Jammu, Feb 21: In Original Application No. 175/2025 titled Parvinder Kour v/s UT of Jammu & Kashmir Through Principal Secretary to Government Power Development Department J&K Reserved on: - 12.08.2025 Pronounced on: - 19.02.2026 after hearing Advocate: - Mr. F.A. Natnoo for applicant a DB of HON’BLE MR. RAJINDER SINGH DOGRA, MEMBER (J) HON’BLE MR. RAM MOHAN JOHRI, MEMBER (A) ordered as under:-
O.A. No. 175/2025 ORDER Per: - Rajinder Singh Dogra, Judicial Member
1. The applicant has filed the present Original Application under Section 19 of the Administrative Tribunals Act, 1985 seeking the following reliefs: - In view of the aforementioned facts the Applicants pray for the following relief(s):-
I. Allow this Original application of the applicant.
II. Direct the respondents to accord sanction to the case of the applicant for release/reimbursement of Rs. 24,16,060.24/- Le. the actual amount of medical and other expenses incurred on the treatment of late husband of the applicant who was suffering from Hypertension and Chronic Liver Disease and had developed bilateral Pneumonia, decomposed CLD with cel/acute kidney injury (sepsis with multi organ dis-function syndrome) and had gone through the CCRT(Continuous renal replacement therapy) and other treatments from Medanta Hospital, Gurgaon from 06-03-2023 to 23-03-2023, in letter and spirit of the Provisions of Jammu and Kashmir Civil Services (Medical Attendance-Cum-Allowance) Rules 1990, along with interest @atleast 15% per annum till its realization, which shall be paid from the pockets of the authorities having remained at the helm of affairs, in the process of such illegal inaction.
III. Any other relief which this Hon'ble Tribunal may deem just and proper in the given facts and circumstances of the case may also be passed in favour of the applicant and against the respondents.
2. The facts of the case as averred by the applicant in her pleadings, are as follows: -
a) The applicant, Smt. Parvinder Kour, widow of Late Sh. Tajinder Pal Singh Salaria, has filed the present Original Application seeking reimbursement of medical expenses amounting to ₹24,16,060.24/- incurred on the treatment of her husband during his hospitalization at Medanta Hospital, Gurgaon, along with interest.
b) Late Sh. Tajinder Pal Singh Salaria was initially appointed as Junior Engineer in the Power Development Department in the year 1993 pursuant to his selection by the J&K Services Selection Board.
Thereafter, on being selected through due process, he was appointed as Assistant Engineer on 23.01.2004 and subsequently promoted as Executive Engineer on 24.07.2019. At the time of the events in question, he was serving as Executive Engineer under JKPTCL.
c) In the first week of March 2023, the deceased officer proceeded to Delhi to visit his sister after seeking leave from the competent authority. Casual leave for five days w.e.f. 06.03.2023 to 11.03.2023 along with permission to leave station was sanctioned vide order dated 06.03.2023.
d) During his stay at Delhi, he developed severe medical complications and was admitted in emergency at Medanta Hospital, Gurgaon on the midnight of 05/06 March 2023.
He remained hospitalized from 06.03.2023 to 23.03.2023. As per the discharge summary, he was admitted under the Hepatology team with complaints of jaundice, abdominal distension, reduced urine output and low-grade fever.
He was diagnosed with Chronic Liver Disease (Decompensated), Bilateral Pneumonia, Sepsis with Multi-Organ Dysfunction Syndrome, Acute Kidney Injury requiring Continuous Renal Replacement Therapy (CCRT), Sustained Low Efficiency Dialysis (SLED), and Hypertension. During hospitalization, he required ventilator support, intubation, intravenous antibiotics, dialysis, echocardiogram, bronchoscopy and other critical care interventions.
e) The total expenditure incurred on the treatment amounted to ₹24,16,060.24/-, as reflected in the hospital bills and vouchers annexed with the application.
f) On 23.03.2023, he was shifted to ASCOMS Hospital, Sidhra, Jammu, where despite continued treatment and ventilator support, he suffered cardiac arrest and expired on 24.03.2023 while still in service.
g) After his demise, the applicant submitted a claim for reimbursement of the aforesaid medical expenses on 08.04.2023 to Respondent No. 3, which was forwarded to the Chief Engineer, JKPTCL for further action.
