Smt. Tulsi Devi Jain vs State And Ors
2022 Latest Caselaw 11100 Raj

HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR S.B. Civil Writ Petition No. 8796/2015

Smt. Tulsi Devi Jain W/o Late Sh. Kapoor Chand Jain, age 65 years, R/o Village Tobher, Tehsil Sarda, District Udaipur.

----Petitioner Versus

1. State of Rajasthan through Director, Elementary Education, Bikaner.

2. Rajasthan State Pensioner Concession Scheme through Director, Pension & Pensioner Welfare Department, Jaipur.

3. Secretary (Treasury Rural), Raj Pensioner Medical Fund, Udaipur.

                                                                   ----Respondent


For Petitioner(s)           :     Mr. Vinay Jain
                                  Mr. Darshan Jain
For Respondent(s)           :     Mr. Ravi Panwar, AGC


               HON'BLE MS. JUSTICE REKHA BORANA
                                       Order
06/09/2022

The brief facts of the case are that the petitioner's husband

was working on the post of Teacher, who retired on 28.02.2000. In

an emergent condition he was treated at Rajasthan Hospital,

Ahemdabad and underwent a surgery of brain tumor in the month

of June, 2013. But he subsequently expired on 06.09.2013. The

petitioner submitted the application for reimbursement of medical

bills of her husband but the same was declined and therefore, she

preferred a writ petition before this Court being S.B. Civil Writ

Petition No.1307/2015. The said writ petition of the petitioner was

disposed of vide order dated 09.02.2015 with the following

directions:

"In view of the above the present petition is disposed of with liberty to the petitioner to file appropriate representation before the concerned authority for

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reimbursement of the medical bills. In case, the said representation is filed within two weeks from today, the said Authority shall consider and reimburse the medical bills within two months from the date of receipt of the representation, in case, she found entitled. However, in case the petitioner is not entitled for the release of the reimbursement a speaking order shall be passed. The petitioner will be at liberty to challenge the same, if so advised, in accordance with law."

In pursuance to the order dated 09.02.2015, the

respondent-Department considered the representation of the

petitioner and rejected the same vide order dated 23.04.2015 on

the premise that firstly, the medical diary of the husband of the

petitioner was not renewed and secondly, the hospital wherein he

underwent the treatment was not a recommended hospital under

the Rajasthan State Pensioners' Medical Concession Scheme, 2009

(hereinafter referred to as "Scheme of 2009"). Further it was

observed that Rajasthan Hospital was a referral hospital and the

procedure to be followed for medical treatment in a referral

hospital was not followed.

Heard learned counsels for the parties and perused the

material available on record.

Exception to Clause 6 (1)(b) of the Scheme of 2009 provides

as under:

"Exception:

In cases where indoor/specialized treatment is taken prior to the date of issue/renewal of Medical Diary during that particular year, the cost of Medical Claim for such treatment shall be reimbursed as per the scheme."

A bare perusal of the said exception makes it clear that if

any treatment is taken prior to the date of issue/renewal of the

medical diary, the cost of medical claim shall be reimbursed as per

the scheme. Therefore, there was no impediment with the

respondent-Department to allow the reimbursement of the

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medical claim of the petitioner because of the said clause or

because of the non renewal of the medical diary of the petitioner's

husband. Moreover, in the case of Ram Kishore Bindal Vs. State

of Rajasthan & Ors.; S.B. Civil Writ Petition No.9485/2014 it

has specifically been held that the denial of the payment of

medical bills is not justified even if the renewal of the medical

diary was made at a subsequent date. So far as the second

ground of denial by the respondent-Department is concerned the

same is also not tenable as admittedly, Rajasthan Hospital,

Ahemdabad where the petitioner's husband underwent treatment

was a referral hospital. In Rama Prasad Sharma Vs. State of

Rajasthan & Ors.; S.B. Civil Writ Petition No.7469/2016 it

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

In the present case, it is clear on record that the treatment

of the petitioner's husband was taken in an emergent situation

outside the State in a referral hospital. Therefore, the denial of the

claim of the medical bills by the respondent-department cannot be

held to be valid even on this ground.

In view of the ratio as laid down in the above mentioned

judgments and in view of the above observations, the present writ

petition is allowed. The respondent-Authorities are directed to

reimburse the medical claim of the petitioner to the extent the

same is permissible in terms of the Scheme of 2009. The

appropriate orders be passed within a period of three weeks from

the date of submission of the copy of the present order to the

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respective Department. It is also made clear that the said amount

would carry an interest @ 6% p.a.

(REKHA BORANA),J 16-AbhishekS/-

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