Bala Kumari Khangarot vs State Of Rajasthan
2022 Latest Caselaw 11549 Raj

HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR S.B. Civil Writ Petition No.5436/2019

Bala Kumari Khangarot D/o Shri Akshya Raj Singh Khangarot W/ o Gajendra Singh, Aged about 33 years, R/o Panchayat Samiti Awas Colony, Bhopalsagar, District Chittorgarh, Rajasthan.

----Petitioner Versus

1. State of Rajasthan through the Secretary, Department of Rural & Panchayati Raj, Government of Rajasthan, Jaipur, Rajasthan.

2. The Chief Executive Officer, Zila Parishad Chittorgarh, District Chittorgarh, Rajasthan.

3. The Development Officer, Panchayat Samiti Bhopalsagar, District Chittorgarh, Rajasthan.

4. Assistant Director, State Insurance and Provident Fund Department, Chittorgarh, District Chittorgarh, Rajasthan.

----Respondents

For Petitioner(s) : Mr. Shaurya Pratap Singh. For Respondent(s) : Mr. Sandeep Shah, Sr. Advocate-cum-

AAG, assisted by Mr. Lakshya Pagaria.

HON'BLE MR. JUSTICE KULDEEP MATHUR Order

16/09/2022

Briefly stated facts of the case are that the petitioner's

husband met with an accident whereupon, he was admitted in a

private hospital. The petitioner's husband remained hospitalized

from 01.11.2017 to 06.11.2017. The petitioner applied for

reimbursement of the medical bills covered under the Medi-claim

Policy before the respondent-authorities. The bills were returned

with an assertion that the petitioner's husband availed treatment

in the hospital which is not an empanelled hospital.

Learned counsel for the petitioner submitted that petitioner's

husband met with an accident causing serious head injuries. In

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the emergent circumstances, the treatment had been taken in a

private hospital, and therefore, reimbursement cannot be rejected

solely on the ground that the hospital was not an empanelled one.

Reliance was placed on a judgment of this Court in the case of

Raghuveer Sharma v. State of Rajasthan & Ors. reported in

(2007 WLC (Raj.) UC 516, in which it was held as under:-

"prime consideration in case of grave emergency, which comes in the mind of family is to save the life of patient and at that point of time whatever hospital comes to their mind and considered just is felt as the best because emergency knows no law and no procedure and when human life is at stake in such situation ultimately responsibility of State cannot be washed out. Technicalities of Rules and Regulations under the Scheme are not required to be followed just in a mechanical manner so as to frustrate very purpose of the Scheme because a person having put in his whole life in the service of the State till attains age of superannuation always require human considerations."

Per contra, learned counsel for the respondents submitted

that the case of the petitioner is not covered under clause 6.3 of

the Medi-claim policy, 2014-15. The treatment in a non-

empanelled private hospital can be taken only in case of grave

urgency viz. life threatening disease like kidney or heart ailments

and accidents. It was further submitted that according to policy in

vogue, emergency certificate of treating doctor establishing

emergent situation is necessary for making any claim for

reimbursement in a private hospital. The claim of the petitioner

was rejected for non compliance of the terms and conditions of

Medi-claim policy.

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A coordinate Bench of this Court in the case of Mool Singh

Vs. the State of Rajasthan & Ors. in S.B. Civil Writ Petition

No.5592/2018 vide order dated 09.09.2022 pleased to held

as under:-

"The medical claim qua the said amount was raised before the respondent Department but the same was rejected on the ground that the petitioner has not shown any emergent situation wherein his wife was required to be treated in the private hospital i.e. SAL Ahmedabad.

In Surjit Singh Vs. 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.

We share the views afore-expressed"

In Rama Prasad Sharma Vs. State of Rajasthan & Ors.; S.B.C.W.P. No.7469/2016, decided on 21.01.2022, passed by this Court, it was 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 view of the ratio as laid down in the above mentioned judgments, it is a law settled that even if some medical treatment is undertaken in a private or unrecognized hospital, the department is under an obligation to reimburse the amount to the extent

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permissible under the Rules governing the same. In the present case, the Rules governing the medical reimbursement are Rajasthan Civil Services (Medical Attendance) Rules, 2013 (hereinafter referred to as 'the Rules of 2013')."

In the light of aforesaid enunciation of law by this Court and

facts of the case, this Court has no hesitation in coming to the

conclusion that the respondent-department is under an obligation

to reimburse the amount to the petitioner for the treatment

underwent by her husband in a private or unrecognized hospital,

to the extent permissible under the Rules / Policy governing the

same. 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 present writ petition is therefore, allowed and the

respondent authorities are directed to reimburse the expenditure

incurred by the petitioner in treatment of her husband, to the

extent it is permissible for treatment in a private or unrecognized

hospital in emergent situation. The necessary exercise shall be

completed by the respondent department within a period of two

months from the date of this order. It is further ordered that in

case the claim of the petitioner is not settled within aforesaid

period, the same shall carry an interest @ 6% per annum.

(KULDEEP MATHUR),J

17. Prashant/-

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