Rajasthan High Court Directs Medical Reimbursement For COVID Treatment At Non-Recognised Hospitals

When a Pandemic Makes Every Hospital the Nearest Lifeline

The Rajasthan High Court has ordered the reimbursement of medical expenses incurred at non-recognised hospitals during the COVID-19 pandemic, holding that the denial of such claims on technical grounds " cannot be sustained in law ."

Justice Rekha Borana, presiding over a Single Bench, allowed a writ petition filed by Anupama Prasad, daughter of Late Dr. Jagdish Prasad Srivastava, a former Associate Professor of Zoology at the University of Rajasthan who superannuated in October 2000 and passed away on 18 November 2021 after prolonged hospitalization in Delhi.

A ₹8.9 Lakh Claim and a 21-Day Rejection

The petitioner raised a medical reimbursement claim of ₹8.9 lakh on 27 July 2022, which was rejected by the University barely three weeks later. The respondent authorities cited three grounds: the absence of documentary evidence confirming the deceased was suffering from COVID-19 (records suggested admission to the Urology Department for a urinary stone and age-related ailments); the failure to show that treatment was unavailable within Rajasthan or that a referral was obtained from SMS Hospital through the Medical Board; and the absence of an emergent situation warranting treatment at the nearest available facility.

Settled Precedents on Non-Recognised Hospitals

The Court anchored its reasoning in two established precedents. In Rama Prasad Sharma v. State of Rajasthan (2022), it was held: "It is now a settled position of law that even in cases where the treatment of an employee has been taken in a non-recognised hospital , the medical reimbursement has to be made at the rate that may be applicable for similar treatment in the recognized government hospitals ." Similarly, the Division Bench in State of Rajasthan v. Tikam Chand Maloo (2018) affirmed that employees are entitled to reimbursement for treatment taken outside the state at unrecognised hospitals during emergencies.

The Pandemic as the Ultimate Emergency

Writing for the Court, Justice Borana observed: "It is an universally accepted fact that during unprecedented COVID-19 pandemic, the immediate availability of medical care was of paramount importance. It was the period when patients were compelled to seek treatment at the nearest available hospital, irrespective of the fact whether such hospital was recognised or outside State, owing to the then prevailing circumstances."

The Court further noted: "The denial of reimbursement of the medical expenses by the respondent-Department on the ground of the treatment having been taken in a non-recognised hospital and that there was no emergent condition , cannot be sustained in law ."

Decision and Relief

The writ petition was allowed, with directions to reimburse the medical claim to the extent permissible under the Rajasthan Civil Services (Medical Attendance) Rules, 2008, or the rules applicable to University employees. The reimbursement must be completed within four weeks of the order, carrying interest at 6 percent per annum.

The ruling reaffirms that the non-recognised status of a hospital is not a bar to medical reimbursement and that extraordinary circumstances like a pandemic demand a purposive interpretation of medical attendance rules.