This court held that government employees are entitled to medical reimbursement even if treatment is received in a private railway hospital, as the real test is the factum of treatment. The writ petition was allowed.
Respondents directed to reimburse ₹1,48,307/- at applicable rates in recognized hospitals within three months with 6% interest on delay.
This page shows the compact analysis of this judgement. The full analysis — procedural history, issue-by-issue holdings with ratio and obiter, advocates, and paragraph-level evidence for every claim — is being added to the record in batches and will appear here when this judgement has been through it.
HIGH COURT OF JUDICATURE FOR RAJASTHAN BENCH AT JAIPUR
S.B. Civil Writ Petition No. 11225/2009
Dalip Singh Nehra son of Shri Tota Ram Nehra, aged about 77 years, resident of Indrapuri Loharu Road, (Rajasthan) Pilani, District Jhunjhunu.
Petitioner
Versus
1.Stute of Rajasthan through its Chief Secretary, Secretariat, Jaipur.
....Respondents
For Petitioner(s) : Mr. Prakash Kaushik For Respondent(s) : Mr. Rohit Choudhary, Dy.GC with Mr. Pankaj Choudhary
HON'BLE MR. JUSTICE ANOOP KUMAR DHAND
Order
21/08/2023
Instant petition has been filed by the petitioner with the
following prayer:
“A. to accept this writ petition and set-aside the order dated 23.6.2008 vide Annexure-1 and direct the respondents to make payment of Medical Bill reimbursement dated 21.3.2008 (Annexure-3);
B. Any other appropriate orders which Hon'ble Court finds just and proper in the facts and circumstances of the case be passed in favour of the petitioner.
C. Cost of the petition be also allowed.”
[CW-11225/2009]
(2 of 4)
Learned counsel for the petitioner submits that the petitioner suffered severe chest pain on the fateful day and looking to his critical condition, he was admitted in Fortis Escorts Hospital where his Coronary Artery Bypass Graft was done in which he has occurred expenses of Rs.1,48,307/-. Counsel submits that after recovery the petitioner submitted an application for reimbursement of the aforesaid amount but the respondents have refused to reimburse the same on a technical count that the treatment was taken in a private unapproved hospital. Counsel submits that the respondents be directed to reimburse the medical bills to the petitioner as per rates applicable for approved hospital.
Per contra, learned counsel for the respondents opposed the arguments raised by the counsel for the petitioner and submitted that the treatment was taken by the petitioner in a private hospital, hence the petitioner is not entitled to get any amount of medical bills, hence the respondents have not caused any illegality in refusing the medi-claim of the petitioner.
Heard and considered the submissions made at the Bar and perused the material available on the record.
This fact is not in dispute that under the critical condition the petitioner was admitted in Fortis Escorts Hospital where his Coronary Artery Bypass Graft was done in which he has occurred expenses of Rs.1,48,307/-. This fact is also not in dispute that after recovery the petitioner submitted an application for reimbursement of the aforesaid amount and the said application was rejected by the respondents on a technical count that the treatment was taken in a private hospital.
[CW-11225/2009]
(3 of 4)
The issue involved in this petition has already been set at
rest by the Hon’ble Apex Court in the case of Shiva Kant Jha Vs.
Union of India (UIO), reported in 2018 (16) SCC 187 as under:-
"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 commonsense, 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 ina 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....."
Following the aforesaid ratio as laid down by the Hon’ble Apex Court in the case Shiva Kant Jha (supra), this Court has reiterated the same position in the case of Rama Prasad Sharma Vs. State of Rajasthan and Ors. (SBCWP No. 7469/2016) decided on 21.02.2022 and Mansho Ram Sharma vs. State of Rajasthan and Ors. (SB CWP No.1021/2011) decided on 12.04.2023, where in it has been upheld by this Court that even in case where the treatment of an employee has been taken in a nonrecognized hospital, the medical reimbursement has to be made at
[CW-11225/2009]
(4 of 4)
the rate that may be applicable for similar treatment in a recognized hospital.
The ratio as propounded by the Hon’ble Apex Court as well as by this Court in the aforesaid judgements clearly indicate that even in cases where an employee undertakes treatment in a nonGovernment hospital/private hospital, reimbursement of the medical bills has to be made to the extent of relevant rules/scheme/policy.
Therefore, in view of the ratio as laid down by the Hon’ble Apex Court in the case of Shiva Kant Jha (supra) and this Court in the case of Mansho Ram Sharma (supra) and looking to the peculiar facts and circumstances of the present case, the writ petition is disposed of with directions to the respondents to consider the case of the petitioner and reimburse the amount as per applicable rates in recognized hospitals.
The respondents are directed to do the needful within a period three months from the date of receipt of a certified copy of this order.
It is made clear that in case compliance of this order is not made within the stipulated time, then the petitioner would be entitled to get interest @ 6% per annum.
All pending application(s), if any, also stands disposed of.
(ANOOP KUMAR DHAND),J
KuD/102
2 issues framed by the court
Whether the petitioner, a government employee, is entitled to medical bill reimbursement for treatment in a private hospital not listed in Government Orders.
Whether rejection of medical claims solely on the ground that the hospital is unapproved is a valid fetter on the employee's right to medical facilities.
Colour shows how this judgement treated each authority
Shiva Kant Jha Vs. Union of IndiaRelied on¶29
2018 (16) SCC 187 · Who else cites this
Rama Prasad Sharma Vs. State of Rajasthan and Ors.Referred¶31
SBCWP No. 7469/2016
Mansho Ram Sharma vs. State of Rajasthan and Ors.Relied on¶31
SB CWP No.1021/2011
Dalip Singh Nehra
State of Rajasthan through its Chief Secretary
The Director, Pension Department
Treasury Officer, Treasury and Accounts Department
Anoop Kumar Dhand
As recorded by the court registry
Judgements on the same questions, provisions and authorities, from every court
