Ratan Singh vs The Honorable High Court Of Raj. ...
2025 Latest Caselaw 5836 Raj

Rajasthan High Court - Jodhpur

Ratan Singh vs The Honorable High Court Of Raj. ... on 7 August, 2025

[2025:RJ-JD:35069-DB]

      HIGH COURT OF JUDICATURE FOR RAJASTHAN AT
                            JODHPUR
             D.B. Civil Writ Petition No. 1792/2021

Ratan Singh S/o Ramdeo Singh, Aged About 56 Years, 111, Sri
Shanker Nagar, Jhalamand Circle, Jodhpur, Presently Working As
USHER (Jamadar) Honble High Court, Jodhpur.
                                                   ----Petitioner
                             Versus
1.    The Honorable High Court Of Raj., At Jodhpur Through
      The Registrar General.
2.    The Registrar Classification, Rajasthan High Court,
      Jodhpur.
3.    The Accounts Officer, Rajasthan High Court Jodhpur.
                                               ----Respondents


For Petitioner(s)            :     Mr. Khet Singh Rajpurohit
                                   Mr. Veeram Singh
For Respondent(s)            :     Mr. Harshvardhan Singh for
                                   Mr. Mahaveer Bishnoi, AAG
                                   Mr. Aniket Tater


           HON'BLE MR. JUSTICE MUNNURI LAXMAN

HON'BLE MR. JUSTICE BIPIN GUPTA Order 07/08/2025

1. The present writ petition has been filed challenging the

rejection of the entire claim of the petitioner for reimbursement of

medical expenses incurred for Coronary Artery Bypass Grafting X3

(Off Pump) (hereinafter referred to as 'CABG treatment').

2. The case of the petitioner is that the petitioner is working as

Jamadar (Class-IV Employee) in Rajasthan High Court and the

petitioner underwent CABG treatment and incurred an expenditure

of Rs. 1,68,000/- for the said treatment and also incurred further

medical expenditure of Rs. 32,000/-. The expenses incurred for

the surgery of CABG, the respondent-authorities sanctioned

Rs. 44,000/- and the rest of the claim was rejected, and as

against the medical expenditure of Rs. 32,000/-, only an amount

of Rs. 28,823/- was paid, and as against another medical

expenditure of Rs. 6,099/-, only Rs. 5,431/- was paid and the rest

[2025:RJ-JD:35069-DB] (2 of 9) [CW-1792/2021]

was rejected. The claim of the petitioner is that under the overall

heads, the respondent authorities denied the reimbursement of

Rs. 1,31,929/-. Such inaction of the respondents is contrary to the

Rules; therefore, he is before this Court.

3. The case of the respondents is that the claim for the

reimbursement was duly considered in the context of Rajasthan

Civil Services (Medical Attendance) Rules, 2013 (hereinafter

referred to as 'the Rules of 2013'). It is also the case of the

respondents that the petitioner's claim is governed by Appendix-XI

and the petitioner's claim was considered in the context of

eligibility contained in Appendix-XI of the Rules of 2013 with

regard to the specific kind of treatment/surgery as contained

under Appendix-XI(4) & Appendix-X(a) of the Rules of 2013. The

respondents further claimed that the entire consideration of the

reimbursement claim was done in compliance with the entitlement

of the petitioner in terms of the applicable Rules and prayed for

dismissal of the petition.

4. Heard learned counsel for the parties.

5. Learned counsel for the petitioner submits that the case of

the petitioner should have been considered under Appendix-XI(1)

of the Rules of 2013 and instead of doing that, they have

considered the claim under Clause 4 of Appendix-XI read with

Appendix-X(a), thereby the actual amount spent by the petitioner

was not fully reimbursed and a fixed amount contemplated under

Appendix-X(a) was only paid; therefore, such rejection with regard

to the specific surgery is not sustainable in terms of the Rules.

6. Learned counsel for the petitioner also contended that this

Court in S.B. Civil Writ Petition No. 9975/2018 titled

[2025:RJ-JD:35069-DB] (3 of 9) [CW-1792/2021]

'Shrigopal Guchiya Vs. State of Rajasthan & Ors.' has

considered the entitlement for reimbursement for a specific kind of

surgery contemplated under Appendix-IX and held that the

claimant therein was entitled to full reimbursement. The petitioner

is also entitled to be treated in accordance with the decision

rendered by this Court in the case of Shrigopal Guchiya (supra).

Therefore, he seeks to allow the petition.

