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2022 DIGILAW 2408 (RAJ)

Satyapal Singh v. State Of Rajasthan

2022-09-09

REKHA BORANA

body2022
JUDGMENT Rekha Borana, J. - The present writ petition has been filed with a prayer for reimbursement of the medical claim of the petitioner which was incurred qua his treatment for brain hemorrhage. The submission of the petitioner is that he had suffered brain hemorrhage and in an emergent condition, he was admitted to Goyal Hospital, Jodhpur and underwent treatment there. After two days of hospitalization i.e. from 04.09.2009 to 06.09.2009 at Goyal Hospital, Jodhpur he was referred to Sir Ganga Ram Hospital, New Delhi and remained hospitalized there from 07.02.2009 to 04.03.2009. At Sir Ganga Ram Hospital, New Delhi he underwent a surgery and qua the complete treatment, he incurred an expenditure of Rs. 5,07,919/- (Rs. 85,204/- incurred at Goyal Hospital, Jodhpur and Rs. 4,22,715/- incurred at Sir Ganga Ram Hospital, New Delhi). When the medical claim was raised with the respondent-Department, only Rs. 25,000/- was sanctioned qua the same. 2. It has been argued by learned counsel for the petitioner that he being admitted in a private hospital due to the emergent condition of brain hemorrhage and then referred to a higher center by the local Doctor, was entitled for reimbursement of the complete medical bills as raised by him. 3. Per contra, it has been submitted by learned counsel for the State as well as the Municipal Corporation, Jodhpur that in terms of Rule 10 of the Rules of Rajasthan Civil Services (Medical Attendance) Rules, 2008 (hereinafter referred to as the Rules of 2008) firstly, no emergent situation as prescribed under the Rules of 2008 has been explained in the present matter and secondly, the treatment has been undertaken by the petitioner in private hospitals both of which are neither recognized nor referral hospitals of the State or the Department. Learned counsel further argued that the claim in question had been raised in the year 2009 and reimbursement of an amount of Rs. 25,000/- was also made in the year 2010 but the present writ petition has been filed in the year 2019 and no reason for such delay has been explained by the petitioner. Learned counsel therefore submitted that the present writ petition is liable to be rejected on the sole ground of limitation. 4. Heard learned counsel for the parties and perused the material available on record. 5. Learned counsel therefore submitted that the present writ petition is liable to be rejected on the sole ground of limitation. 4. Heard learned counsel for the parties and perused the material available on record. 5. Dealing with the first aspect of limitation, it is clear on record that the medical bills were submitted by the petitioner in the year 2009 qua the treatment taken in the year 2009. The limitation as prescribed in the Rules of 2008 provides that a medical claim, if any, has to be raised within a period of two years of the date of treatment. Rule 13(1) of the Rules of 2008 provides as under: "(1) Every Government servant claiming refund of medical expenses incurred on account of medical attendance and treatment for himself and/or members of his family, shall make an application in duplicate in form given in Appendix-VI. Such claims shall be presented within two years from the date of completion of treatment." 6. Admittedly, the petitioner underwent the medical treatment in the year 2009 and the claim qua the same was also raised in the year 2009 itself i.e., within the prescribed period of limitation. So far as the reimbursement of the admitted claim and denial of the un-admitted claim is concerned, a perusal of the communication dated 25.01.2011 (Annex. 8) makes it clear that the Chief Executive Officer of the Municipal Corporation, Jodhpur itself recommended for sanction of the remaining amount qua the drugs and medicines to the petitioner. Moreover, there was no denial of the remaining claim by the Department on any count. In the reply, it has been submitted that the claim reimbursable in terms of the Rules of 2008 could only be the expenses incurred for the treatment undertaken in a Government Hospital. It has been submitted that to ascertain the expenses in a Government Hospital, a Medical Board was constituted by the State and a report of the SMS Hospital, Jaipur was received which specifically stated that the cost of the surgery in question in a Government Hospital would amount to Rs. 25,000/- only. On the basis of the said report, the amount of Rs. 25,000/- was reimbursed to the petitioner. Rest of the claim was not found to be reimbursable and hence it was not reimbursed. 7. 25,000/- only. On the basis of the said report, the amount of Rs. 25,000/- was reimbursed to the petitioner. Rest of the claim was not found to be reimbursable and hence it was not reimbursed. 7. So far as the question regarding the treatment undertaken in a private and unrecognized hospital is concerned, the law on the point is no more res integra. 8. In Shiva Kant Jha v. Union of India (UOI); AIR 2018 SC 1975 decided on 13.04.2018, the Hon'ble Apex Court held as under:- "It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment....." 9. In Surjit Singh v. State of Punjab and Ors. reported in AIR 1996 SC 1388 decided on 31.01.1996, the Hon'ble Apex Court held as under:- "10............ ............ In such an urgency one cannot sit at home and think in a cool and calm atmosphere for getting medical treatment at a particular hospital or wait for admission in some Government medical institute. In such a situation, decision has to be taken forthwith by the person or his attendants if precious life has to be saved." 10. ............ In such an urgency one cannot sit at home and think in a cool and calm atmosphere for getting medical treatment at a particular hospital or wait for admission in some Government medical institute. In such a situation, decision has to be taken forthwith by the person or his attendants if precious life has to be saved." 10. In Rama Prasad Sharma v. State of Rajasthan and Ors.; SBCWP No. 7469/2016 decided on 21.01.2022, this Court held as under:- ".........It is now a settled position of law that even in cases where the treatment of an employee has been taken in non-recognized hospital the medical reimbursement has to be made at the rate that may be applicable for similar treatment in the recognized government hospitals." 11. The ratio as laid down in the above judgments makes it clear that the law on the point is settled that even in the cases where the treatment of an employee has been taken in non-recognized hospital, the medical reimbursement has to be made at the rate that may be applicable for similar treatment in the recognized Government Hospital. So far as the present matter is concerned, the amount which has been reimbursed is only qua the procedure undertaken. So far as the medicines, drugs, anesthesia and room charges etc., are concerned, no amount qua the same has been reimbursed and admittedly the same is payable in terms of the Rules of 2008. 12. Therefore, in view of the ratio as laid down by the Hon'ble Apex Court and in view of the observations as made above, the present writ petition is partly allowed. The respondents are directed to reconsider the claim of the petitioner and reimburse the amount qua the medicines, drugs, anesthesia, room charges and all other heads as payable in terms of the Rules of 2008. The complete consideration and reimbursement thereof would be made within a period of four weeks from the date of receipt of the copy of this order. The said amount would not carry interest looking to the delay caused in filing of the present writ petition. 13. All pending applications also stand disposed of.