Partly allowed

Harbansh Singh v. State of Rajasthan

Rajasthan HC17 Oct 2022CW/6310/2020

Case brief

AI extract

What is this about?

This court held that denying medical reimbursement to a retired employee solely because treatment was taken in a private hospital without an emergent situation is illegal. The petition was partly allowed, directing the respondent to reconsider the claim.

What did the court decide?

Directing the respondents to reconsider the petitioner's claim and reimburse the amount for medicines, drugs, anesthesia, and room charges under the Rules of 2013 within four weeks.

Harbansh Singh Vs State of Rajasthan — 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. 6310/2020

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Harbansh Singh S/o Late Sh Sardar Singh Khanuja, Aged About 65 Years, R/o 8/124, Sindhunagar District Bhilwara

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----Petitioner

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Versus

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State Of Rajasthan, Through District Collector Bhilwara 2. District Treasury Officer, Treasury Office, District Collectorate Building, Bhilwara

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State Consumer Grievance Redressal Commission, Through Deputy Registrar, Ashok Marg, C-Scheme, Jaipur- 302001

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Learned District Consumer Forum, Bhilwara.

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----Respondents

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For Petitioner(s)	: Mr. Chayan Bothra
For Respondent(s)	: Mr. Ravi Panwar

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HON'BLE MR. JUSTICE KULDEEP MATHUR

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Order

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17/ 10/2022

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Brief facts necessary for adjudication of present writ petition are as follows:-

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The petitioner who is a retired employee of the respondentdepartment, underwent medical treatment for ‘High Grade Carcinoma’. A sum of ₹5,76,000 was incurred for the aforesaid treatment. The medical bills submitted by the petitioner for reimbursement were returned by the respondent-department vide letter dated 15.06.2018 on the ground that medical board constituted to determine illness and emergency for aforesaid treatment in its report dated 26.05.2018 had opined that “cancer bladder is not an emergency”. The petitioner being aggrieved by

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(2 of 6)

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[CW-6310/2020]

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the letter dated 15.06.2018 and medical board report dated 26.05.2018, preferred a complaint before the District Consumer Protection Forum, Bhilwara which came to be allowed vide order dated 28.11.2018, directing the respondents to reimburse a sum of ₹3,56,000, ₹25,000 and ₹5,000 towards medical expenses, mental agony and litigation expenses respectively (Total ₹3,86,000) alongwith interest @ 6% per annum from the date of filing of the complaint. The respondent-department being aggrieved by the order dated 28.11.2018, filed an appeal before the State Consumer Grievances Redressal Commission, Jaipur which came to be allowed vide order dated 11.02.2020, observing that since the petitioner was an employee of the State Government, he cannot be considered ‘consumer’, and therefore, the complaint filed before District Consumer Protection Forum, Bhilwara was held to be not maintainable. It is informed that while the appeal was pending before the State Consumer Grievances Redressal Commission, Jaipur, respondent-department reimbursed medical expenses qua the treatment, to the petitioner in compliance of the order dated 28.11.2018 passed by District Consumer Protection Forum, Bhilwara. Since, the order passed by District Consumer Protection Forum, Bhilwara had been reversed in appeal, the petitioner apprehended recovery of the amount already disbursed to him pursuant to order dated 28.11.2018. In the writ petition, it is pleaded that the expenditure incurred by the petitioner in taking treatment is reimbursable. Therefore, he may be permitted to retain the payment already made against in compliance of order dated 28.11.2018. Further, it is pleaded that the respondents may be directed to reimburse the remaining

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(3 of 6)

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[CW-6310/2020]

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payment qua the treatment taken by the petitioner in a private hospital in the emergent situation.

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Learned counsel for the petitioner submitted that the factum regarding petitioner suffering from bladder cancer has been admitted by the medical board in its report dated 26.05.2018, thus, the rejection of the medical claim on the ground that the petitioner failed to show emergent situation for taking treatment in private hospital is not tenable. Counsel further submitted that merely because petitioner prior to filing of present writ petition approached wrong redressal forum, this would not disentitle the petitioner from seeking reimbursement of the expenses incurred qua the treatment pertaining to ‘High Grade Carcinoma’. In the alternative, it was prayed that the petitioner be allowed to retain the amount already disbursed in compliance of order dated 28.11.2018 passed by District Consumer Protection Forum, Bhilwara.

