Medical reimbursement cannot be denied solely for treatment in non-empanelled hospital if genuine and emergent, per Art.21.

O R D E R

M.S.LATIF, M (J) oral

01/ Through the medium of this petition, following reliefs are 5 d sought by the petitioner :

“ The court may be pleased to issue a writ of certiorari for quashment of the impugned order No. DCB/SM/ESTT-62 of 2023 dated 06-10-2023 with further direction by way of issuance of a writ of mandamus commanding the respondents to pay the amount claimed by the petitioner as reimbursement under J&K Civil Services (Medical Attendance-cum-Allowance) Rules, 1990 and produce the record before the court.”

02/ What stems out of the pleadings made in this petition is that the petitioner's son, aged about ten years, was diagnosed as suffering from Posterior Fosa Intra Cranial Sol (Ependymoma – WHO Grade – II) and, as stated, after a preliminary check up by a team of doctors of Neuro Surgery Department at the Sher-i- Kashmir Institute of Medical Sciences (SKIMS), Srinagar, it was opined that for more extra treatment, medical and surgical intervention is required. As such, son of the petitioner got examined at Paras Hospital Gurgaon (annexure II), which hospital, as stated by the petitioner, is equipped with the latest technology available in Neuro Surgery and, accordingly, the surgery was done for the cure of the above medical problem of the son of the petitioner.

03/ Learned counsel for the petitioner submitted the petitioner submitted the medical bills before the competent authority for reimbursement of the same, which was approximately to the extent of Rs. 30/- lacs. However, as submitted, the respondent - Deputy Commissioner (DC) Badgam, vide order dated 06-10- 2023, has rejected the medical claim of the petitioner and it is this 5 d rejection, which is impugned herein assailed on multiple grounds as have been urged in the petition.

04/ It needs a mention here that the matter came up for consideration before the Hon'ble High Court of J&K, Srinagar, earlier, and on 29-11-2023, the court directed the respondents to file their objections within four weeks but needful was not done. Thereafter the matter came to be transferred to this bench of CAT on 17-03-2025 and for three consecutive hearings, none appeared for the petitioner, as a result, petition was dismissed in default. However, same was restored to its original number vide order dated 04-08-2025. Again time was granted to the other side to file the response but of no avail. Even the last and final opportunity of doing the needful was not availed of.

05/ Matter has come up for consideration today and since the reply has not been filed in the matter despite grant of umpteen opportunities, as such, it is taken up for final disposal in accordance with law. Learned counsel for the petitioner submits that it was in view of an emergency that son of the petitioner was shifted to Paras Hospital, Gurgaon. He further submits that the order impugned has been passed in violation of the import of the judgement of the apex court delivered in case titled Shiv Kant Jha 2018 vol.3 SLR 328, wherein Their Lordships have held that 5 d the court has to be liberal in medical reimbursement cases holding further that reimbursement cannot be denied solely on the ground that the patient has undergone treatment in a specialized hospital not approved by the State. Learned counsel further submits that the action of the respondents in withholding the reimbursement of the money to the petitioner is wholly arbitrary, illegal and violative of article 21 of the Constitution of India. To augment the submission, reliance is placed on the law laid down in the judgement passed by the Hon'ble High Court of J&K, Srinagar, in case titled as Bimlaji Bhat and others versus U.T of J&K and others (WPC 1726/2015) decided on 28-09-2022.

06/ It goes without saying that right to medical reimbursement flows primarily from the fundamental right to life guaranteed under article 21 of the Constitution of India. It is also a settled position of law that right to health is integral to right to life and the State has a