7. Learned counsel for the respondents submits that the case of

the petitioner was considered in the light of Rule 7 read with

Appendix-XI(4) and Appendix-X(a). It is also submitted that the

petitioner underwent CABG treatment as is made out from the

medical bills submitted by the petitioner. As per the Rules and

Appendix-X of the Rules of 2013, a fixed sum of Rs. 44,000/- was

fixed for CABG (Off Pump) treatment; though the petitioner

incurred Rs. 1,68,000/-, in view of the fixed allowances to be paid

for a specific kind of procedure/surgery, the petitioner is not

entitled to get reimbursement beyond the amount fixed under

Appendix-X. It is also submitted that Clause 1 of Appendix-XI

would apply in a case otherwise then the specified

procedure/surgery. For specified procedure/treatment, fixed

amount is contained under Appendix-X. When the special

prescribed procedure/surgery is contained under Appendix-X,

Clause 4 of Appendix-XI would apply. It is further submitted that

as per Clause 4 of Appendix-XI, the amount contained for the

specific treatment as reflected in Appendix-X is the amount alone

entitled to be reimbursed and not the claimed amount by the

petitioner.

[2025:RJ-JD:35069-DB] (4 of 9) [CW-1792/2021]

8. Further, learned counsel for the respondents submits that the

decision relied upon by the petitioner is not similar to the facts in

the present case, and it was a case where the claim was made in

respect of the amount spent for the treatment taken in other than

the Government or the approved hospital as permitted under

Rules of the Rules of 2013 if such hospitals have no facilities to

treat such disease.

9. Learned counsel for the petitioner also relied upon the

decision of the Apex Court in the case of State of Rajasthan Vs.

Mahesh Kumar Sharma reported in 2011 4 SCC 257 wherein it

was held that the Government would be justified in allowing the

medical facility to the extent it is permitted by its financial

resources.

10. In the light of the above contentions, it is aptitude to refer to

Rule 7 and Rule 10 of the Rules of 2013 which read as under:

"Rule-7-Indoor / Outdoor Medical Attendance and Treatment in approved Hospitals within the State - Expenses incurred by a Government servant on account of medical attendance, treatment and implants shall be reimbursable to the extent indicated in Appendix-IX & Appendix-XI.

Rule-10- Treatment, including specialized treatment in Referral Hospitals outside Rajasthan - (1) A Government servant and the members of his/her family suffering from a disease for which treatment is not available in any Government Hospital/Approved Hospital/hospitals under Public Private Partnership Arrangement within the State, can be referred to a hospital specified in Appendix-III for medical attendance and treatment upon certification by the Principal of

[2025:RJ-JD:35069-DB] (5 of 9) [CW-1792/2021]

concerned Medical College, based on the opinion of the Medical Board to the effect that the treatment of a particular disease from which the patient is suffering, is not available within Rajasthan, and it is considered absolutely essential for the recovery of the patient to have treatment in the hospital so specified. Upon such reference and treatment being availed of, following charges/ expenses shall be reimbursable :

(i) cost of Allopathic Drugs, Medicines, Vaccines, Sera or other therapeutic substances as reimbursable under these Rules;

(ii) sums actually paid to the Hospital / Institution on account of medical attendance and treatment including charges for surgical operations and nursing facilities;

(iii) expenses incurred on accommodation shall be reimbursed as per Appendix-XV according to the class he/she is entitled to;

(iv) cost of specific Implants to the extent indicated in Appendix-IX;

(v) only one follow-up treatment on the advice of the treating doctor shall be allowed in cases where treatment has been undertaken in a referral hospital out side the State. (2) In case a Government servant takes treatment in the referral hospital without reference as per Sub-rule 10(1) above, the reimbursement shall be allowed to the extent prescribed in Appendix-IX and Appendix-XIII."

11. It is also also advantage to refer to Appendix-X(a) and

Appendix-XI (1 & 4) which read as under:

"Appendix-X(a)(i) Reimbursement for Specific Procedure treatment taken in Government Hospital shall be limited to actual expenses or to the extent as given below, whichever is less:

[2025:RJ-JD:35069-DB] (6 of 9) [CW-1792/2021]

S. Item Extent of No. Reimbursement (Rs.) 1 KNEE JOINT (INCLUDING 1,10,000/- each IMPLANTS) 2 HIP JOINT (INCLUDING 40,000/- each IMPLANTS) 3 LEG BELOW KNEE LEVEL 38,500/- each (INCLUDING IMPLANTS) 4 CABG ON PUMP 55,000/-

5 CABG OFF PUMP 44,000/-

6 ASD 45,000/-

7 VSD 55,000/-

8 BENTALL 1,25,000/-

9 TOF 55,000/-

10 CMV/PDA 10,000/-

11 AORTO BIFEMORAL 45,000/- 12 EMBOLECTOMY 10,000/-

13 CORONARY ANGIOPLASTY 50,000/-

13 CORONARY ANGIOPLASTY 55,000/- (2) WITH BALLOON 14 THALASSEMIA MAJOR 7,00,000/-

(At the rate approved under CM Relief Fund)