Despite lapse of considerable time, no sanction or reimbursement was granted, compelling the applicant to approach this Tribunal.
h) The applicant contends that the treatment was emergent in nature and squarely covered under Rule 6(5) of the J&K Civil Services (Medical Attendance-cum-Allowance) Rules, 1990, which permits reimbursement where a beneficiary temporarily residing outside the State suddenly falls ill and requires hospitalization.
It is argued that denial or delay in reimbursement is arbitrary, violative of statutory rules and infringes the right to life under Article 21 of the Constitution of India.
3. The respondents have filed their written statement wherein they have averred as follows: -
a) The respondents have resisted the claim by filing a written statement raising preliminary objections and contesting the entitlement of the applicant.
b) At the outset, it is contended that no fundamental, statutory or legal right of the applicant has been violated and that the present Original Application is not maintainable.
It is further pleaded that the applicant has suppressed material facts and that no cause of action has accrued.
c) On merits, the respondents do not dispute the service particulars of the deceased officer or the factum of hospitalization and expenditure. However, they assert that the deceased left for Delhi on 04.03.2023 without prior station leave and that sanction for casual leave with permission to leave station was granted only from 06.03.2023 to 11.03.2023.
d) It is further contended that as per the discharge summary, the deceased had been suffering from jaundice for about one month prior to hospitalization, indicating that the illness was not sudden in nature.
According to the respondents, Rule 6(5) of the 1990 Rules requires certification that the beneficiary had suddenly fallen ill outside the State and was not already suffering from the ailment before departure from his hometown.
It is alleged that the deceased had concealed his medical condition at the time of proceeding on leave.
e) The respondents further state that the applicant submitted only the medical bills without enclosing a referral certificate or essentiality certificate from the competent medical authority as required under the Rules.
The Director (Finance), JKPTCL raised queries regarding such certificates. The case was forwarded to the Administrative Department seeking ex-post facto sanction for treatment outside the Union Territory on humanitarian grounds, and the matter is stated to be under process. f) It is also contended that reimbursement under the Rules is subject to verification of vouchers and certification by competent medical authorities, and that until such procedural requirements are fulfilled, no enforceable right accrues to the applicant. g) The respondents finally submit that the matter involves disputed questions of fact and that no arbitrary or illegal action has been committed, and therefore the Original Application deserves dismissal.
4. Heard learned counsel for the parties and perused the pleadings made by them.
5. The applicant, widow of Late Sh. Tajinder Pal Singh Salaria (then Executive Engineer, JKPTCL), has approached this Tribunal under Section 19 of the Administrative Tribunals Act, 1985 seeking reimbursement of medical expenses of ₹24,16,060.24/- incurred on the treatment of her late husband at Medanta Hospital, Gurgaon from 06.03.2023 to 23.03.2023, along with interest.
6. The pleaded facts disclose that the deceased employee served the department for about three decades—appointed as Junior Engineer in 1993, promoted/appointed as Assistant Engineer in 2004 and promoted as Executive Engineer in 2019. In early March, 2023, while at Delhi, he suddenly fell seriously ill and was rushed in emergency and admitted to ICU at Medanta, Gurgaon. He remained hospitalized from 06.03.2023 to 23.03.2023, underwent critical care including ventilator support, renal replacement therapy (CCRT/SLED), and management for multiple complications including Chronic Liver Disease decompensation, pneumonia, sepsis with multi-organ dysfunction and acute kidney injury. The applicant states that ₹24,16,060.24/- was spent on the said treatment. He was shifted to ASCOMS, Jammu on 23.03.2023 and unfortunately expired on 24.03.2023 while in service.
7. After his demise, the applicant submitted the claim with bills on 08.04.2023, which was received and forwarded for further action to the competent level; however, no reimbursement was released, compelling the applicant to litigate.
8. The respondents, while not disputing hospitalization and submission of claim, have raised objections that: (i) the deceased left Delhi on 04.03.2023 “without station leave” and station leave was sanctioned w.e.f. 06.03.2023; (ii) he allegedly concealed that he was suffering from jaundice for about one month; and (iii) the applicant submitted bills without “referral certificate” and “essentiality certificate”, and therefore the claim is “under process” for ex-post facto sanction.
