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2023 DIGILAW 1445 (RAJ)

Ganpat Singh Panwar v. Rajasthan State Road Transport Corporation

2023-07-27

ASHOK KUMAR GAUR

body2023
ORDER : Mr. Ashok Kumar Gaur, J. - The instant writ petition has been filed by the petitioner seeking a direction against the respondents-Corporation to make medical reimbursement of the expenses incurred by the petitioner in treatment of his wife. 2. The brief facts, as pleaded in the writ petition, are:- 2.1 The petitioner was working as Conductor and during service tenure his wife-Snehlata Panwar suffered from brain hemorrhage and immediately she was taken to hospital at Bhilwara. 2.2 The petitioner has pleaded that looking to the serious condition and non-availability of proper treatment at Bhilwara, she was referred to Zydus Hospitals and Healthcare Research Pvt. Ltd., Ahmedabad and she underwent regular treatment from 04.06.2019 and thereafter, she was finally discharged on 18.06.2019. 2.3 The petitioner incurred expenses of Rs.8,95,516/- in the treatment of his wife and to the same effect, he has annexed medical bills, prescriptions, medical report, medicines bills etc. in the writ petition collectively as Annexure-1. 2.4 The petitioner has pleaded that after discharge of his wife from the Hospital, he requested the respondents for reimbursement of the amount incurred by the petitioner as per RSRTC Medical Attendance Regulations, 2011 (hereinafter 'the Regulations of 2011'). 2.5 The petitioner has pleaded that only internal departmental communication was sent by the respondents, however, no final decision was taken and as such, the petitioner after serving notice of demand of justice, has approached this Court. 3. Learned counsel for the petitioner has made following submissions:- 3.1. The Regulations of 2011 provides in Regulation 9(3) that if employee of the Corporation undertakes indoor treatment of life threatening disease like kidney, heart and some sudden accident, in a private hospital outside the State without reference in case of emergent circumstances, the corporation is required to reimburse the medical expenses upto the cost of treatment, that has been incurred in the treatment taken in SMS Hospital, Jaipur. 3.2 The issue with regard to entitlement of the petitioner was wrongly rejected by the respondents by an order dated 24.06.2020 only account of not seeking permission from the Authorities before taking the treatment in a Hospital outside the State. 3.2 The issue with regard to entitlement of the petitioner was wrongly rejected by the respondents by an order dated 24.06.2020 only account of not seeking permission from the Authorities before taking the treatment in a Hospital outside the State. 3.3 The respondents failed to consider that the ailment-brain hemorrhage of wife of the petitioner could not be treated at Bhilwara and since Doctors referred the patient to the nearby available hospital i.e. Ahmedabad, in such a situation, no prior permission could have been obtained by the petitioner before shifting the patient. 3.4 The entitlement of an employee for medical reimbursement as per treatment available in SMS Medical College, Jaipur or treatment at AIIMS, New Delhi has already been decided by the Coordinate Bench and as such, he refers to an order dated 16.09.2022 passed by Principal Seat at Jodhpur in the case of Ibrahim Khan v. RSRTC & Ors; S.B. Civil Writ Petition No.1388/2015. Learned counsel on the strength of said order submitted that medical claim of the petitioner is required to be allowed in terms of Regulations of 2011. 4. Per contra, counsel for the respondents Ms.Devyani Singh Rathore submitted that the petitioner has not placed on record any proof showing that the emergent treatment of wife of the petitioner was required and further petitioner did not seek any prior permission of the Authorities before availing the facility of treatment in a different hospital situated outside the State. 5. Learned counsel for the respondents further submitted that the petitioner was communicated the decision of the respondent vide order dated 24.06.2020 and as such, no liability can be fastened on the respondents-Corporation to reimburse the medical expenses incurred by the petitioner while admitting his wife in a different hospital outside the State. 6. This Court deems it proper to quote Regulation 9(3) of the Regulations of 2011 and the same reads as under :- "9(3). If a Corporation Employee undertakes indoor treatment of life threatening disease like kidney, heart and some sudden accident, in a private hospital outside the State without reference in case of emergent circumstances. 