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2011 DIGILAW 1835 (RAJ)

Neena Jain v. State

2011-08-29

AJAY RASTOGI

body2011
JUDGMENT 1. - Widow has approached this Court with the grievance that her husband (Ravindra Kr. Jain) while in service was admitted in Monilek Hospital, Jaipur on 19/12/2005 and after having undergone kidney transplant for which she herself was donar, was discharged from hospital on 10/01/2006. 2. As alleged, her husband submitted application claiming reimbursement of medical bills on 28/03/2006 for total expenses to the tune of Rs. 3,37,467/-. After her husband died on 26/05/2006, she sent several reminders for release of medical expenses. However, respondent-3 vide letter dated 18/12/2006 asked Superintendent, SMS Hospital, Jaipur to inform about total expenses of kidney transplant if done in SMS Hospital, Jaipur and a copy whereof was endorsed to the petitioner followed by letter dated 20/01/2007 asking for her consent in regard to reimbursement of medical bills in accordance with treatment undertaken in Government Hospital but she being entitled to g et actual medical expenses reimbursed being a member of Rajasthan Civil Services (Medical Attendance) Rules, 1970, she was persistently asked to send consent for reimbursement of medical bills to the extent of Rs. 50,000/- vide letter dated 03/05/2007 (Ann.R/8). 3. Counsel for petitioner submits that in compelling/emergent circumstances, husband of petitioner was admitted for treatment of the disease of chronic renal failure in private hospital, Monilek Hospital, Jaipur where his kidney was transplanted as is evident from certificate (Ann.1) given by treating doctor of Monilek Hospital. 4. Reply to the writ petition has been filed by respondents wherein what has been alleged by petitioner in the writ petition has not been controverted but they have come out with a stereotyped plea and the respondents maintained their stand that since hospital is not approved, in the absence whereof, medical bills could not be reimbursed. 5. This Court has considered rival contentions of the parties and with their assistance, examined material on record. Indisputably, earlier Rajasthan Civil Service (Medical Attendance) Rules, 1970 were in force and after it stands superseded, for serving State Government servants, Rajasthan Civil Service (Medical Attendant) Rules, 2008 ("Medical Rules, 2008") came into force w.e.f. 16/09/2008 and retired personnel are entitled for their medical reimbursement in terms of Rajasthan Pensioner Medical Concession Scheme. 6. Indisputably, earlier Rajasthan Civil Service (Medical Attendance) Rules, 1970 were in force and after it stands superseded, for serving State Government servants, Rajasthan Civil Service (Medical Attendant) Rules, 2008 ("Medical Rules, 2008") came into force w.e.f. 16/09/2008 and retired personnel are entitled for their medical reimbursement in terms of Rajasthan Pensioner Medical Concession Scheme. 6. But to streamline the on going disputes regarding reimbursement of medical bills, the State Government vide Circular dated 06/02/2009 laid down rates of the charges admissible regarding costs of implants, medical attendance & treatment of State Government servant in private/charitable hospitals within the State, w.e.f. 16/09/2008. Upon representations made by Govt. servants, State Govt. vide order dated 27/11/2009 allowed expenses incurred on medical attendance & treatment taken prior to 16/09/2008 in emergent circumstances in private /charitable hospitals within the State by Govt. servants, at the following scale: 1. 100% costs of reimbursement drugs & medicines; 2. 80% of the rate of Government hospitals for tests, investigations and diagnosis charges at that time; 3. Hospital charges (inclusive of consultation, surgery and all other miscellaneous charges) at the rates of cottage charges admissible in Government hospitals as per entitlement of the employee at that time; and 4. Cost of implants at the prevailing rates of SMS Hospital, Jaipur at that time, as may be prescribed/ certified by SMS Hospital, Jaipur or State Govt. The emergent nature of hospitalization in private or charitable hospitals has to be established by an affidavit of the employee supported by a certificate of the treating doctor." It further appears that representations were thereafter made by State Pensioner/Family Pensioners for grant of parity in regard to reimbursement of medical bills and taking note thereof, State Government decided vide order dated 21/12/2009 to extend the facility of medical attendance & treatment to State Pensioner/ Family pensioners, as well in private hospitals as applicable to State Govt. servants under order dated 27/11/2009 pertaining to the period prior to 19/06/2009. 