JUDGMENT :

SANDEEP MOUDGIL, J.

Prayer

1. The jurisdiction of this Court under Articles 226/227 of the Constitution of India has been invoked for issuance of a writ in the nature of Certiorari to quash the impugned orders dated 20.01.2020 and 17.11.2017 (Annexures P-5 & P-6 respectively) passed by respondent No.4 whereby his claim for medical reimbursement of an amount of Rs.1,58,725/- incurred on dialysis treatment of his son was rejected with a further prayer for issuance of a writ in the nature of Mandamus directing the respondents to release an amount of Rs.1,58,725/- on account of medical bills along-with interest @12% per annum.

Brief Facts

2. As borne out from the record, the son of the petitioner was suffering from End Stage Renal Disease, requiring regular dialysis, which is a life-saving treatment. The treatment was taken from a private dialysis centre due to non- availability of facilities at PGIMER, Chandigarh, and the emergent nature of the disease. The petitioner submitted medical bills to the department, but the same were rejected primarily on the ground that the hospital was not on the approved panel and the treatment was not certified as “emergency” by the Civil Surgeon.

3 Aggrieved by the rejection, the present petition has been filed.

Contentions On behalf of the petitioner

4. Learned counsel for the petitioner vehemently contends that the impugned action of the respondents is wholly arbitrary, unjust and violative of the fundamental rights of the petitioner. It is submitted that the son of the petitioner was suffering from End Stage Renal Disease, a life-threatening condition, necessitating continuous and regular dialysis, which is not merely a routine treatment but a life-saving medical necessity. The urgency and gravity of the ailment left the petitioner with no real choice but to arrange immediate treatment from the nearest available medical facility.

5. Learned counsel argues that the rejection of the claim solely on the hyper-technical ground that the hospital was not empanelled and that the treatment was not certified as “emergency” by the Civil Surgeon is wholly untenable in law. The authorities have adopted a mechanical approach, ignoring the overwhelming medical evidence on record demonstrating the life-saving nature of the treatment.

6. Reliance has been placed upon the judgment dated 03.12.2018 passed in CWP No. 13494 of 2016 titled as “Manoj Jain vs. State of Haryana and others” wherein this Court has categorically held that medical reimbursement cannot be denied merely because treatment was taken from a non-empanelled hospital or as an outdoor patient, and that such expenses are liable to be reimbursed at prescribed rates. It is, thus, contended that the impugned orders dated 20.01.2020 and 17.11.2017 (Annexures P-5 & P-6 respectively) are legally unsustainable, being contrary to settled principles of law as well as violative of Article 21 of the Constitution of India, which guarantees the right to life and access to medical treatment.

On behalf of the Respondents

7. Per contra, learned State counsel has argued that the present writ petition is devoid of merit and deserves outright dismissal. It is contended that the claim of the petitioner has been rightly rejected strictly in accordance with the Government policy dated 06.05.2005 governing medical reimbursement.

8. Learned counsel submits that the treatment in question was admittedly taken from a private hospital which was not on the approved panel of the Government, and therefore, the petitioner is not entitled to reimbursement as a matter of right. It is further argued that as per the policy, reimbursement in respect of treatment taken from an unapproved hospital can be granted only in cases of duly certified emergency.

9. In the present case, the Civil Surgeon, Panchkula, upon examination of the medical record, has categorically opined that the treatment was not of emergent nature, and thus the claim falls outside the permissible framework of the policy.