The obligation to provide decent medical facility as an integral part of Article 21 of the Constitution of India and the verification of treatment genuineness, not the hospital's approval, for medical reimbursement claims.

JUDGMENT :

(Prayer: Writ Petition under Article 226 of the Constitution of India, to issue a Writ of Certiorarified Mandamus, calling for the records pertaining to the impugned communication in F.No. 17-1/2009-Adm dated 20.01.2010 on the file of the Respondent No. 2 and quash the same as illegal and consequently direct the Respondent No.2 to provide the medical reimbursement as per the claim of the petitioner dated 06.11.2009, 11.11.2009 and 01.01.2010 for Rs.46,607-85/-, Rs.9,920-60, Rs.10,370/-, Rs.10,359/-, Rs.10,691/- & Rs.11,031/-.)

1. The order of rejection, dated 20.1.2010 rejecting the claim of the writ petitioner for grant of medical reimbursement, is under challenge in the present writ petition.

2. The writ petitioner was employed as Technical Officer in the second respondent Research Centre and retired from service. It is an admitted fact that the writ petitioner is a member of the Medial Health Scheme and therefore, he is eligible to get the medical reimbursement under the scheme. The petitioner's wife underwent certain treatment and accordingly, submitted an application seeking medical reimbursement along the original bills and other records. The application submitted by the petitioner seeking medical reimbursement was rejected in proceedings dated 20.01.2010 on the ground that the writ petitioner had taken treatment for his wife in a hospital which is not approved by the respondents. In other words, Arul Hospital at Trichy is not a recognized hospital by the respondents organisation.

3. The Constitutional Courts have repeatedly held that providing a decent medical facility is a integral part of Article 21 of the Constitution of India. This apart, the claim regarding medical reimbursement cannot be rejected merely on the ground that the treatment was taken in an unapproved hospital. The genuenity of the treatment taken by the employee/pensioner alone is to be verified by the competent authority and not the hospital in which the treatment was taken. Some time, it may not be possible to approach the hospital when a person is on emergency circumstances. An employee in distress cannot search for a approved hospital for taking certain urgent treatments. Under those circumstances, if the treatment was taken in an unapproved hospital the authorities competent are empower to verify the genuinity of the treatment undertaken and not the hospital.

4. This being the legal principles repeatedly held, the rejection of the claim of the writ petitioner is not in consonance with the legal principles settled. Even recently, this Court passed an order on 28.05.2019 in W.P(MD)No.13429 of 2013 etc., batch and the relevant paragraphs are extracted hereunder:-

“78. Assuming that the non network hospital and non listed disease are the major reasons for rejection of most of the claims, even that reasons cannot stand in the legal scrutiny, in view of the catena of decisions, as has been cited above of both this Court as well as the Apex Court. Therefore, all these reasons given in the respective impugned orders are not at all worthy or sustainable and therefore all these impugned orders, in the respective writ petitions, are liable to be quashed.

80. In order to reconsider all these claim made by the respective writ petitioners for medical reimbursement, by remitting the matters back, the following directions are issued:

(i) All the impugned orders in the respective writ petitions in this batch of cases, are hereby quashed.

(ii) The writ petitions where impugned orders are quashed as well as the writ petitions where mandamus sought for, are hereby remanded with directions to the concerned District Level Empowered Committee, before whom, these matters shall be placed and the Committee shall reconsider every individual case.

(iii) While reconsidering, the Committee shall not reject any claim merely on the reason of non network hospital or non listed disease.

(iv) The Committee, wherever possible, shall give suitable direction to the Insurance Company t