Rajat R vs State Of Rajasthan (2024:Rj-Jd:24311)

Rajasthan High Court - Jodhpur

Rajat R vs State Of Rajasthan (2024:Rj-Jd:24311) on 28 May, 2024

[2024:RJ-JD:24311]



     HIGH COURT OF JUDICATURE FOR RAJASTHAN AT
                            JODHPUR
             S.B. Civil Writ Petition No. 7400/2021
Rajat R S/o Shri K. Rajan, Aged About 28 Years, R/o
Sobhalayam, Kattanam, Alappuzha, Kerala State - 690503,
Presently Residing At House No. 73/5, Bank Colony, Military
Hospital Road, Rai Ka Bagh, Jodhpur, Mobile No. 8239603780
                                                     ----Petitioner
                              Versus
1.    State Of Rajasthan, Through Its Additional Chief
      Secretary, Department Of Medical, Health And Family
      Welfare, Secretariat, Jaipur.
2.    The Director, State Insurance And Provident Fund
      Department, (General Insurance Fund), D Block, Vitta
      Bhawan, Janpath, Jaipur.
3.    The Joint Director, Medical And Health Services, Zone
      Jodhpur, Jodhpur.
4.    The Assistant Director, State Insurance And Provident
      Fund Department, Jodhpur City, Jodhpur.
                                                 ----Respondents


 For Petitioner(s)          :    Mr. Yashpal Khileree.
 For Respondent(s)          :    Mr. H.S. Chundawat for
                                 Mr. Mahaveer Bishnoi, AAG.

         HON'BLE MR. JUSTICE ARUN MONGA

Order (Oral) 28/05/2024

1. The grievance of the petitioner herein is against an order dated 07.01.2021 (Annex.11), by which the petitioner's claim for medical reimbursement was rejected on the ground that the petitioner was admitted to a non-panel hospital.

2. Briefly, the relevant facts as pleaded in the petition are that the petitioner was initially appointed to the post of LDC / Junior Assistant by an order dated 27.08.2012 (Annex.1). During his service tenure, he took 47 days of privilege leave (Annex.5) and went to his native place in Kerala on 24.07.2020. On 04.09.2020, he fell seriously ill and was taken to Lokeshore Hospital in Kochi, Kerala. On 05.09.2020, he underwent a kidney operation and was (Downloaded on 03/06/2024 at 08:34:28 PM) [2024:RJ-JD:24311] (2 of 5) [CW-7400/2021] discharged on 10.09.2020 (Annex.6). The petitioner incurred a total amount of Rs. 1,49,289/- for his operation. 2.1 The petitioner submitted an application dated 07.12.2020 (Annex.7) for reimbursement of his medical bills. On 14.12.2020, he received a message on his mobile from the SIPF Department that his claim was rejected. Aggrieved, the petitioner submitted another application dated 24.12.2020 (Annex.9) to the respondents to address his grievance. However, by order dated 07.01.2021 (Annex.11), respondent No.4 - Assistant Director rejected his application on the ground that the hospital where the petitioner was operated on was not empanelled under the Rajasthan Government Health Scheme. Hence, this petition.

3. The defence taken by the respondents in their reply is as follows:

3.1 The terms and conditions between the parties are governed by a contract, namely the Group Medi-Claim Insurance Policy (Annex.3). Thus, if there is any question of violation of the contract terms and conditions, the petitioner has the alternative remedy of filing a civil suit to claim all valid reliefs, wherein all disputed questions of fact can be adjudicated. 3.2 The petitioner has wrongly stated that the operation was undertaken in an emergency. The documents on record reveal otherwise; the discharge summary does not indicate that the operation was performed under emergent circumstances or that there was a life-threatening condition. Furthermore, the petitioner traveled a distance from his place of residence to the hospital, indicating there was no emergency.

