Rajasthan High Court - Jodhpur
Dwarka Das Soni vs State And Ors (2025:Rj-Jd:48515) on 7 November, 2025
Author: Farjand Ali
Bench: Farjand Ali
[2025:RJ-JD:48515]
HIGH COURT OF JUDICATURE FOR RAJASTHAN AT
JODHPUR
S.B. Civil Writ Petition No. 9856/2008
1- Dwarka Das Soni s/o Sh. Sita Ram Ji Soni, Aged about 69
Years, By Caste Soni, Permanent Resident of 5/34-35, Mukta
Prasad Colony. Bikaner. Through Legal Representatives:-
1/1- Smt. Vimla Devi W/o Late Shri Dwarka Das Soni, R/o
5/34-35, M.P. Colony, Bikaner (Raj.).
1/2 Shri Mahesh Chandra Soni S/o Late Shri Dwarka Das Soni,
R/o Gurjaron Ka Mohalla, Behind Sugni Devi Hospital, Bikaner
(Raj.).
1/3 Shri Brahama Kumar Soni S/o Late Shri Dwarka Das Soni,
R/o 3/38, M.P. Colony, Bikaner (Raj.).
1/4 Shri Vishnu Kumar Soni S/o Late Shri Dwarka Das Soni, R/o
2/270, Chankyapuri, Ghatlodia, Ahmedabad (Gujarat).
1/5 Shri Chandra Shekhar S/o Late Shri Dwarka Das Soni, R/o
Judicial Colony, Near Police Line, Barmer (Raj.)
----Petitioner
Versus
1.State of Rajasthan, through the Secretary to the
Government, Department of Pensions and pensioner's
welfare, Secretariat, Jaipur.
2. Rajasthan Pensioners Medical Fund Trust, Jaipur Through its
Trustee and Director, Directorate of Pension, Jaipur.
3.Treasury Officer, Tresury office, Bikaner.
----Respondent
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For Petitioner(s) : Dr. Harish Purohit
For Respondent(s) : Mr. Mahaveer Bishnoi, AAG
assisted by Ms. Navya Sharma
HON'BLE MR. JUSTICE FARJAND ALI
Order
07/11/2025
1. By way of filing this writ petition under Article 226 of the
Constitution of India, the petitioner has prayed for issuance
of an appropriate writ, order or direction to the respondents
to consider and allow his medical reimbursement claim
submitted on 15.11.2007 to respondent No. 3, in accordance
with the provisions of the Rajasthan State Pensioners Medical
Concession Scheme. The petitioner has further sought a
direction to the respondents to pay interest at the rate of
12% per annum on the delayed reimbursement amount, and
to extend any other consequential or appropriate relief
deemed just and proper in the facts and circumstances of
the case.
2. During the pendency of the present writ petition, the
petitioner unfortunately expired on 29.12.2011. The death
certificate issued by the Municipal Corporation, Bikaner, on
16.01.2012 is placed on record. The right to seek
reimbursement of medical expenses, being a part of the
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petitioner's accrued and heritable benefits, survives to his
legal representatives.
3. Breifly stated facts of the case are that , the petitioner,
retired from the post of Office Superintendent on attaining
the age of superannuation on 30.04.1997 and has since been
receiving pension regularly vide P.P.O. No. 603720 and T.S.
No. 11426. Being a retired government employee, the
petitioner was issued a lifetime Medical Diary under the
Rajasthan State Pensioners Medical Concession Scheme
(hereinafter referred to as "the Scheme"), entitling him to
medical benefits admissible to pensioner. It is not in dispute
that the petitioner has a long history of cardiac ailments,
having remained admitted to P.B.M. Hospital, Bikaner
between 07.10.1996 and 18.10.1996 and having undergone
angiography at S.M.S. Hospital, Jaipur on 18.03.1997. In the
year 2006, while visiting Ahmedabad for medical
consultation of his ailing wife, the petitioner experienced
chest pain and, upon medical advice, underwent a T.M.T. test
which revealed arterial blockage. On experiencing acute pain
again in August 2006, he underwent angiography at
Ahmedabad on 28.08.2006, which confirmed triple vessel
coronary artery disease, necessitating urgent bypass
surgery. Accordingly, the petitioner was admitted to S.A.L.
