HIGH COURT OF JUDICATURE FOR RAJASTHAN AT

JODHPUR

S.B. Civil Writ Petition No. 11704/2015

Raghuveer Sharan Goyal S/o Shri Gigan Ram, aged about 72

years, Resident of 24-E Block, Near Gandhi Park, Sriganganagar.

----Petitioner

Versus

1. State of Rajasthan through The Principal Secretary, Finance

Department, Government of Rajasthan, Secretariat, Jaipur.

2. Board of Trustee, Rajasthan State Pensioners Medical

Concession Scheme, Pension and Pensioners Welfare

Department, Rajasthan, Jaipur-through its Director.

3. The Additional Director, Pension and Pensioners Welfare

Scheme, Rajasthan, Jaipur.

4. Joint Director, Pension and Pensioners Welfare Department,

Sriganganagar.

5. District Treasury, Sriganganagar.

----Respondents

For Petitioner(s)

:

Mr. Manoj Bohra

For Respondent(s)

:

Mr. Sandeep Shah, AAG & Sr. Adv.

assisted by Ms. Pratyushi Mehta

HON'BLE MR. JUSTICE KULDEEP MATHUR

Order

21/09/2022

The present petition has been filed with a prayer for

reimbursement of partial medical claim which was denied by the

Department on the count that amount had already been

reimbursed to the extent permissible in terms of the Rajasthan

Civil Services (Medical Attendance) Rules, 2013 (hereinafter

referred to as, ‘Rules of 2013’).

The petitioner’s wife suffered from cardiac problem and was

admitted to PBM Hospital, Bikaner. For her treatment, two DE

Stents were installed by way of an operation, which were

purchased from the Life Saving Medical Store, a part of the PBM

(2 of 4)

[CW-11704/2015]

Hospital. The total expenses incurred for the treatment were to

the tune of Rs. 1,77,708/-, but only Rs. 54,634/- were

reimbursed by the respondent-authority.

Learned counsel for the petitioner submitted that in terms of

the ratio laid down in the case of Sumer Singh vs. State; S.B. C.

W. No.7675/2014 and Smt. Mohan Kanwar Bhansali Vs.

State of Rajasthan; S.B. C.W. No.13482/2013 as the

treatment was undertaken by the petitioner in a government

hospital and the stents as implanted were also purchased from a

shop run by a Government Hospital, therefore, the complete

amount of the claim was liable to be reimbursed.

Per contra, learned counsel for the respondents submitted

that Appendix IX of the Rules of 2013, specifically prescribes the

maximum limit of reimbursement and the department had already

reimbursed in accordance with the Rules of 2013.

Heard learned counsel for the parties and perused the

material available on record.

Appendix-IX of the Rules of 2013 (as amended in the year

2014) is as follows:-

S.

No.

Item

No. of

Stents

Extent of

Reimbursement (Rs.)

1

DE Stent

1

Rs. 70,500/-

2

Bare Metal Stent

1

Rs. 40,000/-

3

DE Stent (1) & Bare Metal Stent (1)

2

Rs.1,14,500/-

(70,500/- +44,000/-)

4

Bare Metal Stent (2)

2

Rs. 82,500/-

5

DE Stent (1) & Bare Metal Stent (2)

3

Rs.1,53,000/-

(70,500/- +42,500/-)

6

Bare Metal Stent (3)

3

Rs. 1,10,000/-

7

Balloon Intra Aortic

1

Rs. 28,000/-

Note: 1. If more than one DE Stent is implanted

than reimbursement for additional DE Stent shall

(3 of 4)

[CW-11704/2015]

be allowed upto the limit of Bare Metal Stent only.

2. The reimbursement for more than three stents

shall not be allowed.”

In the case of Sumer Singh (supra), the Co-ordinate Bench

of this Court held as under:

“On the basis of the aforesaid discussion this Court

of the opinion that the treatment taken in a

Government Hospital has to be completely

reimbursed to the petitioner as the language of the

scheme is very clear that the person concerned

shall be legitimately entitled to complete

reimbursement in the Government Hospital. The

fundamental right under the Article 21of the

Constitution of India envisages that right to life

includes right to medical and health facilities within

the stipulated statutory provisions. The rising

health care costs have always been detrimental to

proper t