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HIGH COURT OF RAJASTHAN (JODHPUR BENCH)
MR. JUSTICE ARUN MONGA, J
DR. MADHA RAM BISHNOI - Appellant
Versus
STATE AND ORS - Respondent
CW / 3755 / 2017
Decided On : 17-03-2025
(A) Rajasthan Civil Services (Medical Reimbursement) Rules, 2013 - Petitioner seeking reimbursement of medical bills for emergency treatment of his wife - Respondents sanctioned only a fraction of the claimed amount citing rules - Court held that the right to health is fundamental under Article 21 of the Constitution - Petitioner entitled to full reimbursement as per applicable rules. (Paras 1-7)
(B) Right to Health - The right to health and self-preservation in an emergency is akin to the right to life, thus entitling state employees to seek immediate medical treatment without prior sanction. (Paras 6-10)
Facts of the case:
The petitioner, a retired Senior Medical Officer, incurred significant medical expenses for his wife's emergency surgeries, totaling Rs. 4,02,575/-, but was reimbursed only Rs. 62,674/-. (Paras 1-2)
Findings of Court:
The court directed full reimbursement of medical expenses incurred by the petitioner under the applicable rules, emphasizing the fundamental right to health. (Paras 7)
Issues: Whether the petitioner is entitled to full reimbursement of medical expenses incurred for private treatment under state rules. (Paras 3-4)
Ratio Decidendi: The court affirmed that the right to health in emergencies is a fundamental right and that state employees are entitled to seek immediate medical treatment without prior approval. (Paras 6-10)
Result: Writ petition allowed.
Order :
1. Petitioner herein is before this Court seeking a direction to the respondents to reimburse his remaining medical bills amount pursuant to bills (Annex.2 and 3) along with interest as per applicable service Rules.
2. Relevant facts as pleaded in the case are that the petitioner retired from service while serving as a Senior Medical Officer on 31.07.2010. On 31.11.2015, the petitioner’s wife suffered from vertigo and severe headache and was taken for emergency surgery at Medipulse Hospital, Jodhpur. She underwent surgery on 01.12.2015 but could not fully recover and was discharged on 07.12.2015, with a recommendation for re-surgery. For this surgery, the petitioner incurred expenses amounting to Rs. 1,33,562/-. On 31.01.2016, the petitioner and his wife went to Mumbai, where she suddenly experienced the same condition and was admitted to a hospital in Mumbai as an emergency case. She was operated on 01.02.2016, and the petitioner incurred an amount of Rs. 2,69,013/- for the surgery. After recovery, she was discharged on 06.02.2016.
2.1. Upon their return, the petitioner submitted medical bills to the Treasury Officer, Rural Treasury, Jodhpur, for reimbursement under the Rules of 2013, along with the requisite documents. The respondents pointed out deficiencies in the bills through a communication dated 16.08.2016 and in view thereof, sanctioned only Rs.62,674/- in total, against the total amount of Rs.4,02,575/- incurred by the petitioner. On 17.01.2017, the petitioner submitted a representation, but to no avail. Hence the petitioner herein seeking the remaining amount of Rs.3,39,901/-.
3. In response to the writ petition inter alia following relevant stand has been taken in the reply:-
“1. With due respect it is respectfully submitted that Petitioner's wife had undergone surgery outside the state in alleged emergent situation, while he went to Mumbai for tour and taken treatment in Bombay Hospital, Mumbai as well as in Medipulse Hospital Jodhpur. Petitioner filed medical bills of Rs. 4,02,575/- for reimbursement. As per Para 4 of scheme of Rajasthan State Pensioners Medical Concession Scheme, 2014 (Here in after referred as 'Scheme of 2014') and as per Rajasthan Civil Services (Medical Reimbursement) Rules 2013 (Here in after referred as 'Rules of 2013') as per appendix xiii and Rule 11 of Rules of 2013 Rs. 35313/ was reimbursed for treatment in Medipulse hospital, Jodhpur. Similarly according to Rule 10 (2) and 11 of The Rules of 2013 and appendix xiii, the 27361/- in total 62,674/- was paid to the petitioner and same was received by the petitioner without any objection. In this manner maximum permissible medical reimbursement is Rs. 62,674/- which has been paid to petitioner and petitioner has received this amount. Therefore, now no claim survives which is payable to the petitioner. Hence, there is no cause of action to maintain the present writ petition in accordance with Scheme of 2014, Rules of 2013 and in light of law affirmed by Hon'ble Apex Court in Civil Appeal No. 2278/2011 (@ SLP) (C) No. 2888/2008 State of Rajasthan vs. Mahesh Kumar Sharma (2011) 4 SCC 257 dated 02.03.2011, laid down in State of Punjab vs. Ram Lubhya Bagga reported in (1998) 4 SCC 117 and State of Karnataka vs. R. Vivekanada Swami (2008) 5 SCC 328 in which it was held that the reimbursement is liable to be made up to the extent of provisions and further in light of decision of Hon'ble Division Bench in case of Anil Kumar Suroliya as well as D.B. Civil Special Appeal (Writ) No. 858/2007 in Rajasthan State & Anr. vs. Mitthu Lal Gupta. The reimbursement to the claim of petitioner was made in accordance with aforementioned legal position. The Relevant Copy of Appendix-xiii is submitted herewith and marked as Annexure R/1.
xxx xxx xxx”
4. It transpires that the respondents have already sanctioned an amount of Rs.62,674/-, however, the full reimbursement was not allowed on the ground that this is the only amount for which the petitioner is entitled un
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.
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 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.
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.
In emergency medical situations, procedural strictness must not impede the reimbursement of medical expenses to pensioners, ensuring timely healthcare access under welfare schemes.
In cases of grave emergency, the responsibility of the state cannot be washed out, and technicalities of rules and regulations under the scheme are not required to be followed in a mechanical manner ....
Government employees are entitled to medical facilities, and reimbursement cannot be denied solely based on treatment in non-recognized hospitals.
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