Case Note & Summary
The petitioner, Shri Parshuram Shankar Motiwale, a Senior Clerk (now Assistant Superintendent) in the District Court, Solapur, filed a writ petition under Article 226 of the Constitution challenging the communication dated 14th June 2021 issued by the Registrar, District Court, Solapur, which denied reimbursement of medical expenses incurred for his 75-year-old mother. The petitioner's mother, a retired Class-IV employee (Kaksha Sevika) receiving a pension of Rs.13,583/- per month, underwent emergency treatment at a hospital that was not empanelled under the Medical Reimbursement Rules applicable to the petitioner, but was recognised under the Central Government Health Scheme (CGHS). The petitioner claimed reimbursement of Rs.1,50,000/- as per the claim dated 13th January 2021. The respondents denied the claim on the ground that the hospital was not empanelled. The court considered the legal issue of whether denial of reimbursement for emergency treatment at a non-empanelled hospital is justified. The petitioner argued that the denial was arbitrary and unreasonable, especially since the hospital was CGHS-recognised and the treatment was emergent. The respondents contended that reimbursement could only be made for treatment at empanelled hospitals. The court analysed the Medical Reimbursement Rules and held that in cases of emergency, where the hospital is recognised under CGHS, denial of reimbursement is unreasonable. The court quashed the impugned communication and directed the respondents to process the claim and reimburse the petitioner at CGHS rates within four weeks. The petition was allowed.
Headnote
A) Service Law - Medical Reimbursement - Dependent Mother - Emergency Treatment - The petitioner, a government employee, sought reimbursement for medical expenses of his 75-year-old mother who underwent emergency treatment at a hospital not empanelled under the Medical Reimbursement Rules but recognised under CGHS. The court held that denial of reimbursement solely on the ground of non-empanelment is unreasonable, especially when the treatment was emergent and the hospital is recognised under CGHS. The court directed reimbursement at CGHS rates. (Paras 1-10) B) Constitutional Law - Article 226 - Writ Jurisdiction - Medical Reimbursement - The court exercised its writ jurisdiction to quash the communication dated 14th June 2021 denying reimbursement, and directed the respondents to process the claim within four weeks. (Paras 1, 10)
Issue of Consideration
Whether the denial of medical reimbursement to a government employee for treatment of his dependent mother at a non-empanelled hospital is justified when the treatment was of an emergency nature and the hospital is recognised under CGHS.
Final Decision
The petition is allowed. The impugned communication dated 14th June 2021 is quashed and set aside. The respondents are directed to process the claim of the petitioner and reimburse the medical expenses at CGHS rates within four weeks from the date of the order.
Law Points
- Medical reimbursement
- Government employee
- mother dependent
- emergency treatment
- non-empanelled hospital
- CGHS rates
- Article 226
- reasonableness
