IN THE HIGH COURT OF CHHATTISGARH AT BILASPUR
AMITENDRA KISHORE PRASAD, J.
Baldau Prasad Kaushik S/o Jagat Ram Kaushik – Appellant
Versus
State of Chhattisgarh – Respondent
WPS No. 3763 of 2023
Decided On : 31-10-2025
| Table of Content |
|---|
| 1. petitioner's eligibility and procedure for medical reimbursement. (Para 1 , 2 , 3) |
| 2. arguments regarding the arbitrary rejection of the reimbursement claim. (Para 4 , 5 , 6 , 7) |
| 3. importance of best interests in medical treatment for children. (Para 8 , 9 , 10) |
| 4. requirement for reasoned orders in administrative decisions. (Para 11 , 12 , 13) |
| 5. right to health as a fundamental right under the constitution of india. (Para 14 , 15 , 16) |
| 6. court's directive to sanction the reimbursement claim. (Para 17 , 18) |
| 7. need for humane approach in medical reimbursement decisions. (Para 19 , 20) |
ORDER :
1. The petitioner is aggrieved by the order dated 24.09.2022, whereby respondent No. 3 has rejected his claim for medical reimbursement amounting to Rs. 54,848/-. The petitioner, serving as Assistant Grade-II in the Secretariat Services, Mantralaya, Raipur, had sought reimbursement for the treatment and surgery of his minor son for Hypospadias at Makhija Pediatric and Neonatology Surgery Center, Bilaspur—an empanelled hospital. Despite due intimation and compliance with all procedural formalities, the claim was rejected arbitrarily on the ground of lack of urgency, and the subsequent representation was also dismissed without valid reason. Hence, this petition seeking following reliefs :
“i. To kindly set aside the rejection order dated 24/9/2022 (Annexure P/1) with respect to medical reimbursement claim of the petitioner passed by respondent no. 3 and further respondent no. 3 may kindly be directed to re-consider the case of the petitioner with respect to payment of medical reimbursement of Rs. 54,848/-.
ii. To kindly the respondents may kindly be directed to pay the medical reimbursement of Rs. 54,848/- with interest @ 12% per annum from the date of application with compensation for delay and mental agony.
iii. To kindly make any other order that may be deemed fit and just in the facts and circumstances of the case.”
2. Facts of the case, in a nutshell, are that the petitioner is serving as an employee of the Secretariat Services under the Government of Chhattisgarh, in the General Administration Department, Mantralaya, Raipur. He is presently posted as Assistant Grade-II in the Department of Women and Child Development, Mantralaya, Mahanadi Bhavan, Nava Raipur, Atal Nagar, District Raipur (C.G.). During the year 2018–2019, the minor son of the petitioner, namely Master Devansh Kaushik, aged about 2 years and 4 months, was diagnosed with Hypospadias (Urinary Difficulty), a congenital condition requiring specialized surgical treatment. The child was under regular medical supervision and treatment at Makhija Pediatric and Neonatology Surgery Center, Bilaspur, where the attending physician advised surgical intervention. The surgery for Hypospadias was to be conducted in two stages. The first stage of the operation was successfully performed in the months of September–October 2018. Thereafter, it was medically advised that the second stage of surgery be carried out at the same hospital to ensure continuity of care and medical safety. In November 2019, the child again developed complications and urinary difficulty, and upon medical examination, was advised immediate admission. Consequently, the second stage of the surgery was performed on 15.11.2019 at Makhija Pediatric and Neonatology Surgery Center, Bilaspur. It is pertinent to mention that Makhija Pediatric and Neonatology Surgery Center, Bilaspur is a hospital duly recognized and enlisted by the State Government of Chhattisgarh for providing medical treatment to State Government employees and their dependent family members. As per the provisions of the Chhattisgarh Civil Services (Medical Attendance) Rules, 2013, it is mandatory that in cases of emergency treatment, the concerned employee must intimate the Director, Medical Education, Chhattisgarh, Raipur and the Head of the Department within 48 hours of the commencement of treatment, and post facto approval may thereafter be ob
The principles of administrative fairness mandate that decisions impacting individuals' rights must be reasoned, and arbitrary rejections are unsustainable under the law.
In emergency medical situations, full reimbursement of medical expenses is mandated regardless of any imposed ceiling limits, emphasizing the right to timely medical treatment.
The main legal point established in the judgment is the obligation of the state to ensure timely medical treatment and the need for a compassionate and sympathetic consideration of medical reimbursem....
Government employees are entitled to full medical reimbursement for emergency treatment, even in non-approved hospitals. Administrative authorities must process such claims within a reasonable timefr....
Full medical reimbursement mandatory for genuine emergency treatment in empanelled hospitals, regardless of CGHS rates.
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