Government employees are entitled to medical facilities, and reimbursement cannot be denied solely based on treatment in non-recognized hospitals.

JUDGMENT

Rekha Borana, J. - The present writ petition has been filed with a prayer for reimbursement of the medical claim of the petitioner which was incurred qua his treatment for brain hemorrhage. The submission of the petitioner is that he had suffered brain hemorrhage and in an emergent condition, he was admitted to Goyal Hospital, Jodhpur and underwent treatment there. After two days of hospitalization i.e. from 04.09.2009 to 06.09.2009 at Goyal Hospital, Jodhpur he was referred to Sir Ganga Ram Hospital, New Delhi and remained hospitalized there from 07.02.2009 to 04.03.2009. At Sir Ganga Ram Hospital, New Delhi he underwent a surgery and qua the complete treatment, he incurred an expenditure of Rs. 5,07,919/- (Rs. 85,204/- incurred at Goyal Hospital, Jodhpur and Rs. 4,22,715/- incurred at Sir Ganga Ram Hospital, New Delhi). When the medical claim was raised with the respondent-Department, only Rs. 25,000/- was sanctioned qua the same.

2. It has been argued by learned counsel for the petitioner that he being admitted in a private hospital due to the emergent condition of brain hemorrhage and then referred to a higher center by the local Doctor, was entitled for reimbursement of the complete medical bills as raised by him.

3. Per contra, it has been submitted by learned counsel for the State as well as the Municipal Corporation, Jodhpur that in terms of Rule 10 of the Rules of Rajasthan Civil Services (Medical Attendance) Rules, 2008 (hereinafter referred to as the Rules of 2008) firstly, no emergent situation as prescribed under the Rules of 2008 has been explained in the present matter and secondly, the treatment has been undertaken by the petitioner in private hospitals both of which are neither recognized nor referral hospitals of the State or the Department. Learned counsel further argued that the claim in question had been raised in the year 2009 and reimbursement of an amount of Rs. 25,000/- was also made in the year 2010 but the present writ petition has been filed in the year 2019 and no reason for such delay has been explained by the petitioner. Learned counsel therefore submitted that the present writ petition is liable to be rejected on the sole ground of limitation.

4. Heard learned counsel for the parties and perused the material available on record.

5. Dealing with the first aspect of limitation, it is clear on record that the medical bills were submitted by the petitioner in the year 2009 qua the treatment taken in the year 2009. The limitation as prescribed in the Rules of 2008 provides that a medical claim, if any, has to be raised within a period of two years of the date of treatment. Rule 13(1) of the Rules of 2008 provides as under:

"(1) Every Government servant claiming refund of medical expenses incurred on account of medical attendance and treatment for himself and/or members of his family, shall make an application in duplicate in form given in Appendix-VI. Such claims shall be presented within two years from the date of completion of treatment."

6. Admittedly, the petitioner underwent the medical treatment in the year 2009 and the claim qua the same was also raised in the year 2009 itself i.e., within the prescribed period of limitation. So far as the reimbursement of the admitted claim and denial of the un-admitted claim is concerned, a perusal of the communication dated 25.01.2011 (Annex. 8) makes it clear that the Chief Executive Officer of the Municipal Corporation, Jodhpur itself recommended for sanction of the remaining amount qua the drugs and medicines to the petitioner. Moreover, there was no denial of the remaining claim by the Department on any count. In the reply, it has been submitted that the claim reimbursable in terms of the Rules of 2008 could only be the expenses incurred for the treatment undertaken in a Government Hospital. It has been submitted that to ascertain the expenses in a Government Hospital, a Medical Board was constituted by the State and a report of the SMS Hospital, Jaip