7. From orders (supra), it depicts that the scale of charges as provided vide order dated 27/11/2009 became applicable to the State Govt. servants/State pensioner & family pensioners for reimbursement of medical bills for medical attendance & treatment being taken in emergent circumstances in a private/charitable hospitals pertaining to the period prior to 16/09/2008, as well. 8. 7. From orders (supra), it depicts that the scale of charges as provided vide order dated 27/11/2009 became applicable to the State Govt. servants/State pensioner & family pensioners for reimbursement of medical bills for medical attendance & treatment being taken in emergent circumstances in a private/charitable hospitals pertaining to the period prior to 16/09/2008, as well. 8. It is relevant to record that to further streamline litigations coming to the Court of law regarding reimbursement of medical bills, State Government in exercise of powers U/r 4 read with R.8(2) of Medical Rules, 2008 vide order dated 16/12/2009 laid down scale - to the extent of which expenses of medical treatment after 16/09/2008 are reimbursable in the form of schedule of charges; however, there is a rider appended thereto that drugs & medicines shall be payable in terms of R.8(2) of Rules, 2008 and the medical treatment undertaken in emergent circumstances, prior to 16/09/2008 are reimbursable in terms of the scale having been notified vide orders dated 06/02/2009 & 27/11/2009 irrespective of the fact that one is a State Government servant or State Pensioner/family pensioner who is made at par vide order dated 21/12/2009. 9. In the opinion of this Court, if treatment has been undertaken by State Govt. servant/State Pensioner/family pensioner prior to 16/09/2008 in emergent circumstances in a private/charitable hospitals within the State, reimbursement of costs of implants, medical attendance & treatment could be allowed only in terms of scale provided vide orders dated 06/02/2009 & 27/11/2009 respectively. 10. In the instant case, petitioner was a serving employee while having undertaken medical treatment in private Monilek Hospital, Jaipur as indoor patient from 29/12/2005 to 10/01/2006 incurring expenses of Rs. 3,37,467/- which was raised on 28/03/2006 (Ann.1) and since medical attendance & treatment was taken prior to 16/09/2008 but bills whereof were not reimbursed as is evident from documents placed on record along-with reply (Ann.R/1 to R/8). 11. As regards emergent hospitalization, it appears from material on record that husband of the petitioner was suffering from acute ailment of chronic renal failure requiring emergent surgical operations (kidney transplant) for saving his life, and taking note of critical & emergent situation, ultimately he was shifted by his family members to Monilek, Jaipur and as per diagnosis report given by treating doctors, emergent nature of his hospitalization in private hospital cannot be ruled out. 12. 12. In the light of what has been taken note of (supra), this Court considers that if husband of the petitioner (who was serving employee) has taken treatment in emergent circumstances by hospitalization in a private hospital, his claim being not reimbursed on the premise that the treatment has been taken in private hospital being not recognised/approved by State Government is not sustainable; he is entitled for reimbursement of medical bills in terms of scale provided vide orders dated 06/02/2009 & 27/11/2009. 13. Consequently, writ petition succeeds and is hereby allowed. Orders dated 03/05/2007 (Ann.R/8) & 25/06/2007 (Ann.R/9) are set aside. Respondents are directed to reconsider case for reimbursement of medical bills for treatment of petitioner's husband (who was serving employee) undertaken in Monilek Hospital, Jaipur, in the light of Rajasthan Civil Service (Medical Attendance) Rules, 2008 read with orders dated 06/02/2009 & 27/11/2009 and after due computation, the same shall be paid to the petitioner along-with interest @6% per annum from the date of presentation of medical bills till actual payment. Compliance of this order be made within three months. No costs.Writ petition allowed. *******