Hospital and Medical Institute, Ahmedabad, where Coronary
Artery Bypass Graft (CABG) surgery was performed on
25.09.2006 and he was discharged on 04.10.2006. For the
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said treatment, the petitioner incurred expenses amounting
to ₹1,14,410/-, including ₹9,410/- for angiography and
₹1,05,000/- for bypass surgery, supported by relevant bills.
Subsequently, on 11.04.2007, the petitioner again suffered
chest pain and was admitted to P.B.M. Hospital, Bikaner,
where he incurred an additional expenditure of ₹945.30 on
medicines. After recovery, the petitioner submitted his
medical reimbursement claim in three sets, duly certified, to
respondent No. 3 on 15.11.2007. It is stated that respondent
No. 3 forwarded the claim to respondent No. 2 on
15.01.2008, but no decision has been communicated to the
petitioner during his lifetime, and the claimed amount has
not been reimbursed till date. The petitioner also made a
representation requesting expeditious settlement of his
claim, but to no avail. The grievance of the petitioner is that
despite submission of the claim in the prescribed manner
and the Scheme providing for reimbursement of such
medical expenses, the respondents have failed to take any
decision thereon. Being aggrieved by the inaction of the
respondents in not deciding or reimbursing the medical claim
for a considerable period, the petitioner's legal
representatives has approached this Court by way of the
present writ petition seeking appropriate directions for
redressal of his grievance.
4. The counsel for the petitioner submitted that the
petitioner(Since deceased) had undergone treatment in an
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emergent and life-threatening situation to save his life, and
thus, under Rule 4E(b) of the Scheme, the respondents are
legally bound to consider and decide his claim for
reimbursement even in absence of prior recommendation.
The petitioner had duly submitted the prescribed claim form
in January 2008, which was forwarded to respondent No. 2,
yet despite lapse of considerable time, the claim remains
undecided without any justifiable reason. Such inaction is
arbitrary, unreasonable, and violative of Articles 14 and 300-
A of the Constitution of India. The petitioner, having spent
his retiral benefits for the said treatment and presently
facing financial hardship due to his wife's illness, is in dire
need of reimbursement. In these circumstances, the
respondents' failure to decide and release the admissible
claim is unsustainable in law, and on these grounds alone,
the writ petition deserves to be allowed.
5. The counsel for the respondent filed a reply and submitted
that the petitioner did not undergo treatment in an emergent
situation but in a planned manner at Ahmedabad, and has
also failed to produce the mandatory certificate from a
qualified Cardiologist as required under Rule 4E(b) of the
Rajasthan State Pensioners Medical Concession Scheme. The
petitioner has already been reimbursed for the treatment
taken at P.B.M. Hospital, Bikaner. Therefore, the writ petition
is devoid of merit and deserves to be dismissed.
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6. Heard learned counsels present for the parties and gone
through the materials available on record.
7. Having considered the rival submissions and upon careful
examination of the record, this Court finds that the core
issue that arises for adjudication is whether the petitioner,
who underwent coronary bypass surgery at S.A.L. Hospital
and Medical Institute, Ahmedabad, without prior
recommendation of the Medical Board, is entitled to
reimbursement of the medical expenses incurred, under the
Rajasthan State Pensioners Medical Concession Scheme,
1997.
8. It is a settled principle of law that the right to health and
medical care is an integral facet of the right to life under
Article 21 of the Constitution of India. The State, being a
welfare employer, is under an obligation to ensure that no
retired employee or pensioner is deprived of timely medical
relief merely on technical or procedural grounds.
9. The object of the Scheme is to extend medical support to
pensioners in need, and therefore, its provisions must
receive a liberal and purposive interpretation rather than a
pedantic or restrictive one. When the circumstances indicate
a bona fide emergent medical situation, strict insistence
upon prior approval or recommendation of the Medical Board
would defeat the very purpose of the Scheme.
