The government must reimburse medical expenses for government employees regardless of hospital accreditation in emergencies, reflecting its constitutional obligation to ensure access to healthcare.

O R D E R

Heard Mr.R.Prem Narayan, learned counsel for the petitioner and Mr.G.Ameedius, learned Government Advocate for the respondents 1 to 4 and Mr.P.Sankaranarayanan, learned counsel for the 5th respondent and perused the materials available on record.

2. The petitioner was working as a Village Administrative Officer under the control of the District Collector, Coimbatore and had retired from service on attaining the age of superannuation on 31.03.2014. On 12.12.2018, the petitioner had a massive heart attack and hence, he was admitted at G.Kuppusamy Naidu Memorial Hospital, Coimbatore and undergone treatment, for this purpose, the petitioner has spent huge sums of money. Being an employee in a Government office, paying monthly premiums directly from his salary for the State Health Insurance Scheme, 2018, he sought reimbursement for the amount incurred for the medical expenses before the 4th respondent. But the 4th respondent forwarded the petitioner's application to the 3rd respondent and the 3rd respondent also recommended for medical reimbursement. But the 5th respondent summarily rejected the request of the petitioner stating that the treatment which was undergone by the petitioner is a non accredited hospital and hence the claim is not covered under the scheme. Hence, the petitioner has come up with the present Writ Petition.

3. Mr.R.Prem Narayan, learned counsel for the petitioner submitted that the claim of the petitioner should not have been denied for the simple reason that the petitioner took the treatment outside the network hospital. Further, the learned counsel for the petitioner relied on the judgment of the Division Bench of this Court in W.A(MD).No.1382 of 2017, dated 09.11.2017, wherein it is held as under:-

“35.It is to be pertinently pointed out that -Right to Health- is an integral part of the Right to Life and the Government is under a Constitutional obligation to provide health welfare facilities. If a Government servant underwent a requisite treatment for his ailment and if necessary proof is produced, then it is the primordial duty of the State Government to bear the expenses incurred thereto and reimburse the same. Just because the Government servant had underwent the treatment at an unapproved Hospital, the expenses incurred thereto cannot be denied by the State Government notwithstanding the fact that the Government servant is a member of the scheme introduced by the Government. Also that the individual Government servant/patient or his family members is/are the proper persons to take a final decision as to where the treatment in question is to be provided, as opined by this Court.

36. It cannot be brushed aside that the State Government is to satisfy the Constitutional obligation to bear/refund the expenses incurred by a Government servant while in service or after retirement from service, of course, based on the policy of the Government. In emergency cases, the treatment that is required will be immediate/forthwith and if one has to comply with the procedure, ultimately, -waiting- in this regard may prove disastrous and fatal.

37.It is to be aptly pointed out that a human being is to take care of himself and in this regard, the individual concerned is the best Judge suited to take a final call/decision. In reality, the self preservation of one's life is enjoined under Article 21 the Constitution of India, as an inviolable right, in the considered opinion of this Court.

38.No doubt, a patient as a lay human being cannot pick and choose the method/mode of surgery. It is for the Doctors/Medical experts to determine and suggest a right course of action as to what/which kind of surgery/treatment is suitable, of course, taking into consideration the nature of the ailment and the status/condition of the concerned patient.

39.Although financial resources are required for providing medical facilities to the needy, ultimately, the State Government has the constitutional obligation to provide enough medical se