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IN THE HIGH COURT OF RAJASTHAN
Jaishree Thakur, J.
Kishan Gopal Bansal - Petitioner
Versus
State of Rajasthan & Ors. - Respondents
S.B. Civil Writ Petition No. 768 of 2015
Decided on : 17-02-2016
MEDICAL REIMBURSEMENT - RAJASTHAN STATE PENSIONERS MEDICAL CONCESSION SCHEME, 2009 - SECTION 3(1) - A retired government servant is entitled to reimbursement of medical expenses incurred for knee replacement surgery at a private hospital outside the state, even without prior approval or referral, as long as the hospital is approved under the scheme.
Fact of the Case:
The petitioner, a retired government servant, underwent knee replacement surgery at a private hospital outside the state without prior approval or referral. He claimed reimbursement of medical expenses under the Rajasthan State Pensioners Medical Concession Scheme, 2009, but his claim was rejected by the respondents.
Finding of the Court:
The court held that the petitioner was entitled to reimbursement of medical expenses as per the scheme, even though he had not taken prior approval or referral, as the hospital where he underwent surgery was approved under the scheme.
Issues: Whether a retired government servant is entitled to reimbursement of medical expenses incurred for knee replacement surgery at a private hospital outside the state, even without prior approval or referral.
Ratio Decidendi: The court relied on the Rajasthan State Pensioners Medical Concession Scheme, 2009, which provides for reimbursement of medical expenses incurred by pensioners for treatment at private hospitals. The court also relied on a Division Bench decision of the Rajasthan High Court, which held that the government cannot insist upon an employee to get himself treated at a recognized government institution and must reimburse the employee at the rates applicable in the recognized government institution.
Final Decision: The court directed the respondents to reimburse the petitioner the medical expenses incurred for knee replacement surgery, as per the rates applicable for similar treatment in recognized government hospitals in the state of Rajasthan, within two months from the date of receipt of the certified copy of the order.
Jaishree Thakur, J.
By way of present writ petition, the petitioner is seeking direction to be issued to the respondents to reimburse the medical expenses borne by him on account of treatment taken at Shalby Hospital, Ahmedabad.
2. The petitioner sought Voluntary Retirement from service while working with the respondent State as a Lecturer in Government College, Pali. He developed acute pain in both his knees and thereafter, took treatment at Mahatma Gandhi Hospital, Jodhpur. Since the petitioner did not get any relief from treatment at Jodhpur, he was advised to take treatment from an expert at Shalby Hospital, Ahmedabad. While the petitioner had gone to Ahmedabad for regular check up, he was advised for immediate replacement of knees and the petitioner underwent surgery on 12.07.2012. On his return, the petitioner submitted a claim of Rs. 2,84,782/- on account of his treatment/knee replacement at Shalby Hospital, Ahmedabad. However, the claim of the petitioner came to be rejected by an order dated 29.03.2014. Aggrieved against the said impugned order, the present writ petition has been filed.
3. It is contended by Mr. Sushil Solanki, learned counsel for the petitioner that the petitioner is entitled to reimbursement of medical expenses incurred by him on account of replacement of knees since Shalby Hospital, Ahmedabad is an approved hospital. The counsel for the petitioner also relies upon the circular dated 06.02.2009 regarding reimbursement of cost of medical attendants and treatment in private hospitals.
4. Per contra, Mr.N.S. Rajpurohit, learned Additional Government Counsel contends that the petitioner underwent treatment at Shalby Hospital, Ahmedabad which is a referral hospital as specified under the Rajasthan State Pensioners Medical Concession Scheme, 2009 and as per the scheme, medical reimbursement can be made only in case when the treatment undergone out of the State is not available in the Government Hospitals in the State of Rajasthan. Since, the petitioner had not taken prior permission or referral, as specified under the rules, he would not be entitled to claim entire medical reimbursement. It is contended that as per the circular dated 6.02.2009 relied upon by the petitioner, entire 100% medical reimbursement would be payable only in case of an emergent situation but the petitioner underwent knee replacement surgery which cannot be said to have been done in an emergent situation.
5. Heard learned counsel for the parties and also perused record of the case.
6. Admittedly, the petitioner, a retired Government Servant, underwent knee replacement surgery on 12.07.2012. He incurred medical expenses to the tune of Rs. 2,84,782/- which the petitioner certainly would have been entitled to its reimbursement as per the rules, in case, he got himself admitted into one of the approved hospitals. The argument raised by the counsel for the respondents that reimbursement cannot be made on account of the fact that he has taken treatment outside the State of Rajasthan and without prior approval/ referral of the medical board is noted to be rejected as not sustainable. Division Bench of this Court in the matter of Anil Kumar Surolia v. State of Rajasthan reported in 2005 (3) WLC Raj. 396 held as under:-
"Government cannot insist upon an employee to get himself treated at recognised Government institution. All that the Government in these circumstances can do is to reimburse the concerned employee at the rates that may be applicable in the recognised Government institution. Reference in this connection may be made to the judgment of the Hon'ble Supreme Court in Surjit Singh v. State of Punjab reported in AIR 1996 SC-1388 and State of Punjab & Ors. v. Mohan Lal Jindal reported in (2001) 9 SCC-217. Consequently, the reimbursement of the medical expenses borne by the State Government employees and pensioners has to be done even if the treatment is undertaken at unrecognised hospital outside the State even though reference may
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