Smt. Sulochana Devi Divedi (Pathak) vs State of Rajasthan and Others

Gopal Krishan Vyas, J.—Heard learned Counsel for the parties.

By way of filing present writ petition, petitioner is claiming reimbursement of medical expenses. The said claim was rejected by the respondents vide order dated 26th July, 2005 (Annexure-2) on the ground that the case of petitioner was not referred by the competent medical authority for further treatment in the hospital out side State where petitioner got medical treatment. The claim of the petitioner was rejected vide order dated 26th July, 2005 on the ground that the hospital in which petitioner got treatment is not in the list of recognized hospital as per scheme of Govt. of Rajasthan.

The petitioner is pensioner and she was allowed pension vide PPO No.851095. The petitioner along with her husband went Ahmedabad to meet their relatives (Manju who is sister of petitioner) where on 04th October, 2004 petitioner all of sudden suffered serious chest pain, therefore, she was taken to nearby hospital which is known as Sterling Hospital, Memnagar, Ahmedabad.

In the hospital, as per advise of the doctors immediate operation of coronary angioplasty was performed to save life of petitioner in which petitioner spent sum of Rs. 1,78,352/- and being pensioner she applied for reimbursement of medical expenses incurred for her treatment at Ahmedabad as per Rajasthan State Pensioner Welfare Medical Concession Scheme. But her claim has been rejected on illegal grounds, therefore, it is prayed that order dated 26th May, 2005 Annexure-2 whereby respondents have refused to accept claim of petitioner may kindly be set aside.

Learned Counsel for the petitioner argued that in emergent situation to save life of the petitioner it was felt necessary to get treatment without referring matter by the competent authority as provided in the scheme. Learned Counsel for the petitioner has invited attention of this Court towards the judgment of this Court reported in WLC 2003 (1) 51 (Gajraj Chand Bhandari v. State of Rajasthan and Ors.) and another judgment reported in 2000 (3) RLW 1708 (Smt. Nirmala Kumar Raizada v. Director Pensions & Pensioners Welfare and Ors.) in which the learned Single Judge of this Court has held that in emergent situation, it should not be expected from the employee to observe the formalities to get his case recommended for treatment from outside the State. Therefore, refusing reimbursement of medical bills is violation of Article 14 and 21 of the Constitution of India. Learned Counsel for the petitioner further argued that mere on technicalities, the petitioner has been denied payment of medical expenses for which she is legally entitled under the Scheme framed by the Welfare State.

Per contra learned Counsel for respondents vehemently argued that when there is scheme formulated by State Government then it is the duty of employee to follow the provisions of the said scheme to claim any reimbursement of medical bills under the Scheme. In this case as per learned Counsel for the respondents, the case of petitioner was not recommended by any competent authority for treatment outside the State and petitioner at his own got treatment outside the State at Ahmedabad without even referred by any competent authority, therefore, petitioner is not entitled for any payment of medical bills as claimed by her.

After hearing both learned Counsel for the parties, I have considered rival submissions made by petitioner as well as by respondents.

In this case, admittedly as per facts in emergent situation, petitioner got treatment of heart disease at Sterling Hospital, Memnagar, Ahmedabad in which huge amount was paid by her and being retired government employee she is entitled for reimbursement of the said amount as per the scheme. Upon perusal of reply and impugned order the denial has been made on the ground that petitioner took treatment from private hospital outside the State in Gujrat in the hospital which is not recognized in the Scheme.

I am in full agreement with the proposition laid down by the Co-ordinate Bench of this Court in case of Smt. Nirmala Kumar Raizada v. Director Pensions & pensioners Welfare and Ors. (supra) in which the Co-ordinate Bench of this Court in which it has been held that in emergent situation, if any treatment is taken by the pensioner outside the state, then, also he is entitled for medical reimbursement. Para - 6 of the aforesaid judgment is as follows:

6- jktLFkku jkT; isa''kulZ dUls''ku Ldhe jkT; ljdkj dh foKfIr fnukad 19@11@1981 }kjk tkjh dh xbZ Fkh A mDr Ldhe ds fu;e 4 �,� esa is''kulZ }kjk jkT; ls ckgj fd;s tkus okys jksxks ds bykt dk mYys[k gS A mDr Ldhe dk fu;e 16 fuEu izdkj gS%

The Board of Trustees may grant to a pensioner any concession relating to medical treatment or attendance which is not provided in this Scheme in individual cases of extreme hardship on merits.

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In this view of the matter, this writ petition is allowed. The respondents are directed to reimburse the medical bills as per Scheme without insisting upon the fact that her case was not recommended/forwarded by the competent doctor for treatment outside the State in the private hospital and petitioner shall be paid the amount of medical bills as per rates of notified and recognized hospital under the Scheme within a period of two months from the date of receipt of certified copy of this order.

No order as to costs.