Emergency medical treatment cannot be denied reimbursement solely due to the hospital's non-inclusion in the approved list, as it violates fundamental health rights.

JUDGMENT

The above writ petition is filed aggrieved by the denial of the reimbursement of medical claim by Exts.P4, P5 and P7 on the sole ground that the hospital was not listed in the Government Order.

2. Petitioner while working at Thrissur Municipal Corporation as a contingent worker, suffered a heart attack. He was immediately taken to the Government District Hospital and taking into consideration the seriousness of the health condition the petitioner was referred to Thrissur Government Medical College. While being taken to the Thrissur Government Medical College, petitioner lost consciousness and his condition deteriorated sharply and since Daya General Hospital and Speciality Surgical Centre, Thrissur was the nearest hospital and equipped with facilities for emergency cardiac intervention, the petitioner was immediately rushed to that hospital to meet the contingency and underwent angioplasty surgery, which was medically necessary and life saving and thereby incurred a total expense of Rs.2,15,000/-. Thereupon petitioner submitted a formal application for reimbursement of the said amount along with all the necessary documents, but the Thrissur Corporation Municipal Council sanctioned only an amount of Rs.1,46,397.12 as per Ext.P1 resolution. It was forwarded to the Director of Urban Affairs, who submitted Ext.P2 letter stating that contingent workers are also entitled for the benefits under the Kerala Government Servants’ Medical Attendance Rules , 1960 (in short, “KGSMA Rules”) as well as the Kerala Municipality (Employees Medical Attendance) Rules 1998. However, the claim was rejected as per Ext.P3 by the 1^st respondent on the sole ground that the petitioner underwent treatment in a private hospital not included in the approved list under the KGSMA Rules. Later, the petitioner was communicated about the same as per Exts.P4, P5 and P7. It is aggrieved by the same that the present writ petition has been filed.

3. A detailed counter affidavit has been filed by the 3^rd respondent, wherein it is admitted that the petitioner has suffered a cardiac emergency while on duty as a sanitation worker and the doctors at Thrissur District Hospital advised to transfer the petitioner to Government Medical College Hospital, Mulankunnathukavu, but while being transfered he became unconscious and was rushed to the nearest hospital, viz., Daya General Hospital, Thrissur, and where he underwent emergency angioplasty. It is further stated in the counter affidavit that the claim was rejected by the Government on finding that the petitioner was treated in a hospital, which is not included in the approved list under the KGSMA Rules.

4. I have heard the rival contentions on both sides.

5. It is an admitted case that the petitioner had a cardiac emergency while on duty as a sanitation worker. Though he was referred to the Government Medical College Hospital, Mulankunnathukavu while on being taken to the said hospital petitioner became unconscious and had to underwent emergency angioplasty in a private hospital nearby viz., Daya General Hospital, Thrissur. A similar issue was considered by this Court in Prasad K.G. v. State of Kerala , 2023 KHC 664, wherein this Court relying on the judgment of the Apex Court inShiva Kant Jha v. Union of India , (2018) 6 SCC 187, held that the right to medical claim could not be denied merely because the name of the hospital is not included in the Government Order. Paragraphs 11 and 15 of the said judgment read as follows:

“11. In the context of the fact situation presented in this case, the question is whether the non-empanelment of a private hospital can be treated as a reason to deny a claim for medical reimbursement to an employee if he is otherwise entitled to the same. A similar question was considered by the Apex Court in Shiva Kant Jha v. Union o