9. The core issue is whether the applicant’s claim for reimbursement of expenses incurred during emergency hospitalization outside the UT is liable to be rejected/withheld on the ground of (a) absence of referral/essentiality certificate at the time of submission, or (b) the respondents’ plea that the ailment was not “sudden” because jaundice was present for a month.
10. The governing provision in such matters is Rule 6 of the J&K Civil Services (Medical Attendance-cum-Allowance) Rules, 1990, particularly Rule 6(5) which provides that where a beneficiary temporarily resides outside the State and falls ill there suddenly and is advised admission, he shall be allowed reimbursement on production of vouchers/certificates, subject to recommendation by the Director Health Services, after satisfaction that the beneficiary fell ill suddenly and could not wait for treatment at home.
11. This Tribunal is of the considered view that the respondents’ approach is hyper-technical and defeats the object of the medical attendance rules. The record itself shows that the deceased required ICU admission, ventilator support and renal replacement therapy due to acute multi-organ dysfunction and sepsis. Even if jaundice was present for some time, it does not follow that the catastrophic deterioration—acute kidney injury, sepsis, respiratory failure, need for ventilator and dialysis—was not sudden. “Sudden” in Rule 6(5) cannot be interpreted to mean absence of any prior symptoms whatsoever; rather, it addresses the situation where, while staying outside the UT, the beneficiary suffers an emergent episode requiring immediate hospitalization and cannot reasonably be expected to travel back and risk life.
12. The respondents’ own stand demonstrates that the matter is not rejected on merits; rather, “queries” were raised and the case was forwarded for ex-post facto sanction on humanitarian grounds and is “still in process”. Once that is the position, the prolonged inaction and non-decision becomes arbitrary. A welfare rule meant to facilitate treatment cannot be converted into a tool to deny reimbursement to the widow of an employee who died in harness after critical treatment.
13. The Hon’ble Supreme Court has consistently held that medical care is integral to the right to life under Article 21, and the State as a welfare employer cannot adopt an unduly rigid approach in medical reimbursement claims. In State of Punjab v. Mohinder Singh Chawla (1997) 2 SCC 83, the Court recognized the right to health/medical care as part of Article 21.
In Shiva Kant Jha v. Union of India (2018), the Court deprecated rejection/curtailment of medical claims on technicalities when treatment is genuine and supported by records. Policy conditions may regulate reimbursement, but they must operate reasonably and cannot be applied to defeat legitimate claims in emergent situations (State of Punjab v. Ram Lubhaya Bagga (1998) 4 SCC 117).
14. Therefore, this Tribunal holds that: a) The applicant’s claim cannot be stalled indefinitely for want of certificates, particularly when the department itself admits that the matter is under process for ex-post facto sanction.
b) The plea of “concealment” is not determinative in the present facts because the immediate hospitalization and critical care event, and the respondents have not shown any material to hold that the hospitalization was elective or avoidable.
15. In view of the above, the Original Application is allowed with the following directions:
a) The respondents are directed to accord sanction to the medical reimbursement claim of the applicant, strictly as per entitlement under the J&K Civil Services (Medical Attendance-cum- Allowance) Rules, 1990, in respect of treatment of Late Sh. Tajinder Pal Singh Salaria at Medanta Hospital, Gurgaon from 06.03.2023 to 23.03.2023.
b) It is declared that the hospitalization of the deceased employee was in emergent circumstances and squarely covered under Rule 6(5) of the Rules of 1990.
The objection regarding absence of prior referral certificate shall not defeat the claim, as procedural requirements cannot override substantive entitlement in life-threatening situations.
c) In the facts of the present case, ex-post facto sanction for treatment outside the Union Territory shall be treated as justified and deemed to have been granted, subject only to verification of bills for arithmetical accuracy.
d) The respondents shall complete verification and release the admissible amount within 12 weeks from the date of receipt of certified copy of this order.
e) No order as to costs.
(RAM MOHAN JOHRI) (RAJINDER SINGH DOGRA) Administrative Member Judicial Member
|