Illustratively, reference may be had to the judgment
rendered by a Coordinate Bench of this Court in Kanhaiya Lal
Dave Versus State of Rajasthan & Ors.: S.B. Civil Writ
Petition No. 420/2009, which in turn relies on another division
bench precedent, wherein it is held as below:
“8.This Court considered the issue of emergent situation in the case
of Gyanendra Kumar Pareek Vs. State of Rajasthan & Ors. Reported
in 2009(4) WLC(Raj.)-95 and held that when a family member
suffers from cardiac ailment, the prime objective of the other family member would be to save his/her life. At that time, services of whichever hospital is suited could be utilized because emergency knows no law and no procedure and when human life is at stake, in such situation, ultimate responsibility of the State cannot be washed off. This Court relied upon the decision of the Division Bench of this Court in Anil Kumar Surolia Vs. State of Rajasthan reported in 2005(3) WLC(Raj.)- 396 wherein the Division Bench observed as under:-
“Government cannot insist upon an employee
to get himself treated at recognized government
institution. All that the Government in these
circumstances can do is to reimburse the concerned
employee at the rates that may be applicable in the
recognized government institution. Reference in this
connection may be made to the judgment of the
Honble Supreme Court in Surjit Singh Vs. State of
Punjab reported in AIR 1996 SC-1388 and State of
Punjab & Ors. Vs. Mohan Lal Jindal reported in
(2001) 9 SCC-217. Consequently, the reimbursement
of the medical expenses borne by the State
Government employees and pensioners has to be done
even if the treatment is undertaken at unrecognized
hospital outside the State even though reference may
not have been taken prior to treatment.”
x-x-x-x-x-x-x
10.Thus, as per scheme of medical concession applicable to the retired employees, the only hurdle against the petitioner for being granted reimbursement of the medical bills is that his wife was subjected to treatment at an unrecognised hospital outside the State and that too without a reference being made. However, as has been noted above, the Division Bench of this Court has already laid the issue to rest by observing that even if the treatment is taken at an unrecognized hospital and without any reference, the reimbursement thereof has to be done at the rates prescribed in the Concession Scheme. x-x-x-x-x-x”
11. On a specific query being put to the learned counsel for the respondents, as to whether the aforesaid judgment is applicable to the case of the petitioner herein; the answer given is in the affirmative. Not only that, it transpires that the aforesaid Single Bench Judgment has attained finality as no intra-Court appeal was filed against the same.
12. In the premise, I see no reason why the benefit thereof is
not also accorded to the petitioner, who is similarly situated.
Question framed in Para 5 of the preceding para of the instant
order is thus answered in affirmative.
HIGH COURT OF JUDICATURE FOR RAJASTHAN AT
JODHPUR
S.B. Civil Writ Petition No. 5714/2011
Sohan Lal Sharma Vs State Finance And Ors
HON'BLE MR. JUSTICE ARUN MONGA
Dated: 04/12/2024.
Citation: [2024:RJ-JD:49546]
1. Grievance of the petitioner herein arises out of an order
dated 27.05.2008 (Annex.5), vide which his claim for medical
reimbursement was rejected on the ground that he received
treatment from a non-recognized hospital. Further, he seeks
quashing of a subsequent communication dated 16.06.2008
(Annexure 6) which it was reiterated that his claim cannot be
accepted.
2. Relevant facts first. The petitioner served as a Lecturer at
District Institute of Education and Training (D.I.E.T.), Jodhpur until
he superannuated on 31.01.2002. As a confirmed and regular
employee of the State of Rajasthan, he was entitled to all benefits,
including medical benefits admissible to State Government
employees.
2.1. On 25.05.2007, petitioner suffered a cardiac arrest. Under
emergency, he was admitted to Goyal Hospital, Jodhpur, for
treatment. To save his life, doctors recommended immediate
[2024:RJ-JD:49546] (2 of 5) [CW-5714/2011]
surgery. Consequently, on 01.06.2007, the petitioner underwent
heart surgery at the hospital and was discharged on 12.06.2007.
2.2. At the relevant time, the Hospital i.e. Escorts Goyal Heart
Center, Jodhpur provided cardiac care facilities in collaboration
with Escorts Heart Institute & Research Center, New Delhi. After
recovering from the ailment, the petitioner submitted a medical
reimbursement claim of Rs. 2,03,063.86 before the competent
authority. On 02.03.2008, he also executed an affidavit affirming
his admission to the hospital from 25.05.2007 to 12.06.2007.
2.3. By letter dated 16.06.2008 petitioner's claim for medical
reimbursement was rejected on the ground that he was treated in
year 2007 at a non-recognized hospital.
2.4. Pertinently, in 2008, aforesaid Goyal Hospital, Jodhpur, was
recognized by the respondent department as an authorized
hospital. Following this recognition, medical reimbursement claims
of other state employees, treated at the hospital, were duly
processed and accepted. However, petitioner’s claim was denied
on the ground that the hospital was not recognized at the time of
his treatment. His surgery was undertaken in a life-threatening
situation, with no other viable alternative, is not in dispute. Hence
this petition.
