Rajasthan High Court - Jodhpur

Satyapal Singh vs State Of Rajasthan on 9 September, 2022

Bench: Rekha Borana

HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR S.B. Civil Writ Petition No. 4678/2019

Satyapal Singh S/o Shri Net Ram Choudhary, aged About 60 Years, R/o 192, Chanikya Nagar, Lal Sagar, Jodhpur.

----Petitioner Versus

1. State of Rajasthan, through Secretary Finance Department (Rules Division), Government Of Rajasthan, Jaipur.

2. State of Rajasthan, through Director, Local Self Department, Jaipur.

3. CEO, Municipal Corporation, Jodhpur.

4. Chief Medical Health Officer, Jodhpur.

5. Superintendent SMS Hospital, Jaipur.

6. Head of Department, Neurosurgery, SMS Hospital, Jaipur.

                                                                ----Respondents


For Petitioner(s)        :     Mr. Navneet Singh Birkh
For Respondent(s)        :     Mr. R.S. Saluja
                               Mr. Rajesh Parihar, AGC
                               Ms. Vandana Bhansali, AGC


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

The present writ petition has been filed with a prayer for

reimbursement of the medical claim of the petitioner which was

incurred qua his treatment for brain hemorrhage. The submission

of the petitioner is that he had suffered brain hemorrhage and in

an emergent condition, he was admitted to Goyal Hospital,

Jodhpur and underwent treatment there. After two days of

hospitalization i.e. from 04.09.2009 to 06.09.2009 at Goyal

Hospital, Jodhpur he was referred to Sir Ganga Ram Hospital, New

Delhi and remained hospitalized there from 07.02.2009 to

04.03.2009. At Sir Ganga Ram Hospital, New Delhi he underwent

a surgery and qua the complete treatment, he incurred an

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expenditure of Rs.5,07,919/- (Rs. 85,204/- incurred at Goyal

Hospital, Jodhpur and Rs.4,22,715/- incurred at Sir Ganga Ram

Hospital, New Delhi). When the medical claim was raised with the

respondent-Department, only Rs.25,000/- was sanctioned qua the

same.

It has been argued by learned counsel for the petitioner that

he being admitted in a private hospital due to the emergent

condition of brain hemorrhage and then referred to a higher

center by the local Doctor, was entitled for reimbursement of the

complete medical bills as raised by him.

Per contra, it has been submitted by learned counsel for the

State as well as the Municipal Corporation, Jodhpur that in terms

of Rule 10 of the Rules of Rajasthan Civil Services (Medical

Attendance) Rules, 2008 (hereinafter referred to as the Rules of

2008) firstly, no emergent situation as prescribed under the Rules

of 2008 has been explained in the present matter and secondly,

the treatment has been undertaken by the petitioner in private

hospitals both of which are neither recognized nor referral

hospitals of the State or the Department. Learned counsel further

argued that the claim in question had been raised in the year

2009 and reimbursement of an amount of Rs.25,000/- was also

made in the year 2010 but the present writ petition has been filed

in the year 2019 and no reason for such delay has been explained

by the petitioner. Learned counsel therefore submitted that the

present writ petition is liable to be rejected on the sole ground of

limitation.

Heard learned counsel for the parties and perused the

material available on record.

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Dealing with the first aspect of limitation, it is clear on record

that the medical bills were submitted by the petitioner in the year

2009 qua the treatment taken in the year 2009. The limitation as

prescribed in the Rules of 2008 provides that a medical claim, if

any, has to be raised within a period of two years of the date of

treatment. Rule 13(1) of the Rules of 2008 provides as under:

"(1) Every Government servant claiming refund of medical expenses incurred on account of medical attendance and treatment for himself and/or members of his family, shall make an application in duplicate in form given in Appendix-VI. Such claims shall be presented within two years from the date of completion of treatment."

Admittedly, the petitioner underwent the medical treatment

in the year 2009 and the claim qua the same was also raised in

the year 2009 itself i.e., within the prescribed period of limitation.

So far as the reimbursement of the admitted claim and denial of

the un-admitted claim is concerned, a perusal of the

communication dated 25.01.2011 (Annex.8) makes it clear that

the Chief Executive Officer of the Municipal Corporation, Jodhpur

itself recommended for sanction of the remaining amount qua the

drugs and medicines to the petitioner. Moreover, there was no

denial of the remaining claim by the Department on any count. In

the reply, it has been submitted that the claim reimbursable in

terms of the Rules of 2008 could only be the expenses incurred for

the treatment undertaken in a Government Hospital. It has been

submitted that to ascertain the expenses in a Government

Hospital, a Medical Board was constituted by the State and a

report of the SMS Hospital, Jaipur was received which specifically

stated that the cost of the surgery in question in a Government

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Hospital would amount to Rs.25,000/- only. On the basis of the

said report, the amount of Rs.25,000/- was reimbursed to the

petitioner. Rest of the claim was not found to be reimbursable and

hence it was not reimbursed.

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. ...........

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............ 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 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