Surendra Kumar Rohadiya vs State And Ors
2022 Latest Caselaw 11473 Raj

HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR S.B. Civil Writ Petition No. 14366/2015

Surendra Kumar Rohadiya S/o Shri Hing Lal Ji Dan, age 61 years, r/o Subhash Colony, Opposite Court, Bilara, District Jodhpur.

----Petitioner Versus

1. The State of Rajasthan through the Secretary (Education Group-II), Department of Education, Secretariat, Jaipur.

2. The Director, Secondary Education, Department of Education, Bikaner.

3. The District Education Officer, Secondary Education, Department of Education Jodhpur.

4. The Director, Pensioner and Pensionary Welfare Department, Government of Rajasthan, Jaipur.

5. Treasury Officer (Rural), Jodhpur.

                                                                ----Respondents


For Petitioner(s)         :     Mr. Darshan Jain.
For Respondent(s)         :     Mr. Anil Kumar Gaur, AAG
                                Mr. Ravi Panwar, AGC.



           HON'BLE MR. JUSTICE KULDEEP MATHUR

                                    Order

15/09/2022

The present writ petition has been filed by the petitioner

with the prayer for reimbursement of the medical claims qua his

treatment pertaining to Coronary Artery Bypass Surgery (CABS).

Briefly stated facts of the case are that petitioner went for a

personal trip to Ahmedabad and he suffered sudden chest pain

whereupon, he was taken to S.A.L. Hospital, Ahmedabad. Under

the advice of treating Doctors, Coronary Artery Bypass Surgery

(CABS) in an emergent situation was conducted on 02.01.2013.

(2 of 4) [CW-14366/2015]

The petitioner remained hospitalized up to 10.01.2013. For the

aforesaid treatment, expenses of Rs.2,07,371/- were incurred.

The petitioner submitted medical bills for the reimbursement to

the respondents, however, the same were returned vide order

dated 01.10.2015 and 17.09.2015 on the premises that firstly, the

treatment at S.A.L. Hospital, Ahmedabad was taken without

reference and secondly, the medical diary was not renewed.

Learned counsel for the petitioner submitted that denial of

reimbursement of the medical bills for the treatment undertaken

by the petitioner in an emergent situation at S.A.L. Hospital,

Ahmedabad, vide order dated 01.10.2015 and 17.09.2015

deserves to be declared illegal, unjust and arbitrary.

Per contra, learned counsel for the respondents submitted

that S.A.L. Hospital, Ahmedabad is not a referral hospital as

defined under Rajasthan State Pensioners Medical Concession

Scheme, 2009 (hereinafter referred to as 'Medical Concession

Scheme, 2009') therefore, if treatment has been taken in the

aforesaid hospital without any emergency, the same cannot be

reimbursed. It was vehemently submitted that as per para-4 of

the Medical Concession Scheme, 2009 read with Rule 3(8) and

Rule 10(2) of Rajasthan Civil Services (Medical Attendance) Rules,

2008, reimbursement of the medical bills can only be allowed

when treatment undertaken is not available in any of the

Government hospital or approved hospital in the State of

Rajasthan.

Heard learned counsels for the parties and perused the

material available on record.

(3 of 4) [CW-14366/2015]

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

medical claim of the petitioner because of the said clause or

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

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

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

has been specifically 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 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

(4 of 4) [CW-14366/2015]

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 was taken in an emergent situation outside the

State. 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 laid down in the above mentioned

judgments and in eight 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

permissible in terms of the Medical Concession Scheme of 2009.

The appropriate orders be passed within a period of two months

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

the respective Department. It is also made clear that in case the

claim of the petitioner is not settled within aforesaid period, the

same shall carry an interest @ 6% p.a.

(KULDEEP MATHUR),J

19. Prashant/-

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