Allowed

Ibrahim Khan v. Raj. State Road Trans. Corpn. and Anr.

Rajasthan HC16 Sept 2022CW/1388/2015

Case brief

AI extract

What is this about?

The High Court of Rajasthan allowed a writ petition seeking reimbursement of medical expenses. The Court held that under emergent circumstances involving life-threatening diseases, an employee is entitled to reimbursement at the rate applicable to recognized government hospitals, even if treatment was undertaken in a non-empanelled private hospital outside the state.

What did the court decide?

Reimbursement of medical claim to the extent permissible under Regulations, 2011, calculated at the rate applicable to recognized government hospitals, with 6% interest per annum.

Ibrahim Khan Vs Raj. State Road Trans… — Pension and Retirement Benefits | Rajasthan HC (2022)

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HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR

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S.B. Civil Writ Petition No. 1388/2015

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Ibrahim Khan S/o Shri Kasam Khan, aged about 59 years, by caste Mohammedan, Resident of Nawabganj, Pajtalai, Nimbeheda, District Chittorgarh (Rajasthan).

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----Petitioner

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Versus

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Raj. State Road Transport Corporation, through its Chief Managing Director, Parivahan Marg, Jaipur (Raj.)

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Chief Manager, R.S.R.T.C., Chittorgarh Depot, Chittorgarh (Rajasthan).

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		----Respondents
For Petitioner(s)	: Mr. Zafar Khan. Mr. Pritam Joshi.
For Respondent(s)	: Mr. Sunil Purohit.

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HON'BLE MR. JUSTICE KULDEEP MATHUR

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Order

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16/09/2022

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The petitioner has preferred this writ petition assailing the order dated 19.08.2014 (Annex.-5), whereby the competent authority i.e. respondent No.2 returned the application dated 04.04.2014 for reimbursement of the medical claim of Rs.1,75,697/- even after submission of all medical bills.

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The case of the petitioner is that he suffered severe chest pain on 06.04.2013, whereupon he was taken to the nearest hospital at Nimbaheda. On the advice of treating Doctors and upon the opinion of Cardiologist, he was taken to CIMS Hospital Private Limited at Ahmedabad for treatment. The treating Doctors of CIMS Hospital Private Limited conducted an operation for

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(2 of 4) [CW-1388/2015]

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removing blockage in the heart of petitioner. The petitioner was subsequently discharged from the hospital on 09.04.2013. The petitioner thereafter raised a medical claim of Rs.1,75,697/- for reimbursement but the same was rejected vide order dated 19.08.2014 on the ground that treatment undertaken by the petitioner was not from a recognized hospital or referral hospital.

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Learned counsel for the respondents vehemently submitted that once petitioner has underwent treatment from a private Hospital which is not an empanelled/ approved/ referral hospital, he would not be entitled for the reimbursement of the amount claimed and therefore, the bills submitted by the petitioner were rightly rejected/ returned back to him.

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Heard learned counsel for the parties.

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The regulation 9.(3) of the RSRTC Medical Attendance Regulations, 2011 (hereinafter referred to as ‘Regulations, 2011), which reads as under:-

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“ 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

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(3 of 4)

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[CW-1388/2015]

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Travelling Allowances shall be admissible in such cases.

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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.”

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From perusal of aforesaid regulation, it is clear that in case an employee had taken 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 may allow reimbursement of the medical expenses incurred up to the cost of treatment that would have been incurred and had the treatment been taken in SMS Hospital, Jaipur.

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Admittedly, the petitioner in the emergent circumstances has undergone an operation at CIMS Hospital Private Limited at Ahmedabad and was discharged on 09.04.2013.

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In Rama Prasad Sharma Vs. State of Rajasthan & Ors.;S.B.C.W.P. No.7469/2016 , the coordinate Bench of this Court held as under :

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“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

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(4 of 4)

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[CW-1388/2015]

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for similar treatment in the recognized government hospitals.”

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In State of Rajasthan & Ors. Vs. Tikam Chand Maloo; D.B.S.A.W. No.1124/2015 , the Division Bench of this Court held as under :

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“it is obvious that this Court took view that in emergent situation, if the Govt. employee took treatment outside the State that too in unrecognized hospital, as per Rules then also, he is entitled for reimbursement of the medical expenses which are scheduled under the Rules.”

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In view of the ratio laid down in Rama Prasad Sharma (supra) and Tikam Chand Maloo (supra) and in view of the observations as made above, the petitioner is entitled to the reimbursement of his medical claims to the extent as permissible in terms of Regulations, 2011.

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The present writ petition is therefore allowed and the respondent authorities are directed to reimburse the medical claim of the petitioner to the extent permissible in terms of Regulations, 2011. The entire exercise be taken by the respondent authorities within a period of three weeks from the date of the present order. It is made clear that the reimbursable amount would also carry an interest at the rate of 6% per annum.

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(KULDEEP MATHUR),J

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4- Prashant/-

Ibrahim Khan v. Raj. State Road Trans. Corpn. and Anr.

Case brief

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Ibrahim Khan v. Raj. State Road Trans. Corpn. and Anr.

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