Punjab-Haryana High Court
V.K. Sharma vs Uhbvnl & Ors on 11 November, 2025
CWP-7306-2016 1
IN THE HIGH COURT OF PUNJAB AND HARYANA AT
CHANDIGARH
216
CWP-7306-2016 (O&M)
Date of decision: 11.11.2025
V.K. Sharma (Retd.)
....Petitioner
Versus
Uttar Haryana Bijli Vitran Nigam Limited and others
....Respondents
CORAM: HON'BLE MR. JUSTICE HARPREET SINGH BRAR
Present: Mr. Wazir Singh, Advocate
for the petitioner.
Mr. Hitesh Pandit, Advocate
for the respondents.
HARPREET SINGH BRAR J. (Oral)
1. The present Civil Writ Petition under Article 226 of the
Constitution of India has been filed praying for the issuance of a writ in
the nature of certiorari, for quashing the impugned order dated
19.08.2015 (Annexure P-4) and order dated 21.07.2015 (Annexure P-6)
passed by respondent No.1, whereby the claim of the petitioner for
medical reimbursement was rejected. A further writ in the nature of
mandamus is sought, directing the respondents to make the payment of
reimbursement of medical bills and other expenses incurred on account
of the treatment of petitioner's daughter, as per the submitted medical
bills and discharge summary.
2. Learned counsel for the petitioner, inter alia, contends that
the petitioner, who is a retired Section Officer, is seeking medical
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reimbursement for the life-saving renal transplant and subsequent
treatment provided to his dependent daughter as she suffered from a
severe and chronic kidney ailment. He further contends that the
petitioner initially attempted to secure her treatment at AIIMS Hospital,
a government-approved facility, but was unable to do so due to the
unavailability of a bed. He, thereafter, approached Vedanta Hospital,
Gurgaon but the estimated cost of the procedure proved too expensive
and un-affordable to the petitioner. Due to the medical emergency and
on account of the critical nature of his daughter's condition, the
petitioner was compelled, as a matter of last resort, to seek the urgent
transplant procedure at Apollo Hospital, New Delhi, an unapproved
private institution. Learned counsel for the petitioner further submits
that the initial partial sanction of Rs.4,14,607/- itself established the
genuineness and essentiality of the treatment and the subsequent denial
for the remaining amount, merely because the Apollo Hospital was
unapproved or the subsequent essential follow-up treatment was
categorized as OPD, amounts to denial of the right to health under
Article 21 of the Constitution of India. He further contends that where
life-saving treatment is taken in an emergency from an unapproved
hospital, the employee is entitled to full reimbursement as technical
grounds such as hospital non-empanelment or the nature of chronic
follow-up treatment or OPD cannot be used to defeat a beneficial
welfare measure. The action of the respondents in denying the full
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medical reimbursement to the petitioner is arbitrary and illegal since the
treatment involved was a life-saving renal transplant.
3. Per contra, learned counsel for the respondents submits
that the procedure was a planned surgery for a chronic condition and
thus, was not a spontaneous emergency. He further submits that the
partial payment of Rs.4,14,607/-, which was the maximum allowable
amount as per the PGI rates, has already been made to the petitioner. He
further contends that the Reimbursement Policy dated 06.05.2005
(Annexure R-3), clearly mandates that reimbursement for treatment in a
non-approved private hospital shall be made only at the rate equal to the
PGI, Chandigarh rates. Therefore, by releasing the payment of
Rs.4,14,60/- calculated as per PGI, Chandigarh rates, the respondents
have discharged their full financial liability as per the policy
instructions. Furthermore, the outstanding claim of Rs.32,997/- relates
to OPD treatment, the reimbursement for which is expressly prohibited
by the policy and cannot be sanctioned, regardless of the PGI,
Chandigarh rates.
4. I have heard learned counsel for the parties and perused the
record with their able assistance.
