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HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR
Kuldeep Mathur, J.
Krishan Lata – Appellant
Versus
State Of Rajasthan & Ors. – Respondents
S.B. Civil Writ Petition No. 4196/2016
Decided On : 19-09-2022
Medical Reimbursement - Private Hospital Treatment - The court held that even in cases where an employee undergoes treatment in a non-recognized hospital/private hospital, the medical reimbursement has to be made to the extent permissible under relevant Rules/Scheme/Policy.
Fact of the Case:
The petitioner underwent brain surgery under emergent circumstances in a private hospital and claimed reimbursement of medical bills. The respondent-authorities accepted partial claim, leading to the petitioner filing a writ petition.
Finding of the Court:
The court partly allowed the writ petition, directing the respondents to reconsider the claim and reimburse the amount for medicines, drugs, anesthesia, room charges, and other heads as payable in terms of the Rules of 2013, if not already paid.
Issues: Reimbursement of medical bills for treatment in a private hospital without prior permission and referral from the respondent-authorities.
Ratio Decidendi: The court relied on previous judgments to establish that even in cases where an employee undergoes treatment in a non-recognized hospital/private hospital, the medical reimbursement has to be made to the extent permissible under relevant Rules/Scheme/Policy.
Final Decision: The respondents were directed to reconsider the claim of the petitioner and reimburse the amount for medicines, drugs, anesthesia, room charges, and all other heads as payable in terms of the Rules of 2013, if not already paid, within a period of eight weeks from the date of receipt of the order.
JUDGMENT
Kuldeep Mathur, J. - Briefly stated facts of the case are that the petitioner went to Gurgaon for personal trip and there he suffered severe headache. The petitioner on becoming unconscious was taken to Medanta (Medicity) Hospital, Gurgaon. The treating Doctor after MRI Scan advised the petitioner to undergo surgery under emergent circumstances. For the surgery underwent, amount ofRs.2,47,426/- was incurred. The petitioner was operated on 07.02.2015 and remained admitted from 06.02.2015 to 11.02.2015. Thereafter, he submitted an application dated 22.06.2015 claiming reimbursement of medical bills. The respondent-authorities in pursuance of the application submitted by the petitioner accepted partial claim to the extent ofRs.30,793/-. Aggrieved by partial acceptance of the claim, the petitioner has preferred the present writ petition.
2. Learned counsel for the petitioner submitted that the petitioner had undertaken brain surgery under emergent circumstances and his claim for medical reimbursement ought to have been accepted in toto by the respondent-authorities.
3. Per Contra, learned counsel for the respondents submitted that the petitioner had taken treatment outside the State without being referred from any medical authority. It was further submitted that the no prior permission was taken from the respondent-authorities. Counsel urged that the claim had been accepted in consonance of Rajasthan Civil Services (Medical Attendance) Rules, 2013 and should not be interfered with.
4. Heard learned counsel for the parties and perused the material available on record.
5. So far as the question regarding reimbursement of the treatment undertaken in a private and unrecognized hospital is concerned, the law is no longer res integra.
6. In Shiva Kant Jha v. Union of India (UOI); AIR 2018 SC 1975 decided on 13.04.2018, the Hon'ble Apex Court held as under:-
"It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment....."
7. In Surjit Singh v. State of Punjab and Ors. reported in AIR 1996 SC 1388 decided on 31.01.1996, the Hon'ble Apex Court held as under:-
"10. ...........In such an urgency one cannot sit at home and think in a cool and calm atmosphere for getting medical treatment at a particular hospital or wait for admission in some Government medical institute. In such a situation, decision has to be taken forthwith by the person or his attendants if precious life has to be saved."
8. In Rama Prasad Sharma v. State of Rajasthan and Ors.; SBCWP No. 7469/2016 decided on 21.01.2022, coordinate Bench of this Court held as under:-
".........It is now a settled position of law that even in cases where the treatment of an employee has been taken in non-recognized hospital the medical reimbursement has to be made at the rate that may be applicable for similar treatment in the recognized government hospitals."
9. The ratio laid down in the above judgments makes it clear that even in the cases where an employee un
Medical reimbursement for treatment in a non-recognized hospital/private hospital must be made to the extent permissible under relevant Rules/Scheme/Policy.
Government employees are entitled to medical facilities, and reimbursement cannot be denied solely based on treatment in non-recognized hospitals.
The main legal point established is that the department is obligated to reimburse the amount for medical treatment undertaken in a private or unrecognized hospital, to the extent permissible under th....
Even in cases where treatment is taken in a non-recognized hospital, medical reimbursement has to be made at the rate applicable for similar treatment in recognized government hospitals.
Government employees are entitled to medical reimbursement for necessary treatments, regardless of hospital empanelment, emphasizing urgency and proper documentation.
The right to medical aid is fundamental under Article 21, and reimbursement for treatment at private hospitals during emergencies cannot be denied, upholding the principles of fairness and timely adm....
Government employees are entitled to medical reimbursement for emergency treatments, regardless of the treatment location, as long as proper documentation is provided.
Government employees are entitled to medical reimbursement for treatment in non-recognized hospitals at applicable rates for similar treatments in recognized hospitals.
The obligation of the department to reimburse medical treatment in a private or unrecognized hospital as per the applicable Rules, despite technicalities of the Medi-claim policy.
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