Research › Search › Judgment

Rajasthan High Court · body

2022 DIGILAW 2475 (RAJ)

Krishan Lata v. State Of Rajasthan

2022-09-19

KULDEEP MATHUR

body2022
JUDGMENT Kuldeep Mathur, J. - Briefly stated facts of the case are that the petitioner went to Gurgaon for personal trip and there he suffered severe headache. The petitioner on becoming unconscious was taken to Medanta (Medicity) Hospital, Gurgaon. The treating Doctor after MRI Scan advised the petitioner to undergo surgery under emergent circumstances. For the surgery underwent, amount ofRs.2,47,426/- was incurred. The petitioner was operated on 07.02.2015 and remained admitted from 06.02.2015 to 11.02.2015. Thereafter, he submitted an application dated 22.06.2015 claiming reimbursement of medical bills. The respondent-authorities in pursuance of the application submitted by the petitioner accepted partial claim to the extent ofRs.30,793/-. Aggrieved by partial acceptance of the claim, the petitioner has preferred the present writ petition. 2. Learned counsel for the petitioner submitted that the petitioner had undertaken brain surgery under emergent circumstances and his claim for medical reimbursement ought to have been accepted in toto by the respondent-authorities. 3. Per Contra, learned counsel for the respondents submitted that the petitioner had taken treatment outside the State without being referred from any medical authority. It was further submitted that the no prior permission was taken from the respondent-authorities. Counsel urged that the claim had been accepted in consonance of Rajasthan Civil Services (Medical Attendance) Rules, 2013 and should not be interfered with. 4. Heard learned counsel for the parties and perused the material available on record. 5. So far as the question regarding reimbursement of the treatment undertaken in a private and unrecognized hospital is concerned, the law is no longer res integra. 6. 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. 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....." 7. 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." 8. In Rama Prasad Sharma v. State of Rajasthan and Ors.; SBCWP No. 7469/2016 decided on 21.01.2022, coordinate Bench of 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." 9. The ratio laid down in the above judgments makes it clear that even in the cases where an employee undergoes treatment in a non-recognized hospital/private hospital, the medical reimbursement has to be made to the extent permissible under relevant Rules/Scheme/Policy. In the present matter, the amount which has been reimbursed appears to have been made against the procedure undertaken. So far as the medicines, drugs, anesthesia and room charges etc., are concerned, amount qua the same is also required to be reimbursed in terms of the Rules of 2013. 10. In the present matter, the amount which has been reimbursed appears to have been made against the procedure undertaken. So far as the medicines, drugs, anesthesia and room charges etc., are concerned, amount qua the same is also required to be reimbursed in terms of the Rules of 2013. 10. Therefore, in view of the ratio laid down by the Hon'ble Apex Court and peculiar facts, the present writ petition is partly allowed. The respondents are directed to reconsider the claim of the petitioner and reimburse amount qua the medicines, drugs, anesthesia, room charges and all other heads as payable in terms of the Rules of 2013, if not already paid. The complete consideration and reimbursement thereof to be completed within a period of eight weeks from the date of receipt of this order. 11. All pending applications also stand disposed of.