical examination report to the sanctioning authority within seven days, who shall follow the above schedule for payment. उ(cid:485)र (cid:352)देश असाधारण गजट, 20 िसत(cid:286)बर, 2011

18. Reimbursement shall be allowed by the sanctioning authority only when the claim is submitted alongwith the following documents on prescribed proforma as given in Appendix "C": (a) Essentiality Certificate duly signed by treating doctor and countersigned by the Superintendent-in-Charge of the hospital by whatever name he may be known. (b) Original copies of all the bills, reference letter, prescription slips and vouchers duly verified by the treating doctor. (c) Technical examination report WRIA No. 5533 of 2023 4 competent authority. (d) In special circumstances any other document (s) in original may also be enclosed to substantiate the claim. (e) Incomplete claim shall not be entertained.

19. (a) Competent authority for technical examination shall be as follows: Amount of claim Competent Authority (i) up to 40,000/- (ii) ₹40,000/-and above (iii) For specialized treatment in private hospitals Medical Officer-in-charge / Superintendent of treating or Government referring Government hospital/ Unsni Aurvedic, Homeopathy hospital. Superintendent-in-Chief/ Medical Superintendent of treating referring Government hospital/ CMO/ District Homeopathic Medical Officer or Regional Aurvedic and Unani Officer. By treating doctor not below the rank of the Professor or Head of the Department of referring institution provided in rule 13(a). (b) The competent authority shall technically validity, examine admissibility of recommend the amount admissible reimbursement both in figures and words. necessity claim and

20. Authorities competent to sanction the reimbursement claim for treatment shall be as follows: (a) for Government Servants: 5 WRIA No. 5533 of 2023 Amount of claim Sanctioning authority Upto ₹1,00,000/- Head of office Above ₹ 1,00,000/- upto ₹2,50,000/- Head of Department Above ₹2,50,000/- upto ₹5,00,000/- Administrative Department in the Government Above 5,00,000/- After recommendation from Health Medical Department the Finance approval of Department, Administrative Department Government. (b) for Retired Government Servants: Amount of claim Sanctioning authority Upto ₹1,00,000/- Above ₹1,00,000/- upto ₹5,00,000/- After recommendation of the technical competent examination Head of Office officer, After recommendation of the competent technical examination officer and on submission by the concerned Head of office the District Magistrate. उ(cid:485)र (cid:352)देश असाधारण गजट, 20 िसत(cid:286)बर, 2011 Amount of claim Sanctioning authority Above ₹5,00,000/- After recommendation of the competent technical examination officer and on submission by the concerned 6 WRIA No. 5533 of 2023 through Head of Office proper channel Administrative Department and after recommendation from Medical and Health Department the Finance approval of Department, Administrative Department.

21. The reimbursable amount shall be drawn from the "Head" from which pay, allowances or pension etc. are generally drawn."

9. A perusal of the aforesaid provisions clearly indicates that the competent authority for purposes of Technical Examination of the reimbursement bills are indicated in Rule 19 and includes the Medical Officer In-charge / Superintendent or the Superintendent in Chief/ Medical Superintendent of treating Government Hospital accordance with the amount of reimbursement sought. The said Rule also indicates the Chief Medical Officer as one of the Competent Authorities for Technical Examination of Reimbursement of Hospital Bills. However, it is relevant factor that the Rules do not indicate any provision for dual verification of the Reimbursement Bills and the Chief Medical Officer has been indicated as a Competent Authority alongwith the Medical Superintendence of the treating Government Hospital.

10. Evidently, the bills are required to be verified either by the Medical Superintendent or the Chief Medical Officer but not both.

11. In view of specific provisions of the Rules of 2011, it is evident that the opposite parties were not following the due procedure indicated in Part v of the Rules of 11 regarding Medical Reimbursement of petitioner's bill.

12. Considering aforesaid facts and circumstances and the Rules indicated here-in-above, a writ in the nature of Mandamus is issued Commanding the opposite parties to verify and technically examine the Medical Bills submitted by petitioner pertaining to his treatment in a Government Hospital either by the Medical Superintendent of the concerned Hospital or by the Chief Medical Officer but not both. Authorities shall also ensure payment of Medical Reimbursement Bills of petitioner within the time 7 WRIA No. 5533 of 2023 frame stipulated in the Rules of 2011.

