Rajasthan High Court - Jodhpur
Rajat R vs State Of Rajasthan (2024:Rj-Jd:24311) on 28 May, 2024
[2024:RJ-JD:24311]
HIGH COURT OF JUDICATURE FOR RAJASTHAN AT
JODHPUR
S.B. Civil Writ Petition No. 7400/2021
Rajat R S/o Shri K. Rajan, Aged About 28 Years, R/o
Sobhalayam, Kattanam, Alappuzha, Kerala State - 690503,
Presently Residing At House No. 73/5, Bank Colony, Military
Hospital Road, Rai Ka Bagh, Jodhpur, Mobile No. 8239603780
----Petitioner
Versus
1. State Of Rajasthan, Through Its Additional Chief
Secretary, Department Of Medical, Health And Family
Welfare, Secretariat, Jaipur.
2. The Director, State Insurance And Provident Fund
Department, (General Insurance Fund), D Block, Vitta
Bhawan, Janpath, Jaipur.
3. The Joint Director, Medical And Health Services, Zone
Jodhpur, Jodhpur.
4. The Assistant Director, State Insurance And Provident
Fund Department, Jodhpur City, Jodhpur.
----Respondents
For Petitioner(s) : Mr. Yashpal Khileree.
For Respondent(s) : Mr. H.S. Chundawat for
Mr. Mahaveer Bishnoi, AAG.
HON'BLE MR. JUSTICE ARUN MONGA
Order (Oral)
28/05/2024
1. The grievance of the petitioner herein is against an order
dated 07.01.2021 (Annex.11), by which the petitioner's claim for
medical reimbursement was rejected on the ground that the
petitioner was admitted to a non-panel hospital.
2. Briefly, the relevant facts as pleaded in the petition are that
the petitioner was initially appointed to the post of LDC / Junior
Assistant by an order dated 27.08.2012 (Annex.1). During his
service tenure, he took 47 days of privilege leave (Annex.5) and
went to his native place in Kerala on 24.07.2020. On 04.09.2020,
he fell seriously ill and was taken to Lokeshore Hospital in Kochi,
Kerala. On 05.09.2020, he underwent a kidney operation and was
[2024:RJ-JD:24311] (2 of 5) [CW-7400/2021]
discharged on 10.09.2020 (Annex.6). The petitioner incurred a
total amount of Rs. 1,49,289/- for his operation.
2.1 The petitioner submitted an application dated 07.12.2020
(Annex.7) for reimbursement of his medical bills. On 14.12.2020,
he received a message on his mobile from the SIPF Department
that his claim was rejected. Aggrieved, the petitioner submitted
another application dated 24.12.2020 (Annex.9) to the
respondents to address his grievance. However, by order dated
07.01.2021 (Annex.11), respondent No.4 - Assistant Director
rejected his application on the ground that the hospital where the
petitioner was operated on was not empanelled under the
Rajasthan Government Health Scheme. Hence, this petition.
3. The defence taken by the respondents in their reply is as
follows:
3.1 The terms and conditions between the parties are governed
by a contract, namely the Group Medi-Claim Insurance Policy
(Annex.3). Thus, if there is any question of violation of the
contract terms and conditions, the petitioner has the alternative
remedy of filing a civil suit to claim all valid reliefs, wherein all
disputed questions of fact can be adjudicated.
3.2 The petitioner has wrongly stated that the operation was
undertaken in an emergency. The documents on record reveal
otherwise; the discharge summary does not indicate that the
operation was performed under emergent circumstances or that
there was a life-threatening condition. Furthermore, the petitioner
traveled a distance from his place of residence to the hospital,
indicating there was no emergency.
[2024:RJ-JD:24311] (3 of 5) [CW-7400/2021]
3.3 Considering the nature of the treatment and the conditions
of the Policy, the petitioner's claim was rightly rejected as he was
admitted to a non-empanelled hospital for pyeloplasty, which is
not considered a medical emergency under the policy's terms and
conditions. The petitioner has not pointed out any illegality in the
order or made a case that the treatment was covered under
Clause 6.3 of the Policy. Hence, the petition deserves to be
dismissed.