(b) Extent of reimbursement of the charges paid by the Government servant to the private diagnostic centres / labs as per Appendix-XVI:

(i) After obtaining NAC from Government hospital -

(a) If the facility of that Rates as per Appendix -XVI test exists in Government hospital

(b) If the facility does If rates are not prescribed in not exist in Government Appendix-XVI, 70% of hospital actual expenditure

(ii) Without obtaining NAC from Government hospital -

[2025:RJ-JD:35069-DB] (7 of 9) [CW-1792/2021]

(a) If the facility of that 80% amount of rates test exists in prescribed Government in Appendix -XVI hospital

(b) If the facility does If rates are not prescribed in not exist in Government Appendix-XVI, 50% of hospital actual expenditure

Appendix-XI-Extent of Reimbursement for treatment taken in Approved Hospital within the State-

1. The reimbursement of bills of treatment taken in Approved Hospital shall be 80% of CGHS, Jaipur rates or actual being charged by the Approved Hospital, whichever is less.

2. XXXXXXXXXXXXXXX

3. XXXXXXXXXXXXXXX

4. These provisions shall be applicable from 27-06- 2015. However, settled cases shall not be re- opened.

5. XXXXXXXXXXXXXX"

12. It is not in dispute that the petitioner is a Class-IV employee

working in the Rajasthan High Court, and it is also not in dispute

that the petitioner underwent CABG (Off Pump) treatment and

incurred an expenditure of Rs. 1,68,000/-. In connection with the

above treatment, the petitioner also incurred various medical

expenditures during the course of the said procedure, and the

respondents have allowed an amount of Rs. 44,000/- as against

the amount of Rs. 1,68,000/-.

13. From a bare reading of Rule 7 of the Rules of 2013, Rule 7

contemplates consideration of the claim in terms of Appendix-IX &

XI. Appendix-IX deals with cases of implants, and Appendix-XI

applies to cases of general treatment in approved hospitals.

Clause 1 of Appendix-XI applies to cases where reimbursement is

[2025:RJ-JD:35069-DB] (8 of 9) [CW-1792/2021]

sought for treatment taken in approved hospitals for general

diseases. Clause 4 of Appendix-XI deals with reimbursement of

specific treatments included in Appendix-X(a). The medical records

of the petitioner clearly show that the petitioner has undergone

the special procedure for specific treatment included in Appendix-

X(a), i.e., CABG (Off Pump) treatment, referred to at Sr. No. 5 of

Appendix-X(a). The amount specified for entitlement to

reimbursement for such a procedure is Rs. 44,000/-.

14. The contention of the learned counsel for the petitioner is

that his case must be considered as per Clause 1 of Appendix-XI

on the premise that Rule 7 of the Rules of 2013 only refers to

Appendix-XI and not Appendix-X, has no legs to stand on, for the

reason that Clause 4 of Appendix-XI clearly specifies that

reimbursement for specific treatment included in Appendix-X(a) is

to be made in accordance with Appendix-X(a) only.

15. In light of Clause 4 and the specific treatment contained

under Appendix-X(a), the petitioner cannot contend that he is

entitled to more than what is prescribed. As seen from the

decision of the Hon'ble Apex Court arising out of the State of

Rajasthan in the case of Mahesh Kumar Sharma (supra), it was

held that the State is justified in prescribing limited medical

facilities considering its financial resources. It was also held that

when a specific amount is specified for entitlement to

reimbursement, the Government employee or his relative cannot

claim reimbursement of medical expenses beyond what is

provided under the Rules. The decision relied upon by the

petitioner in the case of Mahesh Kumar Sharma (supra) is

based on claims covered under Rule 10 of the Rules of 2013. Rule

[2025:RJ-JD:35069-DB] (9 of 9) [CW-1792/2021]

10 of the Rules of 2013 is applicable to cases where treatment has

been taken other than Government hospital or approved hospital,

for the reason that such hospitals do not have treatment for that

particular disease. The procedure is also prescribed. The admitted

case of the petitioner is that the petitioner has taken treatment in

an approved hospital within the State (Rajasthan); therefore, Rule

10 do not apply to the petitioner's case, mutatis mutandis, the

judgment relied upon by the petitioner is not relevant for the

claim of the petitioner as it stands on a different set of facts.

Therefore, we do not find any merit in this writ petition.

16. Accordingly, the present writ petition is dismissed.

                                   (BIPIN GUPTA),J                                         (MUNNURI LAXMAN),J


                                    4-PoonamS/-









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