Reimbursement Of Medical Expenses By State: Kerala High Court Grants Relief To Govt Employee's Father Undergoing Treatment At Private Hospital

The Kerala High Court on Monday ruled that under the Kerala Government Servants Medical Attendance Rules, the State was obliged to reimburse the government servants if they or their family undergoes medical treatment in recognised hospitals, either private or government. 

While setting aside a Government communication rejecting the petitioner's claim for reimbursement, Justice Murali Purushothaman observed that the respondents were not permitted to reject such claims under Article 21 and the aforesaid Rules.  

"There is a Constitutional as well a Statutory obligation on the part of the State to bear the expenses for treatment of the government servant and his family. In the backdrop of Article 21 of the Constitution of India and the Rules issued under the proviso to Article 309, it is impermissible for the respondents to reject the claim of the petitioner for reimbursement of the bills."

The petitioner is an Assistant Professor at Catholicate College. In 2018, his father, who is wholly dependent on the petitioner was diagnosed with Carcinoma Rectum.

Accordingly, he was taken to the Medical and Surgical Oncology Department of the St. Gregorious Medical Mission Hospital, a private speciality hospital for cancer treatment. He was operated on in the Laparoscopic department of the Hospital.

In 2016, the State had issued an order recognising certain private hospitals for treatment to facilitate medical reimbursement benefits under the Kerala Government Servants Medical Attendance Rules, 1960.  

St. Gregorious Medical Mission Hospital and its Medical and Surgical Oncology department were included in the said order. The petitioner's father was admitted four times to this hospital in 2018, and he sought reimbursement for these treatments. 

Meanwhile, in June 2020, the Government issued a circular declaring that medical reimbursement will not be made unless the treatment was availed in Government recognized private hospital.

Based on this circular, the Government issued a communication informing that the petitioner's claim cannot be allowed since the department of Laparoscopic surgery at the Hospital was not empanelled under the Rules.

Accordingly, the applications and bills of the petitioner for reimbursement were returned.

Challenging the circular and the communication, the petitioner and his father moved the High Court seeking a declaration that they are entitled to reimbursement of Rs. 4,68,038/- as claimed.

Advocates Jacob P. Alex, Joseph P. Alex and Manu Shankar P. appearing for the petitioners argued that the respondents cannot deny the claim for medical reimbursement solely because the surgery was performed in the laparoscopic surgery department of the Hospital. 

It was further contended that the Medical and Surgical Oncology department of the Hospital was recognised and recommended by the Government. 

On the other hand, Government Pleader Jimmy George urged that considering the present financial constraints, the State had decided not to reimburse patients treated at unrecognised private hospitals. 

The Court noted that the Supreme Court in State of Punjab & Ors v. Mohinder Singh Chawla & Ors [AIR 1997 SC 1225] had held that the right to health is an integral part of the right to life guaranteed under the Constitution and that the Government had a Constitutional obligation to provide health facilities and bear the expenses incurred by the government servant for the treatment as per the Government policy. 

Moreover, the Judge found that the Kerala Government Servants Medical Attendance Rules provide for reimbursement of the medical expenses incurred by the government servants and their families as defined therein and subject to the conditions provided therein.

Under the Rules and the orders issued thereunder, a claim for reimbursement is admissible even if the hospital from which the treatment availed is a private hospital, provided it is empanelled under the Rules, on satisfying the criteria for recognition.

The Court noted that the said hospital was listed in the Government Order dealing with empanelment of private hospitals for medical reimbursement. Therefore, it was held that the petitioner was entitled to reimbursement of the amounts incurred for his father's treatment at the Hospital as per the Rules.

"It is for the Doctor to decide how a patient should be treated and which surgical procedure is safer and suitable to the patient. When Medical and Surgical Oncology department of the Hospital has been recognised by the Government in Ext. P2, the respondents cannot reject the claim of the 1st petitioner saying that the General and Laparoscopic surgery department from where the 2nd petitioner has received the treatment is not recognized by the Government. Undergoing Laparoscopic surgery for Carcinoma Rectum will not make the treatment as one done in a department other than the Medical and Surgical Oncology department in the Hospital."

Accordingly, the petitioner was directed to resubmit the applications and bills returned and the State was ordered to consider the same afresh in accordance with law within two months. 

Case Title: Dr. George Thomas & Anr v. State of Kerala & Ors.

Citation: 2022 LiveLaw (Ker) 52

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