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.

Order :

FARJAND ALI, J.

1. The instant writ petition under Article 226 of the Constitution of India has been preferred by the petitioner being aggrieved of the action of the respondent in denying reimbursement of the medical bills under the RGHS.

2. The petitioner had served in the Police Department, Government of Rajasthan and retired from the post of Additional Superintendent of Police and as such he is eligible for Rajasthan Government Health Scheme (RGHS) and is entitled to avail all the benefits provided under the said scheme. The said scheme also provided healthcare benefits to the family members of the pentioners under Section 3(3) of the Scheme’s Guidelines (Memorandum). The petitioner's wife Mrs. Anand Kanwer was diagnosed with Right eye full thickness macular hole and she underwent treatment of right eye Vitrectomy (PPV) + ILMPEELING + C3F8 gas tamponade under LA, at Netralaya-Super Speciality Eye Hospital at Ahmedabad and later on the bill of this procedure was submitted on portal for RGHS reimbursement but it has been "REJECTED" with the remark that rejected because this is case is "This a Non-Emergency Condition”.

3. Learned counsel for the petitioner submits that the reimbursement claim of the petitioner under the RGHS was rejected assigning the only reason that the treatment was availed at a non-recognized hospital without there being emergent situation. However, the fact remains that the petitioner’s wife suffered acute pain and vision loss in the right eye, upon which she was taken to Dr. Kaushalendra Kumar (M.S. Phaco Surgeon) at the Rajasthan Eye Hospital and Dr. Kumar, Laser Phaco Center, Sumerpur, Pali, where she was diagnosed with right eye full thickness molecular hole in retina, which could led to distorted vision in the affected eye and required surgical intervention to repair and there was as such no facility and specility doctors in Jodhpur or Pali to perform this surgery, therefore, the doctor referred the patient to Netralaya Super Speciality Eye Hospital at Ahmedabad, where the petitioner underwent the required surgery. Learned counsel for the petitioner submits that the RGHS does not define non-emergent and emergent conditions, therefore, the department should rely on fair and consistent interpretation of the terms, potentially guided by the medical experts. He further submis that there are no restriction or embarge udner the rules of RGHS which could prevent reimbursement to the petitioner despite submitting all the relevant documents through RGHS portal.

4. It was urged that treatment undertaken in an emergency cannot be denied reimbursement merely because it occurred in a private or non-recognized hospital, as the right to medical relief is integral to Article 21 of the Constitution. The respondents’ inaction, it was argued, reflects administrative apathy, violates Articles 14, 16, and 21, and frustrates the object of the welfare scheme. The petitioner, having suffered prolonged financial and mental distress, thus seeks full reimbursement with interest.

5. Learned counsel for the respondents submitted that the petitioner’s grounds are mere reiterations of earlier contentions already dealt with in the reply to the legal notice served by her. The impugned action is lawful, justified, and in conformity with the applicable rules. Under the RGHS, reimbursement of actual expenses incurred in a non-recognized private hospital is impermissible, except to the extent admissible at recognized rates. Reliance is placed on th