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2004 Supreme(SC) 812

SUPREME COURT OF INDIA
K.G. BALAKRISHNAN, DR. A.R. LAKSHMANAN, JJ.
SUMAN RAKHEJA - APPELLANT
VERSUS
STATE OF HARYANA AND ANOTHER - RESPONDENTS
CIVIL APPEAL NO. 5060 OF 2004,
DECIDED ON AUGUST 6, 2004

Headnote:

Reimbursement of Medical allowances - Husband of appellant was a government servant- Appellant incurred expenses to the tune of Rs. 6,01,166/-on his treatment in Appolo Hospital- Application for reimbursement of the medical expenses incurred, was declined by the State, on the ground that the hospital was not an approved hospital- In similar case by the Order of the High Court of Punjab and Haryana in C.W.P.No.588 of 1998, titled Sant Prakash v. The State of Haryana, wherein in an emergency case the patient had to be immediately admitted in hospital, the relief had been granted- In the instant case also deceased was rushed to the hospital as he suffered paralytic attack- Therefore the appellant held entitled to get the refund of the amount of 100% medical expenses at the AIIMS rates and 75% of the expenditure in excess thereto. [Paras 4 and 5]

ORDER

1. LEAVE GRANTED.

2. HEARD COUNSEL FOR THE APPELLANT AS WELL AS THE COUNSEL FOR THE RESPONDENTS.

3. THE APPELLANT IS THE WIFE OF A DECEASED GOVERNMENT SERVANT WHO HAD UNDERGONE TREATMENT IN THE APOLLO HOSPITAL, NEW DELHI, WHICH WAS A PRIVATE HOSPITAL AND WHICH WAS NOT RECOGNISED/APPROVED AT THAT TIME. FOR THE TREATMENT IN THAT HOSPITAL THE APPELLANT INCURRED EXPENSES TO THE TUNE OF RS 6,01,166 AND THE APPELLANT, BY WAY OF AN APPLICATION PRAYED FOR REIMBURSEMENT OF THE MEDICAL EXPENSES INCURRED, BUT THE SAME WAS DECLINED BY THE STATE, ON THE GROUND THAT THE HOSPITAL WHEREIN THE APPELLANTS HUSBAND HAD UNDERGONE THE TREATMENT WAS NOT AN APPROVED HOSPITAL.

4. COUNSEL FOR THE APPELLANT SUBMITTED THAT IN SIMILAR CASE (ANNEXURE P-4) I.E. BY THE ORDER OF THE HIGH COURT OF PUNJAB AND HARYANA IN SANT PRAKASH V. STATE OF HARYANA1 WHEREIN IN AN EMERGENCY CASE THE PATIENT HAD TO BE IMMEDIATELY ADMITTED IN HOSPITAL, THE RELIEF HAS BEEN GRANTED. IN THE PRESENT CASE ALSO THE APPELLANTS HUSBAND HAD TO BE RUSHED TO THE PRIVATE HOSPITAL BECAUSE HE HAD DEVELOPED A PARALYTIC STROKE ON THE LEFT SIDE OF THE BODY, AS THERE WAS BLOOD CLOTTING ON THE RIGHT SIDE OF THE BRAIN AND THEREFORE, G WAS ADMITTED IN AN EMERGENCY CONDITION IN THE HOSPITAL. IN THE PRESENT CASE THE DISCHARGE CERTIFICATE ALSO SHOWS THAT THE CASE WAS AN EMERGENCY ONE. IN SANT PRAKASH EASEL THE DIVISION BENCH HELD THAT THE PETITIONER THEREIN WOULD BE ENTITLED TO 100% MEDICAL EXPENSES AT THE AIIMS RATES AND 75% OF THE EXPENDITURE IN EXCESS THERETO.

5. IN THE RESULT, IN THIS APPEAL ALSO, THE APPELLANT HEREIN WOULD BE ENTITLED TO GET THE REFUND OF THE AMOUNT OF 100% MEDICAL EXPENSES AT THE AIIMS RATES AND 75% OF THE EXPENDITURE IN EXCESS THERETO.

6. IN THE RESULT, THE APPEAL IS ALLOWED. NO COSTS.

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