[2024:RJ-JD:49546]

HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR S.B. Civil Writ Petition No. 5714/2011 Sohan Lal Sharma ----Petitioner Versus State Finance And Ors ----Respondent For Petitioner(s) : Mr. Mukesh Rajpurohit, Ms. Dimple Rajpurohit and Ms. Aditi Sharma.

For Respondent(s) : Mr. Mahaveer Bishnoi, AAG assisted by Mr. HS Chundawat.

HON'BLE MR. JUSTICE ARUN MONGA

Order(Oral)

04/12/2024

1. Grievance of the petitioner herein arises out of an order dated 27.05.2008 (Annex.5), vide which his claim for medical reimbursement was rejected on the ground that he received treatment from a non-recognized hospital. Further, he seeks quashing of a subsequent communication dated 16.06.2008 (Annexure 6) which it was reiterated that his claim cannot be accepted.

2. Relevant facts first. The petitioner served as a Lecturer at District Institute of Education and Training (D.I.E.T.), Jodhpur until he superannuated on 31.01.2002. As a confirmed and regular employee of the State of Rajasthan, he was entitled to all benefits, including medical benefits admissible to State Government employees.

2.1. On 25.05.2007, petitioner suffered a cardiac arrest. Under emergency, he was admitted to Goyal Hospital, Jodhpur, for treatment. To save his life, doctors recommended immediate surgery. Consequently, on 01.06.2007, the petitioner underwent heart surgery at the hospital and was discharged on 12.06.2007.

2.2. At the relevant time, the Hospital i.e. Escorts Goyal Heart Center, Jodhpur provided cardiac care facilities in collaboration with Escorts Heart Institute & Research Center, New Delhi. After recovering from the ailment, the petitioner submitted a medical reimbursement claim of Rs. 2,03,063.86 before the competent authority. On 02.03.2008, he also executed an affidavit affirming his admission to the hospital from 25.05.2007 to 12.06.2007.

2.3. By letter dated 16.06.2008 petitioner's claim for medical reimbursement was rejected on the ground that he was treated in year 2007 at a non-recognized hospital.

2.4. Pertinently, in 2008, aforesaid Goyal Hospital, Jodhpur, was recognized by the respondent department as an authorized hospital. Following this recognition, medical reimbursement claims of other state employees, treated at the hospital, were duly processed and accepted. However, petitioner’s claim was denied on the ground that the hospital was not recognized at the time of his treatment. His surgery was undertaken in a life-threatening situation, with no other viable alternative, is not in dispute. Hence this petition.

3. Stand taken by the respondents in their counter-affidavit, inter alia, is that medical reimbursement of pensioners is governed by the Rajasthan Pensioners Medical Concession Scheme (hereinafter referred to as "the Scheme"). The Scheme permits free medical attendance and treatment for pensioners only at authorized hospitals, clinics, or institutes as per Clauses 4 to 4(g). The petitioner’s claim does not comply with these provisions. Reimbursement is permitted only under the prescribed rules and limits, and government employees cannot claim expenses beyond what is provided under these rules. The Finance Department (Rules Division) of the Government of Rajasthan issued Circular No. F.6(4)FD (Rules)/03 PT dated 05.05.2011 providing guidelines for medical reimbursement claims, including those for cardiac surgeries and other treatments. The petitioner is not entitled to full reimbursement of the expenses incurred for his bypass surgery as the treatment was availed at a private, unrecognized hospital, contrary to the provisions of the scheme.

Hence, the present writ petition is liable to be dismissed.

4. In the aforesaid backdrop, I have heard the rival contentions and gone through the case record.

5. What emerges before this Court for adjudication lies in a very narrow compass, i.e., whether a Government Official or a pensioner, in an emergent situation, having undergone treatment at a private hospital, is entitled to seek reimbursement