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RAJASTHAN HIGH COURT BENCH AT JAIPUR
Rekha Borana, J.
Jal Singh - Appellant
Versus
State of Rajasthan - Respondent
S.B. Civil Writ Petition No. 17666/2012
Decided On : 25-11-2021
Reimbursement - Medical Expenses - Rajasthan Civil Services (Medical Attendance) Rules, 2008 - The court interpreted the provisions of the Rules, emphasizing the entitlement of government employees to medical reimbursement, particularly in emergency situations, and ruled against the denial of such claims without valid justification.
Fact of the Case:
The petitioner, a retired government doctor, sought reimbursement for medical expenses incurred for emergency eye surgery at AIIMS, which was denied by the respondents on grounds of lack of emergency certification and treatment outside Rajasthan.
Finding of the Court:
The court found that the petitioner provided sufficient evidence of an emergency and that AIIMS is not a private hospital, thus ruling that the denial of reimbursement was unjustified.
Issues: Whether the denial of medical reimbursement to the petitioner was valid under the Rajasthan Civil Services (Medical Attendance) Rules, 2008, given the circumstances of the treatment.
Ratio Decidendi: The court held that government employees are entitled to medical reimbursement even if treated outside recognized institutions in emergencies, and the denial of such claims must be substantiated with valid reasons.
Result: The writ petition is allowed, directing reimbursement of Rs. 33,906/- to the petitioner.
JUDGMENT
The present writ petition has been filed by the petitioner for reimbursement of his medical expenses amount of Rs.33,906/- incurred for a surgery of right eye at All India Institute of Medical Science (AIIMS), New Delhi. The petitioner was a Government Doctor, who retired on 31.08.2006. In the present petition petitioner stated that he suffered in his right eye an ailment named Mecular Hole and the diagnosis was Pseudophahia c Idipathic FTMH Stage 2. An emergency arose when he was with his son at Delhi and because of the emergent situation he was rushed to All India Institution of Medical Science (AIIMS), New Delhi, wherein he was admitted and operated for the ailment. He remained hospitalized from 07.05.2011 to 11.05.2011 and for the said complete period of hospitalization and surgery an amount of Rs. 33,906/- was incurred of which he claimed the reimbursement. The said claim of the petitioner was allegedly returned by the Directorate of the Pension & Pensioners Welfare Department on the ground that:
firstly, the treatment of the petitioner had been undertaken in a private hospital outside the State of Rajasthan; secondly, there was no certificate of any emergent situation having been arisen and thirdly, that there was no certificate of reference to the AIIMS, New Delhi.
When called upon by the respondent, petitioner submitted an affidavit clarifying the emergent situation of disease and the treatment thereof.
But the reimbursement was not made by the respondents and hence the present petition has been preferred.
In the reply, it has been stated by the respondents that in terms of Rule 10 (1) and 10(3) of the Rules of Rajasthan Civil Services (Medical Attendance) Rules, 2008 (hereinafter referred as Rules of 2008), the petitioner had not produced any certificate showing emergency of treatment taken by him. It has also been averred that the petitioner has failed to produce any certificate issued by Competent Authority regarding non-availability of such treatment in any Medical College of the State of Rajasthan and further that petitioner had not submitted any document of his reference to the AIIMS Hospital for treatment.
Controverting the facts as stated by the respondents, vide rejoinder the petitioner stated that the document Annexure-2 annexed with the petition was a certificate fulfilling the essential requirements as mentioned under Rule 10 (3) of the Rules of 2008. So far as the certificate pertaining to emergency is concerned, the same was also furnished by the petitioner when called upon.
Heard counsel for both the parties and perused the material available on record.
A bare perusal of Annexure-2 issued by AIIMS, New Delhi makes it clear that the petitioner was treated for the disease in an urgent situation and his condition was deteriorating. The certificate has also been issued by the treating Doctor with specific details which read as under:-
So far as the averment of the respondents that the petitioner was treated in a private hospital is concerned, by no terms AIIMS can be termed to be a private hospital. It has been admitted by the respondents in the reply too that AIIMS was a referral hospital under the Rules and therefore too, rejection of the petitioner's claim for reimbursement cannot be treated to be valid.
It has been specifically averred by the petitioner that the treatment of disease from which he suffered, was not available in any hospital in Rajasthan to which no specific reply has been furnished by the respondents which concludes the fact that no specific denial of the same was made.
Coun
Government employees are entitled to medical reimbursement for emergency treatments, regardless of the treatment location, as long as proper documentation is provided.
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....
The right to medical reimbursement includes emergency conditions even if the treatment occurs at a non-recognized hospital, aligning with the fundamental right to life under Article 21.
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....
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 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 right to health in emergencies is a fundamental right under Article 21, entitling state employees to reimbursement for private medical treatment without prior sanction.
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