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2023 Supreme(Raj) 1738

IN THE HIGH COURT OF RAJASTHAN AT JAIPUR BENCH
ASHOK KUMAR GAUR, J.
Ganpat Singh Panwar – Appellant
Versus
Rajasthan State Road Transport Corporation and Ors. - Respondents
S.B. Civil Writ Petition No.7960 of 2020
Decided on : 27-07-2023

Advocates:
Advocate Appeared:
For the Appellant :Mr.Ankul Gupta, Advocate with Mr.Rahul Ghiya, Advocate.
For the Respondents: Ms.Devyani Singh Rathore, Dy. Govt. Counsel.

Headnote:(A) Rajasthan State Road Transport Corporation Medical Attendance Regulations, 2011 - Regulation 9(3) - Medical reimbursement claim - Writ petition filed for reimbursement of medical expenses incurred during wife's treatment for brain hemorrhage, denied by respondents due to lack of prior approval for treatment outside the state - Court finds that regulations allow reimbursement in emergent situations and respondents failed to follow these guidelines - Reimbursement ordered under the terms of the regulations with interest. (Paras 6, 7, 9, 10, 12, 13, 16)

(B) Medical Reimbursement - Employee entitlement - Court notes that prioritizing life-threatening conditions allows employees to seek treatment outside the state without prior permission, rejecting the claims of the respondent's counsel regarding prior approval. (Paras 11, 12)

Facts of the case:
The petitioner, a Conductor, contested the denial of reimbursement for medical expenses totaling Rs.8,95,516/- incurred during his wife's brain hemorrhage treatment, conducted in a private hospital outside the state after an emergency referral.

Findings of Court:
The respondents failed to adhere to their regulations regarding medical reimbursement, leading to an unjust denial of the petitioner's claim.

Issues: The central issue revolved around the entitlement of the petitioner to medical reimbursement without prior permission for treatment undertaken during an emergency.

Ratio Decidendi: The court highlighted that under emergent circumstances, employees are permitted to seek treatment outside the state and must be reimbursed as per the governing regulations.

Result: Petition allowed, directing reimbursement of medical expenses with interest.

Table of Content
1. petitioner's medical expenses and request for reimbursement. (Para 1 , 2)
2. arguments related to entitlement and regulations. (Para 3 , 4 , 5)
3. court's analysis of regulation 9(3) compliance. (Para 6 , 7 , 8 , 9 , 10 , 11 , 12)
4. court's directive on reimbursement and medical board referral. (Para 13 , 14)
5. conclusion and order permitting reimbursement and interest. (Para 15 , 16 , 17)

ORDER :

Mr. Ashok Kumar Gaur, J. - The instant writ petition has been filed by the petitioner seeking a direction against the respondents-Corporation to make medical reimbursement of the expenses incurred by the petitioner in treatment of his wife.

2. The brief facts, as pleaded in the writ petition, are:-

2.1 The petitioner was working as Conductor and during service tenure his wife-Snehlata Panwar suffered from brain hemorrhage and immediately she was taken to hospital at Bhilwara.

2.2 The petitioner has pleaded that looking to the serious condition and non-availability of proper treatment at Bhilwara, she was referred to Zydus Hospitals and Healthcare Research Pvt. Ltd., Ahmedabad and she underwent regular treatment from 04.06.2019 and thereafter, she was finally discharged on 18.06.2019.

2.3 The petitioner incurred expenses of Rs.8,95,516/- in the treatment of his wife and to the same effect, he has annexed medical bills, prescriptions, medical report, medicines bills etc. in the writ petition collectively as Annexure-1.

2.4 The petitioner has pleaded that after discharge of his wife from the Hospital, he requested the respondents for reimbursement of the amount incurred by the petitioner as per RSRTC Medical Attendance Regulations, 2011 (hereinafter 'the Regulations of 2011').

2.5 The petitioner has pleaded that only internal departmental communication was sent by the respondents, however, no final decision was taken and as such, the petitioner after serving notice of demand of justice, has approached this Court.

3. Learned counsel for the petitioner has made following submissions:-

3.1. The Regulations of 2011 provides in Regulation 9(3) that if employee of the Corporation undertakes indoor treatment of life threatening disease like kidney, heart and some sudden accident, in a private hospital outside the State without reference in case of emergent circumstances, the corporation is required to reimburse the medical expenses upto the cost of treatment, that has been incurred in the treatment taken in SMS Hospital, Jaipur.

3.2 The issue with regard to entitlement of the petitioner was wrongly rejected by the respondents by an order dated 24.06.2020 only account of not seeking permission from the Authorities before taking the treatment in a Hospital outside the State.

3.3 The respondents failed to consider that the ailment-brain hemorrhage of wife of the petitioner could not be treated at Bhilwara and since Doctors referred the patient to the nearby available hospital i.e. Ahmedabad, in such a situation, no prior permission could have been obtained by the petitioner before shifting the patient.

3.4 The entitlement of an employee for medical reimbursement as per treatment available in SMS Medical College, Jaipur or treatment at AIIMS, New Delhi has already been decided by the Coordinate Bench and as such, he refers to an order dated 16.09.2022 passed by Principal Seat at Jodhpur in the case of Ibrahim Khan v. RSRTC & Ors; S.B. Civil Writ Petition No.1388/2015.

Learned counsel on the strength of said order submitted that medical claim of the petitioner is required to be allowed in terms of Regulations of 2011.

4. Per contra, counsel for the respondents Ms.Devyani Singh Rathore submitted that the petitioner has not placed on record any proof showing that the emergent treatment of wife of the petitioner was required and further petitioner did not seek any prior permission of the Authorities before availing the facility of treatment in a different hospital situated outside the State.

5. Learned counsel for the respondents further submitted th

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