HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR
Kuldeep Mathur, J.
Chhagan Lal Mathur – Appellant
Versus
State Of Rajasthan & Ors. – Respondents
S.B. Civil Writ Petition No. 3321/2014
Decided On : 15-09-2022
Reimbursement - Medical Attendance Rules - The court considered the petitioner's claim for reimbursement of medical bills under the Rajasthan Civil Services (Medical Attendance) Rules, 2008. The court held that the claim should be considered in light of the provisions of the Rules of 2008 and directed the respondents to reimburse the amount for medicines, drugs, anesthesia, room charges, and other heads as payable under the Rules of 2008.
Fact of the Case:
The petitioner sought reimbursement for medical expenses incurred at an approved hospital. The respondents partially accepted the claim, leading the petitioner to file a writ petition.
Finding of the Court:
The court partly allowed the writ petition, directing the respondents to reconsider the claim in light of the provisions of Rule 8 of the 'Rules of 2008' and to reimburse the specified medical expenses within eight weeks.
Issues: The main issue was the partial acceptance of the petitioner's claim for reimbursement of medical bills under the Rajasthan Civil Services (Medical Attendance) Rules, 2008.
Ratio Decidendi: The court considered the provisions of Rule 8 of the 'Rules of 2008' and the judgment of the Hon'ble Supreme Court in the case of State of Rajasthan v. Mahesh Kumar Sharma, and directed the respondents to reimburse the specified medical expenses.
Final Decision: The court partly allowed the writ petition and directed the respondents to reconsider the claim in light of the provisions of Rule 8 of the 'Rules of 2008' and to reimburse the specified medical expenses within eight weeks.
JUDGMENT
Kuldeep Mathur, J. - Briefly stated facts of the case are that the petitioner suffered from a cardiac problem and was taking treatment at Mathura Das Mathur Hospital, Jodhpur admitted on 05.05.2013. Thereafter, he was referred to 'higher centre urgent CABG for needful' and was discharged on 07.05.2013. After being discharged, the petitioner went to Jaipur Heart Institute, wherein he was operated on 08.05.2013 and he remained admitted from 07.05.2013 to 16.05.2013. A sum of Rs. 1,48,179/- was incurred as expenses for the treatment underwent by the petitioner. The petitioner submitted reimbursement claim for medical bills through an application dated 14.11.2013. The respondents pursuant to the petitioner's application for reimbursement, sent a cheque of Rs. 44,000/-. 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 was referred to 'higher centre urgent CABG for needful' by Mathura Das Mathur Hospital, Jodhpur. Since, the petitioner undertook treatment at an approved hospital as per Appendix-1 of the Rajasthan Civil Services (Medical Attendance) Rules, 2008 (hereinafter referred to as the 'Rules of 2008'), the claim for reimbursement of medical bills ought to have been accepted in toto. Reliance was placed on the judgments rendered by this Court in the cases of Smt. Usha Mehta v. State of Rajasthan & Ors. (S.B. C.W. No. 6401/2006) and State of Rajasthan & Ors. v. Smt. Usha Mehta (D.B. S.A.W. No. 1309/2014)
3. Per contra, learned counsel for the respondents submitted that the claim of the petitioner was partially accepted in consonance with the Rules of 2008. It was further submitted that though the Jaipur Heart Institute is an approved hospital, the reimbursement is to be made on recommendation of Health Benefit Advisory Committee as mandated by circular of the finance department dated 16.12.2009 and Rule 4 of the Rules of 2008. Reliance was placed on the judgment rendered by the Hon'ble Supreme Court in the case of State of Rajasthan v. Mahesh Kumar Sharma reported in 2011 (4) SCC 257.
4. Heard learned counsels for the parties and perused the material available on record.
5. Rule 8 of the Rules of 2008 states that a Government servant shall be entitled to medical attendance and treatment in approved hospital within State and the expenditure incurred for treatment in an approved hospital shall be reimbursed to the extent mentioned in sub rule 8 of Rule 8 of the 'Rules of 2008'.
6. In the present case, the claim of the petitioner has been admitted partly but so far as claims pertaining to medicines, drugs, anesthesia and room charges etc. are concerned, no amount qua the same has been reimbursed.
7. The judgments relied upon by the counsel for the petitioner have taken into consideration the provisions of Rajasthan Civil services (Medical Attendance) Rules 1970. The aforesaid rules have been revised by introduction of the Rajasthan Civil services (Medical Attendance) Rules 2008, therefore, the case of the petitioner is required to be considered in light of the provisions of Rajasthan Civil services (Medical Attendance) Rules 2008.
8. The Hon'ble Supreme Court in the case of Mahesh Kumar Sharma (supra) held as under:-
"8. In this connection it will be profitable to refer to the judgment of a Bench of three Judges of this Court in State of Punjab and Ors. v. Ram Lubhaya Bagga and Ors. Reported in (1998) 4 SCC 117 where the Bench has laid down that the Government would be justified in limiting the medical facilities to the extent it is permitted by its financial resources. In the instant case, the Government has formulated necessary rules certain situations and upto a certain limit. The Government has been reimbursing the necessary expenditure as permitted by the rules uniformly. It will, therefore, not be proper for a Government employee or for his relatives to claim reimbursement of medical expenses otherwise tha
State of Punjab and Ors. v. Ram Lubhaya Bagga and Ors. Reported in (1998) 4 SCC 117
State of Rajasthan v. Mahesh Kumar Sharma reported in 2011 (4) SCC 257
The main legal point established in the judgment is that claims for reimbursement of medical expenses should be considered in accordance with the provisions of the Rajasthan Civil Services (Medical A....
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....
Government employees are entitled to medical facilities, and reimbursement cannot be denied solely based on treatment in non-recognized hospitals.
Government employees are entitled to medical reimbursement for emergency treatments, regardless of the treatment location, as long as proper documentation is provided.
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.
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 reimbursement for treatment in non-recognized hospitals at applicable rates for similar treatments in recognized hospitals.
The main legal point established in the judgment is that government employees are entitled to full reimbursement of medical expenses incurred for the treatment of themselves or their dependents, and ....
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