Rajasthan High Court - Jodhpur

Harbansh Singh vs State Of Rajasthan on 17 October, 2022

Bench: Kuldeep Mathur

HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR S.B. Civil Writ Petition No. 6310/2020

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

----Petitioner Versus

1. State Of Rajasthan, Through District Collector Bhilwara

2. District Treasury Officer, Treasury Office, District Collectorate Building, Bhilwara

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

4. Learned District Consumer Forum, Bhilwara.

                                                                   ----Respondents


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



           HON'BLE MR. JUSTICE KULDEEP MATHUR

                                     Order

17/10/2022

Brief facts necessary for adjudication of present writ petition

are as follows:-

The petitioner who is a retired employee of the respondent-

department, 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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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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payment qua the treatment taken by the petitioner in a private

hospital in the emergent situation.

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.

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.

Heard submissions advanced at Bar and perused the material

available on record.

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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.

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

"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.

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: -

"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....."

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:-

"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."

In Rama Prasad Sharma v. State of Rajasthan and Ors.; SBCWP No.7469/2016 decided on 21.01.2022, this Court held as under:-

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

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.

Therefore, in view of the ratio as laid down by 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.

All pending applications also stand disposed of"

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

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

"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."

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

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

"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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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."

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 respondent-