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10. In the instant case, the material on record clearly
establishes that the petitioner, aged 67 years, was suffering
from a cardiac ailment and had previously undergone
angiography at S.M.S. Hospital, Jaipur. Upon suffering acute
chest pain at Ahmedabad, he was advised immediate
coronary artery bypass surgery. The angiography report
revealed a 100% arterial blockage, indicating a life-
threatening condition. The surgery, therefore, cannot be
treated as a planned or routine procedure, but rather as an
emergent measure to save the petitioner's life.
11. The Hon'ble Division Bench of this Court in State of
Rajasthan & Ors. v. Surendra Kumar Kalra [RLW 2008
(3) Raj. 1953] and the Hon'ble Supreme Court in Suman
Rakheja v. State of Haryana [(2004) 13 SCC 562] have
consistently held that where medical treatment is taken in an
emergency, reimbursement cannot be denied merely on the
ground that such treatment was undertaken in a private or
non-recognized hospital, provided the expenses are
restricted to the rates applicable to recognized government
hospitals. Similar principles were reiterated in Surjit Singh
v. State of Punjab [AIR 1996 SC 1388] and State of
Punjab v. Mohan Lal Jindal [(2001) 9 SCC 217].
12. This Court in Kanhaiya Lal Dave v. State of
Rajasthan & Ors. [S.B. Civil Writ Petition No.
420/2009] and Gyanendra Kumar Pareek v. State of
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Rajasthan [2009 (4) WLC (Raj.) 95] further observed
that "emergency knows no law and no procedure,"
emphasizing that when human life is at stake, the State's
responsibility cannot be abdicated on technicalities.
13. In Kanhaiya Lal Dave (supra), which in turn relied upon
the Division Bench judgment in Anil Kumar Surolia v.
State of Rajasthan [2005 (3) WLC (Raj.) 396], this
Court elaborated upon the doctrine of emergent medical
necessity in the following terms:
"When a family member suffers from cardiac ailment, the
prime objective of the other family member would be to save
his/her life. At that time, services of whichever hospital is
suited could be utilized because emergency knows no law
and no procedure, and when human life is at stake, in such
situation, ultimate responsibility of the State cannot be
washed off.
Government cannot insist upon an employee to get himself
treated at a recognized government institution. All that the
Government in these circumstances can do is to reimburse
the concerned employee at the rates that may be applicable
in the recognized government institution. Consequently, the
reimbursement of the medical expenses borne by the State
Government employees and pensioners has to be done even
if the treatment is undertaken at an unrecognized hospital
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outside the State even though reference may not have been
taken prior to treatment."
14. This exposition, drawing strength from Surjit Singh
(supra) and Mohan Lal Jindal (supra), lays down that once
emergent circumstances are established, reimbursement
cannot be denied merely on the ground that treatment was
obtained at an unrecognized hospital or without prior
reference.
15. In view of these legal principles, and considering the
petitioner's age, medical history, and the nature of ailment
reflected in the angiography report, this Court finds sufficient
material to conclude that the treatment was undertaken in
an emergent condition and squarely falls within Rule 4E(b) of
the Scheme. The respondents' stand that the treatment was
"planned" is unsustainable and contrary to both medical
evidence and the spirit of welfare jurisprudence.
16. The prolonged inaction of the respondents in deciding
the petitioner's claim despite submission in 2008 is highly
unreasonable and arbitrary. Their failure to process the claim
in accordance with the Scheme violates Articles 14 and 300-
A of the Constitution, as it results in unjust deprivation of the
petitioner's legitimate entitlement.
17. Accordingly, this Court holds that the petitioner was
entitled to medical reimbursement as per Rule 4E(b) of the
Rajasthan State Pensioners Medical Concession Scheme, and
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the said entitlement now survives tom his legal
representatives, restricted to 80% of the hospital expenses,
limited to the general ward rates of the All India Institute of
Medical Sciences, New Delhi, along with interest at the rate
of 6% per annum from the expiry of 30 days after
submission of the bills till actual payment.
18. The respondents are, therefore, directed to verify the
petitioner's claim and supporting documents, compute the
admissible amount in terms of the Scheme, and release the
same to the legal representatives of the deceased petitioner
within a period of three months from the date of receipt of
this order.
19. The writ petition is accordingly allowed to the aforesaid
extent. No order as to costs.
(FARJAND ALI),J
281-Mamta/-
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