13. Resultantly, the petition succeeds and is allowed. Parties to bear their own costs. October 29, 2025 Subodh/- (Manish Mathur,J.) SUBODH KUMAR SINGH SUBODH KUMAR SINGH High Court of Judicature at Allahabad, High Court of Judicature at Allahabad, Lucknow Bench Lucknow Bench

1. Heard Mr. Abhishek Mishra, learned counsel for petitioner and learned State Counsel for opposite parties.

2. Petition has been filed seeking a direction to concerned authority for making actual payment of Medical Reimbursement Bills of petitioner pertaining to treatment undertaking in Government Hospitals in terms of Rule 19 of the U.P. Government Servants (Medical Attendance), Rules 2011 as amended from time to time. Further prayer has been sought for a direction not to send the Medical Reimbursement claims of petitioner to the Chief Medical Officer for Technical Examination.

3. On 13.08.2025, following order had been passed:- "1. Heard learned counsel for petitioner and learned State Counsel appearing on behalf of the opposite parties.

2. Primary grievance of petitioner is that medical bills submitted for out door treatment duly verified/technically examined by Medical Superintendents of Government Hospital are being sent for further verification to Chief Medical Officer concerned. It is submitted that there is no such provision under U.P. Government Servants (Medical Attendance) Rules, 2011[hereinafter referred to as the Rules of 2011] as even amended in year 2021 for such dual verification. He has adverted to amended Rules of 2011 notified on 05.01.2022 to submit that the provision which substituted previous Rule 10 of Rules of 2011 pertained only to indoor treatment and to be specifically verified/technically examined by Medical Superintendents and such Bills need not be technically re-examined by any Chief Medical Officer or any other authority. the Bills are required indicates 2 WRIA No. 5533 of 2023

3. In such circumstances, learned State Counsel is granted two weeks' time to file a short affidavit particularly adverting as to whether there are any specific provisions under the Rules or Government Order(s) pertaining to reimbursement of medical bills submitted by an employee as an outdoor patient and whether such dual verification is required?

4. List this case on 29.08.2025 at 02:15 P.M"

4. In pursuance thereof, a short counter affidavit has been filed on behalf of State.

5. Learned counsel for petitioner has drawn attention to Part V of the Rules of 2011 pertaining to procedure required to be adopted for purposes of reimbursement of Medical Claims. It is submitted that in terms of Rules 16 and 17, the Sanctioning Authority of the head of office as the case may be, is required to send the claim for reimbursement to the competent authority for Technical Examination. He has thereafter alluded to Rule 19 of the Rules of 2011 which indicates the Competent Authority. It is therefore submitted that it is only the Medical Superintendent of the Hospital concerned who is indicated as the competent authority for evaluation and examination of bills pertaining to Medical Reimbursement and therefore the bills of petitioner after verification by the Medical Superintendent of the Government Hospital are being incorrectly sent to the Chief Medical Officer concerned. It is submitted that this amounts to dual verification of Medical Reimbursement Bills of petitioner which are the primary reason for delay in Reimbursement Claims of petitioner.

6. Learned State counsel placing reliance on the counter affidavit as well as the supplementary affidavit dated 25.09.2025 submits that as per Rules of 2011, the competent authority no doubt has been indicated in Rule 19 of the Rules of 2011 but also submits that even after verification of bills by the Medical Superintendent, the same are being sent to Chief Medical Officer concerned only for purposes of further verification and examination of the bills as a matter of abundant caution and custom.

7. Upon consideration of submissions advanced by learned counsel for parties and perusal of material on record, it is admitted that petitioner is undergoing treatment in a Government Hospital and his Medical Bills were verified by the Medical Superintendent concerned whereafter it was 3 WRIA No. 5533 of 2023 being sent to the Chief Medical Officer concerned.

8. Part V of the Rules of 2011 specifically pertained to procedure required to be adopted for reimbursement purpose, the same are as follows:- PART-V REIMBURSEMENT

16. The beneficiary shall submit the reimbursement claim in prescribed proforma as given in Appendix "C" to the sanctioning authority as soon as possible but not later than three months after the completion of the treatment: Provided that the reimbursement claim of a pensioner shall be submitted to the Head of Office of the district from where he/she is drawing pension or place of residence. Where there is no such office, the District Magistrate of the concerned district shall be the Head of Office and also the Head of Department for this purpose.

