Back
2014 Supreme(Raj) 208
IN THE HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR
VINEET KOTHARI, J.
Jawahar Lal Bohra
Vs.
State of Rajasthan & Ors.
Civil Writ Petition No.6350/2005
Decided on: 26th March 2014
Mr. Vikas Balia, for the petitioner.
Mr. Sunil Joshi, for
Mr. Rajesh Panwar, AAG for the respondent- State.
A Government servant is entitled to reimbursement of medical expenses incurred for treatment outside the State of Rajasthan in an emergency, even if the hospital where the treatment was taken is not a recognized hospital.
Headnote:
MEDICAL REIMBURSEMENT - GOVERNMENT SERVANT - TREATMENT OUTSIDE STATE - RECOGNIZED HOSPITAL - HARMONIOUS CONSTRUCTION OF RULES - REIMBURSEMENT AT RATES OF RECOGNIZED HOSPITAL.
Fact of the Case:
Petitioner, a retired Government servant, underwent heart surgery at the Asian Heart Institute, Mumbai, in 2004. He claimed reimbursement from the State Government under the Medical Attendance Rules, 1970, but his claim was rejected on the ground that the Asian Heart Institute was not a recognized hospital. The petitioner challenged the rejection of his claim by filing a writ petition.
Finding of the Court:
The Court held that the petitioner was entitled to reimbursement of his medical expenses incurred for treatment outside the State of Rajasthan, even though the Asian Heart Institute was not a recognized hospital. The Court found that the Rules of 1970 provided for reimbursement of medical expenses incurred by Government servants for treatment outside the State in an emergency, and that the list of recognized hospitals was limited and did not include all possible hospitals where such treatment could be obtained. The Court also found that the Government order dated 19.12.2004, which specified the limits of costs for reimbursement of medical expenses, did not include the equipment used in the petitioner's surgery.
Issues: 1. Whether the petitioner was entitled to reimbursement of his medical expenses incurred for treatment outside the State of Rajasthan, even though the Asian Heart Institute was not a recognized hospital? 2. Whether the Government order dated 19.12.2004, which specified the limits of costs for reimbursement of medical expenses, applied to the petitioner's case?
Ratio Decidendi: 1. The Court held that the petitioner was entitled to reimbursement of his medical expenses incurred for treatment outside the State of Rajasthan, even though the Asian Heart Institute was not a recognized hospital. The Court found that the Rules of 1970 provided for reimbursement of medical expenses incurred by Government servants for treatment outside the State in an emergency, and that the list of recognized hospitals was limited and did not include all possible hospitals where such treatment could be obtained. The Court also found that the Government order dated 19.12.2004, which specified the limits of costs for reimbursement of medical expenses, did not include the equipment used in the petitioner's surgery. 2. The Court held that the Government order dated 19.12.2004, which specified the limits of costs for reimbursement of medical expenses, did not apply to the petitioner's case. The Court found that the equipment used in the petitioner's surgery was not included in the list of equipment specified in the Government order.
Final Decision: The Court disposed of the writ petition by directing the Director of the Medical and Health Department of the State Government to forward the relevant papers of the actual treatment taken by the present petitioner at the Asian Heart Institute, to the Bombay Hospital, Mumbai and request them to supply the information with regard to the expenses which would have been incurred in the Bombay Hospital, had the petitioner taken this treatment actually in Bombay Hospital itself at that point of time. Upon such information being received, the amount as permissible and chargeable by the Bombay Hospital, may be paid to the present petitioner against his claim of actual expenses incurred by him for his treatment in Asian Heart Institute, Mumbai.
1. The petitioner having retired as Superintending Hydrogeologist from the Ground Water Department of the respondent State Government in the year 1997 is before this Court by way of present writ petition, which was filed on 22.10.2005 with the following prayers:-
“This petition for writ, in the nature of mandamus may kindly be allowed, By an appropriate writ, order and direction:
i). The impugned communication dated 23.03.2005 (Annex.3) and 15.07.2005 (Annex.7) may kindly be quashed and set aside.
ii). Their respondents may kindly be directed to immediately make the payment of the expenses incurred by the petitioner in his treatment to the tune of Rs.3,16,016/-only.
iii).That the respondents may further be directed to make the payment of the interest @ 18% to the petitioners.
iv). Any other appropriate relief, which this Hon'ble Court deems fit and necessary in the facts and circumstances of the case, be granted.
v). Cost of the writ petition be ordered to be awarded in favour f the petitioner.”
2. For the surgical intervention made for his heart ailment for the disease, 'Mitral Valve Replacement and Ticuspid Valve Repair', the petitioner took this treatment in the Asian Heart Institute, Mumbai, in the year 2004. It so happened that the petitioner after his retirement in 2004 went to Bhiwandi, District: Thane, in the State of Maharashtra near Mumbai on 04.11.2004 to meet the family of his two sons who were living there and to celebrate the ‘Diwali’ there but unfortunately he fell ill there and in an emergency he was admitted in the Asian Heart Institute, Mumbai, where after initial Angiography done on 30.11.2004 on the further medical advice on 04.12.2004 he was again operated and in a open heart by-pass surgery, the “Mitral valves” were replaced in his heart. After remaining in the said Asian Heart Institute, Mumbai, for some time, he was discharged on 18.12.2004. Upon return from Mumbai to Jodhpur, the petitioner claimed a sum of Rs.3,13,016/-from the respondent-State after deducting a sum of Rs.1 lac from the total medical expenses of Rs.4,13,516/-, already received by him from the insurance company for the medi-claim made by him from the said insurance company. However, his claim has been entirely rejected by the respondent-State by the impugned order (Annex.3) dated 23.03.2005 on the ground that the Asian Heart Institute, Mumbai, was not in the list of recognized hospitals by the State Government and, therefore, the claim of the reimbursement made was liable to be returned back unpaid.
3. Upon issuance of the notices in the present writ petition, the respondent-State has filed a reply to the writ petition and along-with the reply to the writ petition they have also filed a copy of the order dated 19.12.2004 as Annex.R/3 giving the limits of costs of same equipments for such reimbursement by the State and also laying down the guidelines for the treatment of heart ailment in a recognized hospital outside the State with or without the recommendation of the Medical Board to the extent of 80% of the hospital expenses incurred by the patient. The equipments, the cost of which is reimbursable as per the said order dated 19.12.2004 are only Pacemaker, Angioplasty or Balloonplasty or for Stent(s) used in such Angioplasty in cases of heart known as 'Cardio-Thoracic Surgical' in a recognized hospital outside the State in emergent circumstances without any recommendation of the Medical Board. The said order permits reimbursement to the extent of 80% of the hospital expenses, limited to Rs.48,000/-i.e. 80% of the general ward charges of AIIMS, Delhi, provided that a certificate from a Cardiologist, who hold a decree of D.M. in Cardiac or MCH in Cardio Thoracic Surgery, stating that the pensioner's condition was such that immediate treatment was essential, is so furnished by the claimant.
4. Learned counsel for the petitioner, Mr. Vikas Balia, submitted that the case of the present petitioner, a retired Government servant, falls u
