Rajasthan High Court - Jodhpur
Kusum vs State Of Rajasthan on 19 September, 2022
Bench: Kuldeep Mathur
HIGH COURT OF JUDICATURE FOR RAJASTHAN AT
JODHPUR
S.B. Civil Writ Petition No. 19190/2018
Kusum W/o Shri Dau Lal Joshi, Aged About 68 Years, 25 E 26
Chopasani Housing Board, Jodhpur.
----Petitioner
Versus
1. State Of Rajasthan, Through Its Secretary, Rajasthan
Pensioners' Medical Fund, Government Of Rajasthan,
Jaipur.
2. The Treasury Officer, Rural Treasury, Jodhpur.
----Respondents
For Petitioner(s) : Mr. Sunil Bhandari
For Respondent(s) : Mr. Anil Kumar Gaur, AAG
Mr. Ravi Panwar, AGC
HON'BLE MR. JUSTICE KULDEEP MATHUR
Order
19/09/2022
Brief facts of the case are that the petitioner underwent both
knee joint replacement surgery at Manipal Hospital, Jaipur. The
petitioner was admitted from 27.02.2017 to 04.03.2017 and the
surgery was performed on 28.02.2017. A sum of ₹3,10,078/- was
incurred for the aforementioned treatment. Thereafter, she filed
an application claiming reimbursement of medical bills for the
above mentioned amount. The claim of the petitioner for
reimbursement of the said amount was returned by the
respondent No.2 vide letter dated 11.05.2017 on the ground that
the medical diary for the financial year 2016-2017 was not
available at the time of her treatment as required by Clause 7(1)
of Rajasthan State Pensioners Medical Concession Scheme, 2014.
(2 of 3) [CW-19190/2018]
Aggrieved by the denial of claim, the petitioner has preferred
present writ petition.
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 Manipal Hospital,
Jaipur vide order dated 11.05.2017 deserves to be declared
illegal, unjust and arbitrary.
Per contra, learned counsel for the respondents submitted
that the petitioner renewed her medical diary on 20.04.2017,
thus, she is entitled only for reimbursements for treatment
undertaken in the year 2017-18. The counsel urged that the order
returning the claim of the petitioner was in conformity with the
Scheme in vogue i.e. Scheme of 2014, therefore, the order dated
should not be interfered with.
Exception to Clause 7 of the Scheme of 2014 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 in allowing the
reimbursement of the medical claim of the petitioner on the
ground 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
(3 of 3) [CW-19190/2018]
has specifically been 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.
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
to be made at the rate that may be applicable for
similar treatment in the recognized government
hospitals."
In view of the ratio laid down in the above mentioned
judgments and facts of the case, 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 Scheme of 2014. The appropriate orders be passed within a
period of two months from the date of submission of the copy of
the present order. It is also made clear that in case the claim of
the petitioner is not settled within the aforesaid period, the same
shall carry an interest @ 6% p.a.
No order as to costs.
KULDEEP MATHUR),J
16-Ravi Khandelwal /-
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