Rajasthan High Court - Jodhpur
Om Parkash Joshi vs State And Ors on 19 September, 2022
Bench: Kuldeep Mathur
HIGH COURT OF JUDICATURE FOR RAJASTHAN AT
JODHPUR
S.B. Civil Writ Petition No. 5192/2015
Om Parkash Joshi S/o Shri Moolraj Joshi, aged about 66 years,
R/o C-20 Kamla Nehru Nagar, Second Extension Chopasni Road,
Jodhpur
----Petitioner
Versus
1. State of Rajasthan through Secretary, Finance Department of
Govt. of Rajasthan, Jaipur. (Raj.)
2. Member Secretary and Director Pension and Pensioners
Welfare Department, Rajasthan, Jyoti Nagar, Jaipur.
3. Treasury Officer (Rural), Jodhpur, (Raj.).
----Respondents
For Petitioner(s) : Mr. Harish Jangid, for
Mr. Hemant Shrimali
For Respondent(s) : Mr. Anil Kumar Gaur, AAG
Mr. Ravi Panwar, AGC
HON'BLE MR. JUSTICE KULDEEP MATHUR
Order
19/09/2022
Briefly stated facts of the case are that the petitioner felt
sudden pain in left side of the chest and in an emergent situation,
he was admitted to Goyal Hospital, Jodhpur on 22.07.2010, where
he underwent Coronary Artery By-pass Grafting surgery (CABG). A
sum of Rs.1,40,000/- was incurred for the aforesaid surgery. The
petitioner was discharged from the hospital on 29.07.2010.
Thereafter, he submitted an application dated 18.08.2010 claiming
medical reimbursement from the respondent-department along
with an emergency certificate, issued by the aforesaid hospital. A
sum of ₹44,000/- was paid to the petitioner pursuant to his
application for medical reimbursement. Aggrieved by the partial
(2 of 4) [CW-5192/2015]
acceptance of the claim, the petitioner has filed the present writ
petition.
Learned counsel for the petitioner submitted that the
petitioner in emergent circumstances underwent by-pass surgery
at Goyal Hospital and therefore, the claim of the petitioner for
medical reimbursement ought to have been accepted in toto by
the respondent-department. The counsel further submitted that
the partial acceptance of reimbursement claim deserves to be
declared illegal and arbitrary.
Per contra, the learned counsel for the respondents
submitted that the claim had been accepted to the tune of
₹44,000/- in accordance with circular dated 21.05.2009, issued by
the Finance Department and Rule 4 of Pensioner Medical
Concession Scheme, 2009 (hereinafter referred to as 'Scheme,
2009'). Counsel placed reliance on the judgment rendered by the
Hon'ble Supreme Court in the case of State of Rajasthan v
Mahesh Kumar (Civil Appeal No. 2278/2011 (@) SLP © No.
2888/2008).
Heard submissions advanced at Bar and perused the material
available on record.
So far as the question regarding reimbursement of the
treatment undertaken in a private and unrecognized hospital is
concerned, the law is no longer 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
(3 of 4) [CW-5192/2015]
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. ...........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,coordinate
Bench of 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."
(4 of 4) [CW-5192/2015]
The ratio laid down in the above judgments makes it clear
that even in the cases where an employee undergoes treatment in
a non-recognized hospital/private hospital, the medical
reimbursement has to be made to the extent permissible under
relevant Rules/Scheme/Policy. In the present matter, the amount
which has been reimbursed appears to have been made against
the procedure undertaken. So far as the medicines, drugs,
anesthesia and room charges etc., are concerned, amount qua the
same is also required to be reimbursed in terms of the Rules of
2008.
Therefore, in view of the ratio laid down by the Hon'ble Apex
Court and peculiar facts, the present writ petition is partly
allowed. The respondents are directed to reconsider the claim of
the petitioner and reimburse amount qua the medicines, drugs,
anesthesia, room charges and all other heads as payable in terms
of the Rules of 2008, if not already paid. The complete
consideration and reimbursement thereof to be completed within a
period of eight weeks from the date of receipt of this order.
All pending applications also stand disposed of.
(KULDEEP MATHUR),J
8-Ravi Kh/-
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