4. In the aforesaid backdrop, I have heard learned counsel for
the respective parties, perused the case file, and I am of the view
that the petition deserves to be allowed.
5. The reasons are not far to seek. Let us see how.
6. The conceded position which emerges is that neither the
ailment of the petitioner nor the medical treatment at the relevant
time is disputed. Merely because he did not receive treatment
from an empanelled hospital, the petitioner's claim was denied.
7. In this respect, reference may be had to a judgment
rendered by me in a similar situation in the case of Kesra Ram
Vs. State of Rajasthan & Anr.: S.B. Civil Writ Petition
No.9571/2008, decided on 23.02.2024. For ready reference,
relevant of the same being apposite is reproduced hereinbelow:
"7. Qua entitlement of reimbursement for treatment in
emergency from a private hospital, learned counsel for the
petitioner, in course of his arguments, relies on the various
judgments viz. Surjit Singh Vs. State of Punjab & Ors.- (1996)
2 Supreme Court Cases 336; Shobha Devi Choudhary Vs.
Union of India & Anr. 2022 SCC Online Raj 2868; Thomas T.
Vs. State of Rajasthan & Ors. : S.B. Civil Writ Petition
No.3749/2006 passed by this Court.
8. Adverting, now to the defense as pleaded in the reply filed
with this court, it is evident that no explicit stand has been taken
[2024:RJ-JD:24311] (4 of 5) [CW-7400/2021]
therein regarding the petitioner's not being entitled to
reimbursement for treatment at a private hospital. However, the
impugned note/order dated 19.02.2008 from the CMHO, which
is inter alia under challenge herein, same expressly states the
rejection of his claim is on account of private treatment.
9. XXXXXX
10. In the parting, I may hasten to add that reference in
particular may be had to Supreme Court judgment rendered in
Surjit Singh (supra), and as also rightly relied by learned
counsel for the petitioner in the context of right to self-
preservation being a findamental right. Case of the petitioner is
squarely covered by the ratio enunciated therein. As held by
Supreme Court, it is settled position in law that the right to
health and self-preservation by medical treatment in an
emergency is akin to the right to life, as enshrined in Article 21
of the Constitution of India. This right is fundamental, sacred,
precious, and inviolable. Employees of State have a right to take
steps to preserve their own lives when faced with a life threat in
an emergency. Accordingly, given the facts of the instant case,
the petitioner herein had the right to take steps for his self-
preservation, including seeking emergency medical treatment
without having to wait for prior sanction and/or waiting for his
turn in a government hospital or an authorised hospital instead
of rushing to a private hosiptal i.e. Soni Hospital, Jaipur herein,
in view of apparent threat to life at the relevant time. As an
upshot, I see no reason, why the petitioner be not accorded the
benefit of reimbursement of his medical bills."
10. From the record, it is evident that there is no dispute
regarding the fact that the petitioner was taken to the hospital in
Kerala while he was on leave and had gone to his native place in
Kerala. In such a situation, it is neither possible nor expected for
the petitioner to travel from Kerala to Rajasthan to receive
treatment at an empanelled hospital in Rajasthan.
11. As an upshot of my discussion hereinabove, the petition is
allowed. The impugned order dated 07.01.2021 (Annex.11) is set
aside. The respondents are directed to verify the medical bills of
the petitioner and, within the permissible limit prescribed by the
[2024:RJ-JD:24311] (5 of 5) [CW-7400/2021]
Department, process and reimburse the same to the petitioner
along with interest as per applicable service rules.
12. Pending application(s), if any, also stand disposed of.
(ARUN MONGA),J
137-Sumit/-
Whether Fit for Reporting: Yes / No
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