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2014 Supreme(Raj) 354
HIGH COURT OF RAJASTHAN
Jawahar Lal Bohra Vs. State of Rajasthan & Ors. (Dr. Kothari, J.)
HON'BLE DR. VINEET KOTHARI, J.
Jawahar Lal Bohra
Versus
State of Rajasthan & Ors.
S.B. Civil Writ Petition No.6350 of 2005, decided on 26.03.2014
Vikas Balia, for Petitioner;
Sunil Joshi, for Rajesh Panwar, AAG, for Respondent-State
Headnote:Medical Attendance Rules, 1970, Rule 6, 7 and 12 — Re-imbursement of medical expenses incurred on treatment in emergency out of state — A retired pensioner — On `Diwali' went to meet his some living Bhiwandi (Bombay) — Fell ill, admitted in Asian Heart Institute, Mumbai where undergone open heart by-pass surgery — Claimed Rs. 3,13,016/- After deducting Rs. 1 lac received from insurance company for mediclaim — Rejected as the hospital was not in the list of Govt. recognized hospitals — Held — As per Rule 6 and 7 of the 1970 Rules, a pensioner has taken treatment in a hospital outside the State of Rajasthan in emergency, he is entitled to reimbursement of medical expenses at least at the rates of nearest recognised hospitals — Reimbursement of insurance claim under a separate contract has no over riding effect and cannot negative the claim — Directed to make reimbursement of actual amount within 3 months. (Paras 17 to 22)
Writ petition disposed of.
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Hon'ble Dr. KOTHARI, J.—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 of 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 alongwith 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 Go