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Per contra, learned counsel for the respondents submitted that the petitioner undertook treatment in private hospital of own volition without there being any emergent situation warranting treatment in absence of reference by a Government hospital in accordance with the Rajasthan Civil Services (Medical Attendance) Rules, 2013. Learned counsel further submitted that medical bills submitted by the petitioner had already been partially reimbursed in compliance of order dated 28.11.2018, therefore, once order dated 28.11.2018 had been set aside in appeal, the petitioner cannot be permitted to retain the amount paid in compliance of aforesaid order.

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Heard submissions advanced at Bar and perused the material available on record.

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(4 of 6)

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[CW-6310/2020]

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A coordinate Bench of this Court in the case of Satyapal Singh vs. State of Rajasthan & Ors. (S.B. C.W.

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No.4678/2019) , held as under:-

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“So far as the question regarding the treatment undertaken in a private and unrecognized hospital is concerned, the law on the point is no more res integra.

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In Shiva Kant Jha Vs. Union of India (UOI); AIR 2018 SC 1975 decided on 13.04.2018, the Hon'ble Apex Court held as under: -

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"It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment….."

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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:-

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“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."

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In Rama Prasad Sharma v. State of Rajasthan and Ors.; SBCWP No.7469/2016 decided on 21.01.2022, 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

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(5 of 6)

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[CW-6310/2020]

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medical reimbursement has to be made at the rate that may be applicable for similar treatment in the recognized government hospitals."

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The ratio as laid down in the above judgments makes it clear that the law on the point is settled that even in the 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 Hospital. So far as the present matter is concerned, the amount which has been reimbursed is only qua the procedure undertaken. So far as the medicines, drugs, anesthesia and room charges etc., are concerned, no amount qua the same has been reimbursed and admittedly the same is payable in terms of the Rules of 2008.

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Therefore, in view of the ratio as laid down by

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the Hon'ble Apex Court and in view of the observations as made above, the present writ petition is partly allowed. The respondents are directed to reconsider the claim of the petitioner and reimburse the amount qua the medicines, drugs, anesthesia, room chargesand all other heads as payable in terms of the Rules of 2008. The complete consideration and reimbursement thereof would be made within a period of four weeks from the date of receipt of the copy of this order. The said amount would not carry interest looking to the delay caused in filing of the present writ petition.

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All pending applications also stand disposed of”

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Similarly, this court in the case of Anda Ram vs. State of

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Rajasthan & Ors. (S.B. C.W. No.1464/2016) , held as under:-

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“The hyper technical ground cannot supersede the object of Medi-claim policies i.e. to provide shield against increasing medical costs due to hospitalization in severe illness. The claim cannot be merely rejected on these hyper technical grounds when the treatment is not disputed by the respondent-department.”

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The J & K & L High Court recently in the case of Bimla Ji

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Bhat vs. Union of India (OWP No.1726/2015), held as under:

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“The amount of medical reimbursement is constitutional obligation towards sufferer which is a beneficial legislation in a welfare State for its employees, therefore, the rules and instructions

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(6 of 6)

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[CW-6310/2020]

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formulated should be construed liberally in favour of the employees for granting them the relief rather than to adopt the wooden attitude to deprive the person of his/her dues.”

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In view of enunciation of law by the Hon’ble Apex Court and the J & K & L High Court and this Court, the present writ petition is partly allowed. The denial of reimbursement of medical bills submitted by the petitioner only on the ground of having taken treatment in a private hospital without emergency is declared illegal. The respondent-department is directed to consider the petitioner’s claim for reimbursement of the medical bills qua treatment undertaken to the extent permissible under the Rules of 2013. In case, after consideration, it is found that petitioner is entitled for reimbursement over and above the amount already disbursed, then the same shall be released in favour of the petitioner within a period of two months from the date of this order. If the amount already disbursed in compliance of order dated 28.11.2018 is found to be more than the entitlement as per the Rajasthan Civil Services (Medical Attendance) Rules, 2013, then the petitioner shall deposit the same with the respondentdepartment within a period of three months from date of such assessment arrived at by the respondent-department.

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No order as to costs.

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(KULDEEP MATHUR),J

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KshamaD/-

Harbansh Singh v. State of Rajasthan

Case brief

What is this about?

What did the court decide?

Harbansh Singh v. State of Rajasthan

Case brief

What is this about?

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