17. (a) The sanctioning authority or the Head of Office in case of the pensioner shall send the claim to the competent authority for technical examination within ten days from the date of its submission. The concerned authority shall return back the claim to sanctioning authority or the Head of Office, as the case may be, after due technical examination indicating the actual reimbursable amount within fifteen days. (b) Unless certain objections have been raised and communicated, the reimbursement order shall be issued within one month from the date of receiving the technical examination report from the sanctioning authority and the Drawing and Disbursing Officers shall ensure its actual payment within the next fifteen days. If in the case of the pensioners, the Head of Office is not the sanctioning authority, he shall forward the reimbursement claim alongwith the technical examination report to the sanctioning authority within seven days, who shall follow the above schedule for payment. उ(cid:485)र (cid:352)देश असाधारण गजट, 20 िसत(cid:286)बर, 2011

18. Reimbursement shall be allowed by the sanctioning authority only when the claim is submitted alongwith the following documents on prescribed proforma as given in Appendix "C": (a) Essentiality Certificate duly signed by treating doctor and countersigned by the Superintendent-in-Charge of the hospital by whatever name he may be known. (b) Original copies of all the bills, reference letter, prescription slips and vouchers duly verified by the treating doctor. (c) Technical examination report WRIA No. 5533 of 2023 4 competent authority. (d) In special circumstances any other document (s) in original may also be enclosed to substantiate the claim. (e) Incomplete claim shall not be entertained.

19. (a) Competent authority for technical examination shall be as follows: Amount of claim Competent Authority (i) up to 40,000/- (ii) ₹40,000/-and above (iii) For specialized treatment in private hospitals Medical Officer-in-charge / Superintendent of treating or Government referring Government hospital/ Unsni Aurvedic, Homeopathy hospital. Superintendent-in-Chief/ Medical Superintendent of treating referring Government hospital/ CMO/ District Homeopathic Medical Officer or Regional Aurvedic and Unani Officer. By treating doctor not below the rank of the Professor or Head of the Department of referring institution provided in rule 13(a). (b) The competent authority shall technically validity, examine admissibility of recommend the amount admissible reimbursement both in figures and words. necessity claim and

20. Authorities competent to sanction the reimbursement claim for treatment shall be as follows: (a) for Government Servants: 5 WRIA No. 5533 of 2023 Amount of claim Sanctioning authority Upto ₹1,00,000/- Head of office Above ₹ 1,00,000/- upto ₹2,50,000/- Head of Department Above ₹2,50,000/- upto ₹5,00,000/- Administrative Department in the Government Above 5,00,000/- After recommendation from Health Medical Department the Finance approval of Department, Administrative Department Government. (b) for Retired Government Servants: Amount of claim Sanctioning authority Upto ₹1,00,000/- Above ₹1,00,000/- upto ₹5,00,000/- After recommendation of the technical competent examination Head of Office officer, After recommendation of the competent technical examination officer and on submission by the concerned Head of office the District Magistrate. उ(cid:485)र (cid:352)देश असाधारण गजट, 20 िसत(cid:286)बर, 2011 Amount of claim Sanctioning authority Above ₹5,00,000/- After recommendation of the competent technical examination officer and on submission by the concerned 6 WRIA No. 5533 of 2023 through Head of Office proper channel Administrative Department and after recommendation from Medical and Health Department the Finance approval of Department, Administrative Department.

21. The reimbursable amount shall be drawn from the "Head" from which pay, allowances or pension etc. are generally drawn."

9. A perusal of the aforesaid provisions clearly indicates that the competent authority for purposes of Technical Examination of the reimbursement bills are indicated in Rule 19 and includes the Medical Officer In-charge / Superintendent or the Superintendent in Chief/ Medical Superintendent of treating Government Hospital accordance with the amount of reimbursement sought. The said Rule also indicates the Chief Medical Officer as one of the Competent Authorities for Technical Examination of Reimbursement of Hospital Bills. However, it is relevant factor that the Rules do not indicate any provision for dual verification of the Reimbursement Bills and the Chief Medical Officer has been indicated as a Competent Authority alongwith the Medical Superintendence of the treating Government Hospital.

10. Evidently, the bills are required to be verified either by the Medical Superintendent or the Chief Medical Officer but not both.

11. In view of specific provisions of the Rules of 2011, it is evident that the opposite parties were not following the due procedure indicated in Part v of the Rules of 11 regarding Medical Reimbursement of petitioner's bill.

12. Considering aforesaid facts and circumstances and the Rules indicated here-in-above, a writ in the nature of Mandamus is issued Commanding the opposite parties to verify and technically examine the Medical Bills submitted by petitioner pertaining to his treatment in a Government Hospital either by the Medical Superintendent of the concerned Hospital or by the Chief Medical Officer but not both. Authorities shall also ensure payment of Medical Reimbursement Bills of petitioner within the time 7 WRIA No. 5533 of 2023 frame stipulated in the Rules of 2011.

13. Resultantly, the petition succeeds and is allowed. Parties to bear their own costs. October 29, 2025 Subodh/- (Manish Mathur,J.) SUBODH KUMAR SINGH SUBODH KUMAR SINGH High Court of Judicature at Allahabad, High Court of Judicature at Allahabad, Lucknow Bench Lucknow Bench