Manager, Ramsnehi Chikitsalaya and Anusandhan Kendra v. Nanuram
2024-05-28
VINIT KUMAR MATHUR
body2024
DigiLaw.ai
ORDER : Vinit Kumar Mathur, J. - Heard learned counsel for the parties. 2. The present writ petition has been filed against the order dated 10.10.2023 passed by the learned Permanent Lok Adalat, Bhilwara, whereby the application filed by the respondent No.1 under section 22B of the Legal Services Authorities Act, 1987 was allowed. 3. Briefly noted the facts in the present writ petition are that the respondent No.1 suffered an ailment of the heart and he was rushed to the hospital of the petitioner, wherein the respondent No.1 undergone an operation. The expenditure incurred in the treatment of the respondent No.1 was Rs. 1,24,000/-, which amount was entirely paid by the respondent No.1. The respondent No.1 is insured under the 'Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojna'. The respondent No.1 submitted the documents before the hospital authorities showing that he is covered by the 'Ayushman Bharat Sheme' of the State Government, therefore, the expenditure incurred in his treatment may be recovered from the State Government, however, those documents were not received by the petitioner. 4. Although, the entire amount was paid by the respondent No.1, however, immediately after the discharge from the hospital, the respondent No.1 filed the requisite documents before the District Collector, Bhilwara for reimbursement of the expenditure incurred in his treatment. Since the amount was not paid to the respondent No.1, the respondent No.1 preferred an application before the Permanent Lok Adalat, Bhilwara under section 22B of the Legal Services Authorities Act, 1987. The Permanent Lok Adalat, Bhilwara, after hearing the counsel for the parties, allowed the application preferred by the respondent No.1 vide order dated 10.10.2023 and awarded a sum of Rs. 1,16,420/- in favour of the respondent No.1 along with a cost of Rs. 5000/- to be recovered from the petitioner. Aggrieved of the order dated 10.10.2023, the present writ petition has been filed. 5. Learned counsel for the petitioner vehemently submits that no document was submitted by the respondent No.1 which shows that petitioner is insured under the 'Ayushman Bharat Bima Yojana' and, therefore, the petitioner has rightly charged the amount from the respondent No.1 for extending him the treatment.
Aggrieved of the order dated 10.10.2023, the present writ petition has been filed. 5. Learned counsel for the petitioner vehemently submits that no document was submitted by the respondent No.1 which shows that petitioner is insured under the 'Ayushman Bharat Bima Yojana' and, therefore, the petitioner has rightly charged the amount from the respondent No.1 for extending him the treatment. Learned counsel further submits that the claim petition itself before the Permanent Lok Adalat, Bhilwara was filed by the respondent No.1 after a period of one year from the date of his operation, which clearly shows that the respondent No.1 was negligent in not submitting the requisite documents for getting the benefit under the 'Ayushman Bharat' Scheme. He submits that if the requisite documents are submitted to the petitioners at this point of time, then objections may be raised by the State Government for grant of amount under the 'Ayushman Bharat' Scheme and the petitioner-Hospital will suffer loss of the same for no fault of them. He therefore prays that the writ petition may be allowed and the order dated 10.10.2023 may be quashed and set aside. 6. Per contra, the learned counsel for the respondent No.1 submits that the condition of the respondent No.1 was critical and at that point of time, it did not occur to the relatives of the respondent No.1 to submit the documents of the 'Ayushman Bharat' Scheme, however, subsequently after the operation was performed, although the requisite documents were submitted, but the hospital authorities i.e. the petitioner failed to receive the same. He submits that immediately after the discharge from the hospital, the respondent No.1 approached the District Collector and filed the requisite documents for reimbursement of the amount incurred in the treatment. Since the amount was not reimbursed to the respondent No.1, he was constrained to file an application before the Permanent Lok Adalat. 7. Learned counsel for the respondent No.1 submits that as far as the respondent No.1 being covered under the 'Ayushman Bharat' Scheme is concerned, there is no dispute, as the respondent No.1 is holding all the requisite documents showing that he is covered under the said Scheme. In these circumstances, he submits that the order passed by the Permanent Lok Adalat, Bhilwara is just, proper and correct and does not call for any interference. 8.
In these circumstances, he submits that the order passed by the Permanent Lok Adalat, Bhilwara is just, proper and correct and does not call for any interference. 8. I have considered the submissions made at the bar and have gone through the relevant record of the case. 9. The fact that the respondent No.1 is covered under the 'Ayushman Bharat' Scheme is not disputed and the requisite documents produced before the Permanent Lok Adalat, Bhilwara show that he is a bonafide person who is covered under the 'Ayushman Bharat' Scheme for getting the treatment. 10. The fact that requisite documents showing the respondent No.1 being covered under the 'Ayushman Bharat' Scheme were not produced by him at the time of admission in the hospital will not disentitle the respondent No.1 to get the benefit under the scheme. Since the respondent No.1 was having the heart ailment and at that point of time, he and his family members must not be in a correct frame of mind, therefore, it could have been a bonafide mistake on their part to have not produced the requisite documents before the hospital authorities. However, in the opinion of this court, if those documents are produced subsequently before the hospital authorities or the competent authorities of the State Government, it will not disentitle the respondent No.1 to get the benefits under the 'Ayushman Bharat' Scheme. 11. Nothing has been brought on record or submitted before this court which shows that if a person does not submit the requisite documents of he/she being covered under the 'Ayushman Bharat' Scheme at the time of treatment, the same will disentitle him to get the benefit of the scheme. Since in the present case, the petitioner is covered by the scheme and merely because he had not produced those documents at the time of treatment will not be taken as a situation where he can be denied the benefit of the scheme. The learned Permanent Lok Adalat, Bhilwara has considered the matter in the right perspective and has rightly ordered the petitioner to reimburse the amount incurred by the respondent No.1 for his treatment. 12. In view of the discussions made above, the writ petition is disposed of with a direction to the petitioner to refund the amount of Rs.
The learned Permanent Lok Adalat, Bhilwara has considered the matter in the right perspective and has rightly ordered the petitioner to reimburse the amount incurred by the respondent No.1 for his treatment. 12. In view of the discussions made above, the writ petition is disposed of with a direction to the petitioner to refund the amount of Rs. 1,16,420/- as ordered by the learned Permanent Lok Adalat, Bhilwara in favour of the respondent No.1 within a period of two weeks, provided the respondent No.1 furnishes the entire documents of him being covered under the 'Ayushman Bharat' Scheme to the petitioner. 13. The petitioner shall take up the matter of reimbursement of the amount incurred in the treatment of the respondent No.1 with the State Government and the State Government shall consider the same in accordance with law and remit the amount to the petitioner within a period of eight weeks thereafter. 14. The cost of Rs. 5,000/- imposed by the Permanent Lok Adalat, Bhilwara is quashed and set aside. 15. Stay petition as well as other pending applications, if any, shall also stand disposed of.