Prakash Chandra Mehta vs State And Ors
2022 Latest Caselaw 11745 Raj

HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR S.B. Civil Writ Petition No. 3218/2016

Prakash Chandra Mehta, S/o Karan Raj Mehta, aged about 72 years, R/o D-53, Sastri Nagar, Jodhpur.

----Petitioner Versus

1. The State of Rajasthan through the Secretary, Education Department, Govt. of Rajasthan, Jaipur.

2. The Director, Pension and Pensioners Welfare Department, Jaipur.

3. The Treasurer (Rural), Jodhpur.

----Respondents

For Petitioner(s) : Mr. Sushil Solanki For Respondent(s) : Mr. Anil Kumar Gaur, AAG Mr. Salman Agha, Asstt. to AAG

HON'BLE MR. JUSTICE KULDEEP MATHUR

Order

21/09/2022 The present writ petition has been filed by the petitioner,

who is a retired government employee with the prayer for

reimbursement of the medical claims qua the treatment of the

petitioner's wife pertaining to replacement of both knees at

Ahmedabad.

Briefly stated facts of the case are that petitioner along with

his wife had gone to Ahmedabad to meet their relatives where she

developed acute pain in her legs and was advised to undergo

knee-replacement surgery by the doctors of Apollo Hospital,

Ahmedabad (Gujarat). The petitioner was admitted for operation

on 11.04.2013 and remained admitted till 17.04.2013. A sum of

₹4,25,000/- was incurred for both knee-replacement surgery

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underwent by the petitioner. The petitioner submitted medical bills

along with necessary documents for reimbursement to the

department. The respondent department vide order dated

05.09.2014, rejected the request for reimbursement on the

ground that the same is not covered under Rajasthan Civil

Services (Medical Attendance) Rules, 2008.

Aggrieved by this, the present writ petition has been

preferred.

Learned counsel for the petitioner submitted that in an

emergent situation, the petitioner underwent both knee-

replacement on 12.04.2013 at Apollo Hospital, Ahmedabad,

Gujarat. Counsel 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:-

"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 an employee is not permitted to undergo treatment in a

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private hospital without any emergent situation. Counsel

submitted that the claim for reimbursement of expenses incurred

in the treatment undertaken at Apollo Hospital, Ahmedabad had

rightly been rejected as the procedure prescribed under the

Medical Attendance Rules, 2008 was adhered to by the petitioner.

Heard learned counsel for the parties and perused the

material available on record.

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 hold 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

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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,

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, Ahmedabad (Gujarat) for both knee-replacement to the

extent permissible for treatment in a private or unrecognized

hospital in an 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.

No order as to costs.

(KULDEEP MATHUR),J 128-Ravi Kh/-

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