6. This Court deems it proper to quote Regulation 9(3) of the Regulations of 2011 and the same reads as under :- "9(3). If a Corporation Employee undertakes indoor treatment of life threatening disease like kidney, heart and some sudden accident, in a private hospital outside the State without reference in case of emergent circumstances. Corporation may allow reimbursement of the medical expenses incurred upto the cost of treatment, that would have been incurred and the treatment been taken in SMS Hopital, Jaipur and if facility of that treatment is not available in SMS Hospital, Jaipur upto the cost of treatment at AIIMS, New Delhi, upon such emergent circumstances being explained satisfactorily. No Travelling Allowances shall be admissible in such cases. Provided that if the total expenditure on medical attendance and treatment as per the provisions of sub-Regulation (2) is more than Rs.5 lacs then the Head of Office will refer the case to the Principal of Medical College to constitute a Medical Board to ascertain the genuineness of the claim. The reimbursement on this account shall be governed as per opinion of the Medical Board and the excess claim, if any, shall be disallowed." 7. This Court, on a bare perusal of Regulation 9(3) of the Regulations of 2011, finds that if treatment of life threatening disease is taken in a private hospital outside the State without reference in case of emergent circumstances, the Corporation is required to allow the reimbursement of medical expenses incurred upto the cost of treatment taken in SMS Hospital, Jaipur and if facility is not available in SMS, Jaipur, then the cost of treatment at AIIMS, New Delhi is required to be given. 8. This Court further finds that proviso to Regulation 9(3) further laws down the condition that if treatment is of more than Rs.5 Lacs, then the Head of Office will refer the case to the Principal of Medical College i.e. SMS Medical Jaipur to constitute a Medical Board to ascertain the genuineness of the claim and the reimbursement will be governed as per opinion of the Medical Board and if there is excess claim, the same may be disallowed. 9. This Court finds that the respondents have failed to act as per their own Regulations and as such, they are wrongly denied reimbursement for the expenses incurred by the petitioner in treatment of his wife. 10. 9. This Court finds that the respondents have failed to act as per their own Regulations and as such, they are wrongly denied reimbursement for the expenses incurred by the petitioner in treatment of his wife. 10. This Court finds that the Coordinate Bench at Principal Seat, Jodhpur has also taken a similar view in the case of Ibrahim Khan (supra). 11. The submission of counsel for the respondents that no prior permission was sought before shifting the patient to outside the State, has been noted to be rejected. This Court finds that the regulation itself provides that if there is an emergent situation, employee or any person entitled for medical reimbursement, can take the patient to a hospital which may not be within the State, if the life threatening disease is suffered by the person. 12. The submission of counsel for the respondents that decision has been taken by the respondents while passing the order dated 24.06.2020 and as such, claim of the petitioner was not required to be considered, suffice it to say by this Court that the respondents failed to consider their own Regulation and as such, the rejection letter issued on 24.06.2020 runs contrary to the regulation. 13. This Court, accordingly, allows the present writ petition and the respondents are directed to reimburse the medical claim of the petitioner with extent possible under the terms of Regulations of 2011. 14. The claim of the petitioner if is more than Rs.5 Lakh then the Head of Office is also required to refer the matter to the Medical College to constitute a Medical Board to ascertain the genuineness of the claim and if the Board gives opinion in favour of the petitioner, claim of the petitioner has to be dealt with accordingly. 15. The respondents are directed to carry out the aforesaid exercise within a period of six weeks after receipt of copy of this order. 16. The petitioner would also be entitled for interest @ 6% per annum on the amount to be paid to the petitioner on account of medical reimbursement of the actual expenses incurred by the petitioner. 17. The petition stands allowed accordingly.