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Reimbursement Of Medical Claim By Govt Employees Should Not Be Denied Mechanically: Gujarat High Court Reiterates
PRIYANKA PREET
1 Aug 2022 9:00 AM IST
The Gujarat High Court has reiterated that a Government employee is entitled to avail the benefits of medical facilities without any fetters, and that their claim for reimbursement should not be denied by the State mechanically.The Bench of Justice Biren Vaishnav extensively relied on the decision of a Coordinate Bench in Chanrakant Kantilal Dave v. State of Gujarat to order full reimbursement...
The Gujarat High Court has reiterated that a Government employee is entitled to avail the benefits of medical facilities without any fetters, and that their claim for reimbursement should not be denied by the State mechanically.
The Bench of Justice Biren Vaishnav extensively relied on the decision of a Coordinate Bench in Chanrakant Kantilal Dave v. State of Gujarat to order full reimbursement of expenses borne by the Petitioner herein during his Angioplasty. The bench reiterated:
"It is a settled legal position that the Government employee during his lifetime or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated."
The Petitioner had incurred an expense of Rs.,1,76,757 in her medical treatment. She claimed that part reimbursement worth Rs.62,100 for her surgery at Rajasthan Hospital was misconceived.
Per contra, the govt pleader argued that the Petitioner underwent surgery at Rajasthan Hospital and not a government hospital. Therefore, only part reimbursement could be made.
The High Court relied on Chanrakant Kantilal (supra) to address the issue, considering it had similar circumstances. It reiterated:
"The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds."
The Bench also noted from the case that care availed from a hospital which was not recognised or approved by the State Government could not be a satisfactory reason for depriving the employee of the reimbursement. This was in consonance with the principles of a Welfare State such as India. Further, the law also does not require the employee to take prior permission where the survival of the patient is of prime concern. These principles were determined by the Apex Court in Shiv Kant Jha versus Union of India, 2018(3) SLR 328 (S.C.).
Thus, keeping in mind these decisions, the High Court directed the full reimbursement of the balance amount with a 9% per annum interest rate to the Petitioner within 10 weeks.
Case No.: C/SCA/6345/2019
Case Title: GULAMKADAR KASAMBHAI SHAIKH v/s THE STATE OF GUJARAT THRU THE PRINCIPAL SECRETARY
Citation: 2022 LiveLaw (Guj) 302