3. Stand taken by the respondents in their counter-affidavit,
inter alia, is that medical reimbursement of pensioners is
governed by the Rajasthan Pensioners Medical Concession
Scheme (hereinafter referred to as "the Scheme"). The Scheme
permits free medical attendance and treatment for pensioners
only at authorized hospitals, clinics, or institutes as per Clauses 4
to 4(g). The petitioner’s claim does not comply with these
[2024:RJ-JD:49546] (3 of 5) [CW-5714/2011]
provisions. Reimbursement is permitted only under the prescribed
rules and limits, and government employees cannot claim
expenses beyond what is provided under these rules. The Finance
Department (Rules Division) of the Government of Rajasthan
issued Circular No. F.6(4)FD (Rules)/03 PT dated 05.05.2011
providing guidelines for medical reimbursement claims, including
those for cardiac surgeries and other treatments. The petitioner is
not entitled to full reimbursement of the expenses incurred for his
bypass surgery as the treatment was availed at a private,
unrecognized hospital, contrary to the provisions of the scheme.
Hence, the present writ petition is liable to be dismissed.
4. In the aforesaid backdrop, I have heard the rival contentions
and gone through the case record.
5. What emerges before this Court for adjudication lies in a
very narrow compass, i.e., whether a Government Official or a
pensioner, in an emergent situation, having undergone treatment
at a private hospital, is entitled to seek reimbursement of the
medical expenses?
6. Before addressing the issue, first and foremost, what
requires to be noticed is that the petitioner herein was in an
emergent situation is not disputed, as is borne out from the stand
taken in the reply.
7. The petition is being opposed on the ground that since the
private hospital was not empaneled, therefore, the only admissible
claim of the petitioner has to be the upper limit of the expenses
payable to him as notified under the Service Rules.
8. Learned counsel for the respondents apprises the Court that
the petitioner has already been paid a sum of Rs.48,000/- as per
[2024:RJ-JD:49546] (4 of 5) [CW-5714/2011]
the Rules. He contends, that the petitioner is not entitled to the
balance of the claim as per his medical bills qua the expenditure
incurred in the unpaneled private hospital.
9. I am unable to persuade myself with the stand taken by the
learned counsel for the respondents in light of the settled position
of law, vide a catena of judgments rendered from time to time.
10. Illustratively, reference may be had to the judgment
rendered by a Coordinate Bench of this Court in Kanhaiya Lal
Dave Versus State of Rajasthan & Ors.: S.B. Civil Writ
Petition No. 420/2009, which in turn relies on another division
bench precedent, wherein it is held as below:
“8.This Court considered the issue of emergent situation in the case
of Gyanendra Kumar Pareek Vs. State of Rajasthan & Ors. Reported
in 2009(4) WLC(Raj.)-95 and held that when a family member
suffers from cardiac ailment, the prime objective of the other family
member would be to save his/her life. At that time, services of
whichever hospital is suited could be utilized because emergency
knows no law and no procedure and when human life is at stake, in
such situation, ultimate responsibility of the State cannot be washed
off. This Court relied upon the decision of the Division Bench of this
Court in Anil Kumar Surolia Vs. State of Rajasthan reported in
2005(3) WLC(Raj.)- 396 wherein the Division Bench observed as
under:-
“Government cannot insist upon an employee
to get himself treated at recognized government
institution. All that the Government in these
circumstances can do is to reimburse the concerned
employee at the rates that may be applicable in the
recognized government institution. Reference in this
connection may be made to the judgment of the
Honble Supreme Court in Surjit Singh Vs. State of
Punjab reported in AIR 1996 SC-1388 and State of
Punjab & Ors. Vs. Mohan Lal Jindal reported in
(2001) 9 SCC-217. Consequently, the reimbursement
of the medical expenses borne by the State
Government employees and pensioners has to be done
even if the treatment is undertaken at unrecognized
hospital outside the State even though reference may
not have been taken prior to treatment.”
x-x-x-x-x-x-x
10.Thus, as per scheme of medical concession applicable to the
retired employees, the only hurdle against the petitioner for being
granted reimbursement of the medical bills is that his wife was
subjected to treatment at an unrecognised hospital outside the State
and that too without a reference being made. However, as has been
noted above, the Division Bench of this Court has already laid the
issue to rest by observing that even if the treatment is taken at an
unrecognized hospital and without any reference, the reimbursement
thereof has to be done at the rates prescribed in the Concession
Scheme. x-x-x-x-x-x”
11. On a specific query being put to the learned counsel for the
respondents, as to whether the aforesaid judgment is applicable to
the case of the petitioner herein; the answer given is in the
affirmative. Not only that, it transpires that the aforesaid Single
Bench Judgment has attained finality as no intra-Court appeal was
filed against the same.
12. In the premise, I see no reason why the benefit thereof is
not also accorded to the petitioner, who is similarly situated.
Question framed in Para 5 of the preceding para of the instant
order is thus answered in affirmative.
13. Accordingly, the petition is allowed. Respondents are directed
to verify and process the medical bills of the petitioner, and if
found in order, his claim to be processed as prescribed rates, and
after deducting the amount already paid, the balance be paid with
interest @ 6% with effect from 30 days after the submission of
the bills from the actual date of it.
14. Pending application(s), if any, stand disposed of.
(ARUN MONGA),J
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