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2015 DIGILAW 124 (RAJ)

Samunder Singh v. State of Rajasthan

2015-01-15

SANDEEP MEHTA

body2015
JUDGMENT 1. - By way of the instant writ petition, the petitioner seeks a direction to the respondents to reiumburse the medical expenses borne by him in the treatment of his cardiac ailment, which he had to undergo in an emergent condition at the Heart & General Hospital, Jaipur in October 2010. 2. The petitioner is a retired Head Constable from RAC Department of the State of Rajasthan. He retired from service in the year 1999 and was issued with a PPO and so also a medical diary by the respondents. It is alleged in the writ petition that the petitioner fell ill and was admitted at the Heart & General Hospital, Jaipur on 5.10.2010 in an emergent condition. He was subjected to Coronary Angiography, PTCA, stent in LAD. He incurred expenses to the tune of Rs. 1,59,999/- toward his treatment and the cost of medicines etc. 3. The petitioner submitted the bills of medical expenses to the respondent department and claimed reimbursement thereof but the respondents did not pay any heed to his claim application. Hence, the petitioner has approached this Court for issuance of a writ/direction to the respondents for reimbursement of his medical bills. 4. Learned counsel for the petitioner relied on the decisions of this Court in the cases of Jawahar Lai Bohra v. State of Rajasthan (S.B. Civil Writ i petition No. 6350/2005) decided on 26.3.2014 and Gyanendra Kumar Pareek v. State of Rajasthan & Ors. reported in 2009(4) WLC (Raj.) 95 and prayed that the writ petition be accepted and the respondents be directed to reimburse the medical expenses borne by the petitioner in accordance with Rajasthan State Pensioners Medical Concession Scheme. 5. Learned counsel for the respondents vehemently opposed the submissions advanced by the learned counsel for the petitioner. He referred to the contents of reply filed to the writ petition and submitted that the petitioner was not having a pensioner's medical diary or the smart card and therefore, he is not entitled to get any relief under the Scheme. He further o urged that the petitioner underwent treatment at an unrecognized hospital without prior permission of the Director Medical & Health Services or the Principal of the concerned Medical College in accordance with the Scheme and thus, he is not entitled to the reimbursement of his medical bills. However, the fact that the petitioner bore expenses of Rs. He further o urged that the petitioner underwent treatment at an unrecognized hospital without prior permission of the Director Medical & Health Services or the Principal of the concerned Medical College in accordance with the Scheme and thus, he is not entitled to the reimbursement of his medical bills. However, the fact that the petitioner bore expenses of Rs. 1,59,999/- towards 5 his treatment and submitted bills for the reimbursement thereof is not disputed. 6. The controversy regarding the entitlement of the retired Government employees to receive medical reimbursement has already been settled by this Court in a catena of decisions including the judgment rendered in the case of Gyanendra Kumar Pareek v. State of Rajasthan & Ors. reported in 2009 (4) WLC (Raj.) 95 and in the case of Jawahar Lai Bohra v. State of Rajasthan (S.B. Civil Writ petition No. 6350/2005) decided on 26.3.2014. 7. It is not in dispute that the petitioner, a retired employee, developed a sudden cardiac problem. He was admitted in an emergent situation in the Heart & General Hospital, Jaipur and was subjected to Coronary Angiography, PTCA, stent to LAD. Without any doubt, it was on account of emergent condition wherein the petitioner had to be subjected to Coronary Angiography, PTCA, stent to LAD in the above hospital. 8. This Court considered the issue of emergent situation in the case of Gyanendra Kumar Pareek v. State of Rajasthan & Ors. Reported in 2009(4) WLC(Raj.)-95 and held that when a family member suffers from cardiac ailment, the prime objective of the other family member would be to save his/her life. At that time, services of whichever hospital is suited could be utilised because emergency knows no law and no procedure and when human life is at stake, in such situation, ultimate responsibility of the State cannot be washed off. This Court relied upon the decision of the Division Bench of this Court in Anil Kumar Surolia v. State of Rajasthan reported in 2005(3) WLC(Raj.)- 396 wherein the Division Bench observed as under:- "Government cannot insist upon an employee to get himself treated at recognised Government institution. All that the Government in these circumstances can do is to reimburse the concerned employee at the rates that may be applicable in the recognised Government institution. All that the Government in these circumstances can do is to reimburse the concerned employee at the rates that may be applicable in the recognised Government institution. Reference in this connection may be made to the judgment of the Hon'ble Supreme Court in Surjit Singh v. State of Punjab reported in AIR 1996 SC-1388 and State of Punjab & Ors. v. Mohan Lai Jindal reported in (2001) 9 SCC-217 . Consequently, the reimbursement of the medical expenses borne by the State Government employees and pensioners has to be done even if the treatment is undertaken at unrecognized hospital outside the State even though reference may not have been taken prior to treatment." 