Can't Deny Medical Reimbursement By Discriminating Between Indoor Patient And Outdoor Patient: Jharkhand High Court

The Jharkhand High Court has held that the determination of whether a patient should be categorized as "indoor" or "outdoor" depends on the expert judgment of the attending doctors at the respective hospital. The Court has further emphasized that if the medical professionals decide to provide treatment without hospitalizing the patient as an "indoor patient," then denying reimbursement solely based on the treatment being categorized as that of an "outdoor patient" is not justifiable, and such a distinction in treatment expenditure cannot be considered a reasonable classification.The Division Bench comprising Justices Sujit Narayan Prasad and Navneet Kumar observed, “This Court on the basis of applicability of principle of purposive construction and by taking into consideration the policy decision of the State Government dated 29.01.2004 issued by the Finance Department of the State of Jharkhand, by taking into consideration the mandate of Article 21 of the Constitution of India, making out the policy for reimbursement of expenditure incurred on the medical treatment and denying the said benefit only on the ground that the treatment was taken in the capacity of outdoor patient cannot be said to be proper and rationale.”“The question of inducting a patient as “indoor” or “outdoor” depends upon the decision of the experts i.e., the doctors of the concerned hospital and if the doctors have taken decision for giving treatment without admitting the patient in the hospital as “indoor patient” and in such circumstances denying the expenditure incurred by way of only because treatment was given in the capacity of “outdoor patient”, the same cannot be justified and will not be proper for the reason that if there will be distinction in between the expenditure to be incurred in the capacity of “indoor patient” or the “outdoor patient” same cannot be said to be based upon reasonable classification,” the bench added.The Division Bench in its verdict emphasized that the policy decision of the State was only to see that there must be reference by the Medical Board/Council. The ruling came in response to an intra-court appeal challenging a Single Judge's decision. The Single Judge had previously quashed the refusal of medical reimbursement for the treatment of the petitioner's daughter and directed the authorities to release the remaining reimbursement and traveling allowance within twelve weeks from the date of the order.As per the factual matrix of the case, the petitioner had been promoted to the position of Joint Secretary in the Water Resources Department, Government of Jharkhand, and subsequently retired at the age of superannuation on April 30, 2016. During his tenure as a Section Officer in the office of the Chief Engineer, Water Resources Department in Ranchi, the petitioner's daughter experienced vision problems. To address her condition, she underwent examinations at the Eye Department of Rajendra Institute of Medical Sciences (RIMS), Ranchi. The medical board of the State Government at RIMS, Ranchi, recommended further treatment at either the All India Institute of Medical Sciences (AIIMS), New Delhi, or Shankar Netralaya in Chennai.Following the medical board's referral, the petitioner's daughter received treatment on five occasions at Shankar Netralaya in Chennai, each time with the department's approval. The petitioner duly submitted medical bills, which were signed by the Department Head of Eye at Shankar Netralaya in Chennai, and requested reimbursement for both travel and medical allowances. While the travel expenses were reimbursed, the medical treatment costs were denied due to the health department's policy decision, which stated that the petitioner's daughter was treated as an 'outdoor patient' rather than an 'indoor patient.'Aggrieved by the rejection, the petitioner sought legal recourse by approaching the High Court, seeking quashing of the rejection orders and the issuance of directions to the respondents to pay the medical bills and the remaining travel allowances, wherein the Single Judge had ruled in favour of the petitioner.One of the major issues presented to the division bench revolved around the question of whether permitting the State Government to differentiate between "indoor patients" and "outdoor patients" for medical reimbursement goes against the principles outlined in Article 21 of the Constitution of India.The State-respondent pointed out the government circular dated 15.09.2006 whereby and whereunder it was decided that outdoor patients are not entitled for medical reimbursement, however, they are entitled for traveling allowance only. The Court held, “Since the said policy decision of the health department is based upon the policy decision of the finance department, the nodal department dated 29.01.2004, wherein there is no conferment of power upon the health department to carve out distinction in between the expenditure incurred as “indoor patient” or “outdoor patient”. “The...

Can't Deny Medical Reimbursement By Discriminating Between Indoor Patient And Outdoor Patient: Jharkhand High Court

Bhavya Singh

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