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[2024:RJ-JD:24311] (3 of 5) [CW-7400/2021] 3.3 Considering the nature of the treatment and the conditions of the Policy, the petitioner's claim was rightly rejected as he was admitted to a non-empanelled hospital for pyeloplasty, which is not considered a medical emergency under the policy's terms and conditions. The petitioner has not pointed out any illegality in the order or made a case that the treatment was covered under Clause 6.3 of the Policy. Hence, the petition deserves to be dismissed.

4. In the aforesaid backdrop, I have heard learned counsel for the respective parties, perused the case file, and I am of the view that the petition deserves to be allowed.

5. The reasons are not far to seek. Let us see how.

6. The conceded position which emerges is that neither the ailment of the petitioner nor the medical treatment at the relevant time is disputed. Merely because he did not receive treatment from an empanelled hospital, the petitioner's claim was denied.

7. In this respect, reference may be had to a judgment rendered by me in a similar situation in the case of Kesra Ram Vs. State of Rajasthan & Anr.: S.B. Civil Writ Petition No.9571/2008, decided on 23.02.2024. For ready reference, relevant of the same being apposite is reproduced hereinbelow:

"7. Qua entitlement of reimbursement for treatment in emergency from a private hospital, learned counsel for the petitioner, in course of his arguments, relies on the various judgments viz. Surjit Singh Vs. State of Punjab & Ors.- (1996) 2 Supreme Court Cases 336; Shobha Devi Choudhary Vs. Union of India & Anr. 2022 SCC Online Raj 2868; Thomas T. Vs. State of Rajasthan & Ors. : S.B. Civil Writ Petition No.3749/2006 passed by this Court.

8. Adverting, now to the defense as pleaded in the reply filed with this court, it is evident that no explicit stand has been taken (Downloaded on 03/06/2024 at 08:34:28 PM) [2024:RJ-JD:24311] (4 of 5) [CW-7400/2021] therein regarding the petitioner's not being entitled to reimbursement for treatment at a private hospital. However, the impugned note/order dated 19.02.2008 from the CMHO, which is inter alia under challenge herein, same expressly states the rejection of his claim is on account of private treatment.

9. XXXXXX

10. In the parting, I may hasten to add that reference in particular may be had to Supreme Court judgment rendered in Surjit Singh (supra), and as also rightly relied by learned counsel for the petitioner in the context of right to self- preservation being a findamental right. Case of the petitioner is squarely covered by the ratio enunciated therein. As held by Supreme Court, it is settled position in law that the right to health and self-preservation by medical treatment in an emergency is akin to the right to life, as enshrined in Article 21 of the Constitution of India. This right is fundamental, sacred, precious, and inviolable. Employees of State have a right to take steps to preserve their own lives when faced with a life threat in an emergency. Accordingly, given the facts of the instant case, the petitioner herein had the right to take steps for his self- preservation, including seeking emergency medical treatment without having to wait for prior sanction and/or waiting for his turn in a government hospital or an authorised hospital instead of rushing to a private hosiptal i.e. Soni Hospital, Jaipur herein, in view of apparent threat to life at the relevant time. As an upshot, I see no reason, why the petitioner be not accorded the benefit of reimbursement of his medical bills."

10. From the record, it is evident that there is no dispute regarding the fact that the petitioner was taken to the hospital in Kerala while he was on leave and had gone to his native place in Kerala. In such a situation, it is neither possible nor expected for the petitioner to travel from Kerala to Rajasthan to receive treatment at an empanelled hospital in Rajasthan.

11. As an upshot of my discussion hereinabove, the petition is allowed. The impugned order dated 07.01.2021 (Annex.11) is set aside. The respondents are directed to verify the medical bills of the petitioner and, within the permissible limit prescribed by the (Downloaded on 03/06/2024 at 08:34:28 PM) [2024:RJ-JD:24311] (5 of 5) [CW-7400/2021] Department, process and reimburse the same to the petitioner along with interest as per applicable service rules.

12. Pending application(s), if any, also stand disposed of.

(ARUN MONGA),J 137-Sumit/-

                                   Whether Fit for Reporting:              Yes / No




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