Medical reimbursement cannot be denied solely due to a name change of a recognized hospital, provided the entity remains the same.

ORDER :

SURAJ GOVINDARAJ, J.

1. Learned AGA accepts notice for respondents Nos.1 to 4.

2. The petitioner is before this Court seeking for the following reliefs:

a. Issue the Writ in the nature of certiorari quashing the order passed by the respondent no. 4 vide his order bearing

3. The short grievance of the petitioner is that his medical reimbursement claim has been rejected solely on the ground that the hospital from which he availed treatment does not find a place in the Government- recognised list of private hospitals eligible for medical reimbursement, as per Annexure-A1.

4. Learned counsel for the petitioner submits that the hospital in question ‘Kasturba Medical College Hospital, Manipal’ was indeed present in the approved list. However, pursuant to a formal request dated 23.03.2021, the hospital sought for change of name to ‘Kasturba Hospital, Manipal’, in conformity with the registration certificate issued by the Karnataka Private Medical Establishment Authority, Udupi.

5. It is further submitted that despite the name change and the hospital’s communication, the updated name has not been incorporated in the Government list, resulting in rejection of the reimbursement claim.

6. The learned Additional Government Advocate contends that only the names of hospitals appearing as is in the approved list can be considered and that deviations, including name changes, cannot be accepted.

7. I have heard the learned counsel for the petitioner and the learned AGA and have carefully perused the material on record.

8. The only question that arises for consideration is:

Whether medical reimbursement can be denied solely due to a change in the name of the hospital, even though it remains the same entity that was previously recognised?

9. The purpose of maintaining a recognised list of private hospitals under Clause (ff) of Rule 3 of the Karnataka Government Servants (Medical Attendance) Rules, 1963, is to ensure that services are availed from vetted and approved institutions. The recognition involves inspection and assessment of the hospital’s infrastructure and services.

10. It is evident that if treatment is availed from an unrecognised hospital, reimbursement is not permissible. However, in the present case, Kasturba Medical College Hospital, Manipal was an approved institution.

11. Following its name change to Kasturba Hospital, Manipal, the hospital submitted a formal application on 23.03.2021 seeking correction in the recognised list. Despite this, the authorities have failed to update the name, resulting in rejection of reimbursement claims.

12. The hospital remains the same legal entity, and the name change was duly recorded under the Karnataka Private Medical Establishment Act. Denial of reimbursement merely on account of non-updated nomenclature, when the entity remains the same, is arbitrary and legally unsustainable. The respondent authorities were obligated to verify the request and update the recognised list after following the due procedure. Their failure to do so cannot prejudice the petitioner.

13. I answer the point framed by holding that medical reimbursement cannot be denied solely due to a change in the name of the hospital, even though it remains the same entity that was previously recognised.

ORDER

i. Writ petition is allowed.

ii. A writ of certiorari is hereby issued, quashing the order passed by respondent No. 4, dated 03.07.2024 (Annexure–C), and also the orders passed by respondent No. 2, dated 31.08.2024 (Annexures–E and E1).

iii. Respondent No. 2 is directed to reconsider the petitioner’s application for medical reimbursement, taking into account the change in the name of Kasturba Medical College Hospital, Manipal to Kasturba Hospital, Manipal, in accordance with applicable proced