5. The core issue before this Court is whether the respondents
were justified in denying the balance medical reimbursement claim on
the technical grounds that the hospital was unapproved and the follow-
up treatment was categorized as OPD, despite the life-saving nature of
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the procedure and the chronic disease suffered by the petitioner's
daughter.
6. The claim for medical reimbursement ought not to be
dismissed merely because the claimant underwent treatment in a non-
empanelled. In such cases, the test of essentiality and emergency comes
into play, which dictates that if the medical procedure was undergone by
the claimant in an emergency, on the advice of a doctor based on his
medical record, in order to save his life, the reimbursement for the same
must be made. Not only is the preservation of human life instinctive, but
it also forms a part of Article 21 of the Constitution of India, and
therefore, it shall always retain the highest priority.
7. Moreover, the State bears an obligation to ensure the
availability of timely medical care to those in need. As such, it cannot
expect the citizens to refrain from availing timely care, merely for the
reason of non-empanelment of the hospital. Such conduct on the part of
the State does not satisfy the criteria of fairness and reasonableness and
therefore, amounts to a violation of the fundamental rights enshrined in
Article 21 of the Constitution of India. Reliance in this regard can be
placed on the judgments rendered by a two Judge bench of the Hon'ble
Supreme Court in Surjit Singh vs. State of Punjab and others(1996) 2
SCC 336, whereby, speaking through Justice M.M. Punchhi, the
following was opined:
"8. The policy, providing recognition for treatment of open
heart surgery in the Escorts, specifically came to be
examined by a Division Bench of the Punjab and Haryana
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High Court at Chandigarh in C.W.P. No. 13493 of 1992
titled as Sadhu R. Pall v. State of Punjab through Secretary,
Health and Family Welfare Punjab, Civil Secretariat,
Chandigarh and others, 1994(1) SCT 552 (P&H). decided
on 6.10.1993, wherein the claim of the then writ petitioner
to medical reimbursement was accepted when in order to
save his life he had got himself operated upon in the
Escorts, and the plea of the State that he could be paid
rates as prevalent in the AIIMS was rejected. Special Leave
Petition No. 22024 of 1995 against the said decision was
dismissed by this Court on 2.2.1994. The other judgments
of the High Court following the decision in Sadhu R. Pall's
case are :
(1) C.W.P. No. 18562 of 1992 decided on
10.5.95 titled K.L. Kohli v. State of Punjab and
others, 1995(4) SCT 280 (P&H);
(2) C.W.P. No. 260 of 1995, decided on
30.5.1995 titled Ravi Mohan Duggal v. State
of Punjab and others (DB)
(3) C.W.P. No. 5669 of 1994 decided on 4.9.94
titled Prem Singh Gill v. State of Punjab and
others;
(4) 1995(4) SCT 816 (P&H) : 1995 (III)
Punjab Law Report 529 titled Tarlok Chander
v. State of Punjab etc. (SB); and
(5) 1996(2) SCT 148 (P&H) : 1995 (III),
Punjab Law Reporter 682 titled Mrs. Surya
Pandit v. State of Punjab and others (SB)
xxx xxx xxx
10. It is otherwise important to bear in mind that self
preservation of one's life is the necessary concomitant of
the right to life enshrined in Article 21 of the Constitution
of India , fundamental in nature, sacred, precious and
inviolable. The importance and validity of the duty and
right to self-preservation has a species in the right of self
defence in criminal law...
11. The appellant therefore had the right to take steps in
self preservation. He did not have to stand in queue before
the Medical Board, the manning and assembling of which,
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bare-facedly, makes its meetings difficult to happen. The
appellant also did not have to stand in queue in the
Government hospital of AIIMS and could go elsewhere to
an alternate hospital as per policy. When the State itself
has brought the Escorts on the recognised list, it is futile
for it to contend that the appellant could in no event have
gone to the Escorts and his claim cannot on that basis be
allowed, on suppositions. We think to the contrary..."
