Smt. Nirmala Kothari vs State And Ors
2022 Latest Caselaw 11551 Raj

Citation : 2022 Latest Caselaw 11551 Raj
Judgement Date : 16 September, 2022

Rajasthan High Court - Jodhpur

Smt. Nirmala Kothari vs State And Ors on 16 September, 2022

Bench: Kuldeep Mathur

HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR S.B. Civil Writ Petition No.300/2018

Smt. Nirmala Kothari, wife of Late Shri Prakashraj Kothari, by caste Kothari, aged about 76 years, resident of Kothari Pole, Sirohi.

----Petitioner Versus

1. The State of Rajasthan, through the Principal Secretary, Medical & Health & Family Welfare Department.

2. Secretary to the Government of Rajasthan, Finance Department, Jaipur.

3. The Member Secretary & Director Pension & Pensioners Welfare Rajasthan State Pensioners Medical Concession Scheme, Jaipur.

4. Joint Secretary, Board of Trustees, Rajasthan Pensioners Medical Fund Directorate of Pension & Pensioners Welfare Department, Jaipur.

5. The District Collector, Sirohi.

6. The Member Secretary cum Treasury Officer, Sirohi.

                                                                  ----Respondents


For Petitioner(s)          :     Mr. Rajesh Shah.
For Respondent(s)          :     Mr. Anil Kumar Gaur, AAG, through
                                 V.C.
                                 Mr. Anupam Goyal Vyas.
                                 Mr. Ravi Panwar, AGC.



            HON'BLE MR. JUSTICE KULDEEP MATHUR

                                      Order

16/09/2022

The present writ petition has been filed by the petitioner,

who is wife of a retired Government employee (pensioner) namely

Shri Prakash Raj Kothari with the prayer for reimbursement of the

medical claims qua the treatment of the petitioner-wife pertaining

(2 of 5) [CW-300/2018]

to replacement of right knee due to an injury suffered at

Ahmedabad.

Briefly stated facts of the case are that petitioner slipped

over a surface and suffered injury in her knees and was thereafter

taken to Apollo Hospital, Gandhinagar (Gujarat). She was

admitted under an emergent situation and after examination, the

treating Doctor advised that looking to the acute Osteoarthritis

and the injury suffered, the petitioner has to undergo right knee

replacement. The petitioner was admitted for operation on

20.02.2017 till 24.02.2017. A sum of Rs.1,93,000/- was incurred

for the right knee replacement surgery underwent by the

petitioner. The petitioner's husband submitted medical bills along

with necessary documents for reimbursement to the department.

The respondent department vide order dated 18.09.2017, rejected

the request for reimbursement on the ground that the same is not

covered under Rule-11 of the Rajasthan Civil Services (Medical

Attendance) Rules, 2013.

Aggrieved by this, the present writ petition is preferred.

Learned counsel for the petitioner submitted that in an

emergent situation, the petitioner underwent right knee

replacement on 20.02.2017 at Apollo Hospital, Gandhinagar,

Gujarat. A certificate justifying emergent situation was also

produced along with the medical bills. He further submitted that

denial of reimbursement of the medical bills deserves to be

declared illegal and arbitrary by this Court. Reliance was placed on

a judgment of this Court in Raghuveer Sharma v. State of

Rajasthan & Ors. reported in (2007 WLC (Raj.) UC 516, in

the aforesaid case, the Court has held as under:-

(3 of 5) [CW-300/2018]

"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 medical bills submitted for reimbursement of the

treatment undertaken at Apollo Hospital, Gandhinagar have rightly

been rejected as the procedure provided under the Medical

Attendance Rules, 2013 was not followed. An employee is not

permitted to undergo treatment in a private hospital without any

emergent situation.

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

Vs. the State of Rajasthan & Ors. in S.B. C.W.

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:-

(4 of 5) [CW-300/2018]

"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 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

undertaken by the petitioner in a private or unrecognized hospital,

(5 of 5) [CW-300/2018]

to the extent permissible under the Rules / Policy governing the

same.

The present writ petition is therefore, allowed and the

respondents authorities are directed to reimburse the expenditure

incurred by the petitioner for treatment undertaken at Apollo

Hospital, Gandhinagar (Gujarat) for right knee replacement to the