9. Certain amendments were made in the Rajasthan State Pensioners Medical Concession Scheme vide order dated 19.12.2004 which are relevant for the purpose of disposal of this writ petition and are reproduced hereinbelow:- "The Governor is pleased to make the following amendments in the Rajasthan State Pensioners Medical Concession Scheme, namely-In the said Scheme. 1. The existing words "Implantation of Pacemaker and Angioplasty/ Balloonplasty" appearing in the sub-para 4B(i) shall be deleted and the existing sub-para 4B (ii) may be re-numbered as sub-para 4B(iii) and new sub para 4B(ii) may be inserted as under:- "(ii) A Pensioner and the members of his family as defined in sub-para (5) of para 3 of the scheme shall be entitled for grant of financial assistance in respect of specialised treatment of implantation of Pacemaker and Angioplasty/Balloonplasty taken in Government Hospital within the State of Rajasthan as under: (a) Pacemaker Actual cost of Pacemaker subject to the maximum of Rs. 60,000/- (b) Angioplasty/Balloonplasty Actual expenditure incurred subject to the maximum of Rs. 35,000/- (c) For Stent/Stents Actual expenditure incurred subject to the maximum of Rs. 75,000/-." 2. The existing para 4E shall be substituted by the following namely : "4E. Treatment of heart ailment in recognised hospital outside the State (with or without the recommendation of the Medical Board) (w.e.f. 5.8.2004). (a) In case it is recommended by the Medical Board that by-pass surgery for heart is indicated, the pensioner can get himself operated in any of the hospitals recognised by the Government outside the State for this purpose. Such pensioner may be allowed 80% of hospital expenses limited to Rs. 48,000/- being 80% of General Ward charges of All India Institute of Medical Sciences, New Delhi. Such pensioner may be allowed 80% of hospital expenses limited to Rs. 48,000/- being 80% of General Ward charges of All India Institute of Medical Sciences, New Delhi. (b) in case a pensioner undergoes by-pass surgery of heart (cardio Thoracic surgery) in any recognised hospital outside the State in emergent circumstances without any recommendation of the Medical Board, he may be allowed 80% of hospital expenses limited to Rs. 48,000/- i.e. 80% of General ward charges of All MS, New Delhi provided that he submits a Certificate from a cardiologist who took a degree of D.M. In Cardialogy as MCH in Cardio Thoracic Surgery stating that pensioner's condition was such that immediate treatment was essential. In case a pensioner takes treatment of Angioplasty/Balloonplasty and stent(s) in recognised hospitals outside the state, he/she may be allowed financial assistance as under:- (i) For Angioplasty/Balloonplasty Actual amount of expenditure incurred subject to the maximum of Rs. 35,0001- (ii) For Stent/Stents Actual cost of Stent/Stents subject to the maximum of Rs. 60,000/- (80% of Rs. 75,000/-)" 10. Thus, as per the said amendment, the only hurdle against the petitioner for being granted the relief of reimbursement of her bills is that he took treatment at unrecognised hospital within the State. However, as has been noted above, the Division Bench of this Court has already laid the issue to rest by observing that even if the treatment is taken at unrecognized hospital and without any reference, the reimbursement thereof has to be done at the rates prescribed in the Concession Scheme. Another order came to be passed by the State Govt, on 21.12.2009 which completely puts the controversy to rest and reinforces petitioner's claim for reimbursement. The order is quoted hereinbelow:- "No. F.1(6) FD(Rules)/2012 Jaipur dated 21 DEC 2009 Subject:- Reimbursement of cost of implants and reimbursement of medical attendance and treatment in private hospitals to pensioners/family pensioners under Rajasthan Pensioners Medical Concession Scheme. State Government has decided to extend the facility of Medical Attendance and treatment to State pensioners/family pensioners in private or charitable hospitals, as applicable to State Government servants under Finance Department order No. F.6(4)FD(Rules)/03 Pt.- I dated 27.11.2009 pertaining to the period prior to 19.06.2009. Such claims of treatment shall be considered and decided by the Sub-Committee of the Trust." 11. Such claims of treatment shall be considered and decided by the Sub-Committee of the Trust." 11. As a consequence, the action of the respondents in refusing to reimburse the medical bills of the petitioner cannot be approved as being unjust and arbitrary. 12. In such situation, the petitioner is entitled to be reimbursed with medical expenses borne by him in his treatment at the Heart & General Hospital, Jaipur in accordance with the Rajasthan State Pensioners Medical Concession Scheme. Furthermore, for the period during which the reimbursement was not given to the petitioner, he is entitled to receive interest as well. 13. Accordingly, it is hereby directed that the respondents shall forthwith reimburse the amount of medical expenses borne by the petitioner in his treatment in the Heart & General Hospital, Jaipur and in addition thereto, the cost of medicines shall also be reimbursed to the petitioner in accordance with the Rajasthan State Pensioners Medical Concession Scheme. The reimbursement shall be made within a period of four weeks from the date of receipt of copy of this order. Furthermore, the amount to be paid to the petitioner shall also carry interest @ 9% w.e.f. the date on which the bill was presented. If the payment has delayed beyond the period of four weeks, the amount due shall carry interest @ 12%. 14. No order as to cost.Writ Petition Disposed of as above. *******