8. The respondents' own action in sanctioning the initial
amount validates the genuineness and essentiality of the major
procedure i.e. renal transplant. The subsequent denial based on the OPD
nature of the follow-up treatment, especially for a chronic and life-
threatening condition like Chronic Kidney Disease (CKD), goes against
the purpose of the medical reimbursement scheme, which exists to
protect the life and health under Article 21 of the Constitution of India.
9. Moreover, the legal position on this matter is now well-
settled. The Division Bench of this Court in LPA No.174 of 2022, titled
as State of Haryana and another vs. Manoj Jain and others, decided
on 27.01.2025, while dealing with an identical issue concerning CKD
treatment taken in OPD from an unapproved hospital, upheld the
allowance of the claim. The Division Bench of this Court unequivocally
rejected the argument that reimbursement could be denied solely on the
ground of OPD treatment for a chronic condition. For clarity and
precedent, Paragraph 12 of the said judgment is reproduced hereunder:
"12. 'Chronic' means a condition that does not get
completely better and lasts over a long time. A patient with
CKD is also at an increased risk of other ailments like
heart attack or stroke. It is not disputed by the appellants
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that the wife of respondent No.1-writ petitioner had taken
treatment from the aforesaid hospitals. As the wife of
respondent No.1-writ petitioner was suffering from CKD,
the treatment given by the concerned Doctor(s) in the
OPD, was totally dependent upon the expertise of the said
Doctor(s) and therefore, the denial of the claim of the
medical reimbursement of the wife of respondent No.1-writ
petitioner on the ground that it was taken in OPD, is not
based on a reasonable classification. We further find that
the disease being chronic in nature, the treatment even if
taken in OPD, cannot be termed to be not falling in
category of 'emergency treatment', particularly when the
disease relating to renal requires a continuous treatment.
The judgments of the Hon'ble Apex Court in Ram Lubhaya
Bagga and Mahesh Kumar (supra) is of no help to the
appellant in view of its subsequent judgment in Shiva Kant
Jha (supra)."
10. Thus, the ratio of law laid down by the Division Bench in
Manoj Jain's case (supra) is directly applicable to the facts of the
present case. The treatment undertaken by the petitioner's daughter was
of an emergent and life saving nature necessitated by her chronic kidney
disease and the urgent requirement of a renal transplant. There was no
fault or negligence on the part of the petitioner as he had initially
admitted his daughter for treatment in a government approved hospital
but due to the unavailability of a bed and on account of her critical
health, he was left with no other option but to shift his daughter to
Apollo Hospital, New Delhi, where the renal transplant was undertaken
as a last resort to save her life. The subsequent technical classification
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of the essential follow-up care as 'OPD' cannot be permitted to defeat
the petitioner's legitimate claim for reimbursement. The preservation of
human life is a fundamental right and the medical reimbursement
scheme being a welfare measure must be interpreted in a broad and
purposive manner as laid down by the Hon'ble Supreme Court in Shiva
Kant Jha v. Union of India, AIR 2018 Supreme Court 1975.
11. In view of the foregoing reasons, the test of essentiality and
emergency stands fully satisfied. Accordingly, the writ petition is
allowed and the impugned orders dated 19.08.2015 (Annexure P-4) and
21.07.2015 (Annexure P-6) are hereby quashed. The respondent - Uttar
Haryana Bijli Vitran Nigam Limited is directed to reimburse the
petitioner for the entire medical expenses incurred for his daughter's
renal transplant procedure and related follow-up treatment, after
adjusting the amount of Rs.4,14,607/- already paid, within a period of
six weeks from the date of receipt of a certified copy of this order,
failing which the amount shall carry interest at the rate of 9% per annum
until the payment is made.
(HARPREET SINGH BRAR)
JUDGE
11.11.2025
yakub
Whether speaking/reasoned: Yes/No
Whether reportable: Yes/No
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