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2022 DIGILAW 2513 (RAJ)

Pramila Tak v. State Of Rajasthan

2022-09-23

KULDEEP MATHUR

body2022
JUDGMENT Kuldeep Mathur, J. - Briefly stated facts of the case are that the petitioner's husband was admitted in Krishna Super Speciality Hospital, Jodhpur due to severe chest pain. The treating doctors looking at the severity of case, referred him to Apollo Hospital, Ahmedabad, where he passed away on 08.09.2015 while taking treatment. 2. The petitioner applied for reimbursement of medical bills before the respondent-authorities amounting toRs.9,80,992/-. The bills were returned with an assertion that the petitioner's husband availed treatment in a non-empanelled hospital and has also not annexed the certificate of the treating doctor, showcasing emergent situation for availing treatment in a non-empanelled/private hospital. 3. Learned counsel for the petitioner submitted that petitioner's husband had been taken to a private hospital due to emergent circumstances therefore, reimbursement cannot be rejected solely on the ground that the hospital was not an empanelled one or the certificate of treating doctors justifying emergency for availing treatment was not annexed. Reliance was placed on a judgment of this Court in the case of Raghuveer Sharma v. State of Rajasthan & Ors. reported in (2007 WLC (Raj.) UC 516, in which it was held as under:- "prime consideration in case of grave emergency, which comes in the mind of family is to save the life of patient and at that point of time whatever hospital comes to their mind and considered just is felt as the best because emergency knows no law and no procedure and when human life is at stake in such situation ultimately responsibility of State cannot be washed out. Technicalities of Rules and Regulations under the Scheme are not required to be followed just in a mechanical manner so as to frustrate very purpose of the Scheme because a person having put in his whole life in the service of the State till attains age of superannuation always require human considerations." 4. Per contra, learned counsel for the respondents submitted that the treatment in a non-empanelled/private hospital can be taken in case of grave urgency viz. life threatening disease like kidney or heart ailments and accidents. It was further submitted that according to the rules/policy in vogue, emergency certificate of treating doctor establishing emergent situation is necessary for making any claim for reimbursement in a private hospital. 5. A co-ordinate Bench of this Court in the case of Mool Singh v. the State of Rajasthan & Ors. It was further submitted that according to the rules/policy in vogue, emergency certificate of treating doctor establishing emergent situation is necessary for making any claim for reimbursement in a private hospital. 5. A co-ordinate Bench of this Court in the case of Mool Singh v. the State of Rajasthan & Ors. in S.B.CWP No. 5592/2018 vide order dated 09.09.2022 was pleased to held as under:- "The medical claim qua the said amount was raised before the respondent Department but the same was rejected on the ground that the petitioner has not shown any emergent situation wherein his wife was required to be treated in the private hospital i.e. SAL Ahmedabad. 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. We share the views afore-expressed" 6. In Rama Prasad Sharma v. State of Rajasthan & Ors.; S.B.C.W.P. No. 7469/2016, decided on 21.01.2022, passed by this Court, it was 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." 7. In the light of aforesaid enunciation of law, the respondent-department is under an obligation to reimburse the amount to the petitioner for the treatment underwent by her husband in a private or unrecognized hospital, to the extent permissible under the Rules/Policy governing the same. The claim cannot be rejected on the grounds mentioned in letters dated 23.02.2016 and 28.04.2016 (Annex. 10), viz. lack of certificate showing emergency by treating doctors along with the medical bills submitted for reimbursement, particularly, when the treatment undertaken has not been disputed by the respondent-department. 8. The claim cannot be rejected on the grounds mentioned in letters dated 23.02.2016 and 28.04.2016 (Annex. 10), viz. lack of certificate showing emergency by treating doctors along with the medical bills submitted for reimbursement, particularly, when the treatment undertaken has not been disputed by the respondent-department. 8. The present writ petition is therefore, allowed and the respondent authorities are directed to reimburse the expenditure incurred by the petitioner in treatment of her husband, to the extent permissible for taking treatment at a private or unrecognized hospital in emergent situation. The necessary exercise shall be completed by the respondent department within a period of two months from the date of this order. It is further ordered that in case the claim of the petitioner is not settled within aforesaid period, the same shall carry an interest @ 6% per annum. 9. No order as to costs.