Article 21 | Medical Reimbursement Can't Be Denied For Emergency Treatment At Non-Empanelled Hospital: Punjab & Haryana High Court

The Punjab and Haryana High Court has directed the Haryana Government to reimburse the remaining medical expenses of a government employee incurred for the emergency treatment of his wife in a non-empanelled private hospital, holding that denial of reimbursement without reasons is arbitrary and violative of the right to life under Article 21 of the Constitution.Justice Sandeep Moudgil said, "In emergent and life-threatening situations, a patient or attendant has no real or meaningful choice to wait for admission or treatment at PGIMER, and the right to life guaranteed under Article 21 of the Constitution mandates timely and effective medical care. The petitioner was compelled by circumstances beyond his control to obtain emergency treatment from a private hospital to save the life of his wife. Consequently, denial of full reimbursement of the actual expenditure incurred amounts to penalising the petitioner for circumstances not attributable to him and defeats the very object and purpose of the medical reimbursement policy."The petitioner, Suresh Kumar, approached the High Court seeking issuance of a writ of certiorari for quashing an order passed in 2020, whereby the State sanctioned only ₹43,005 against his total medical claim of ₹4,63,770.51, leaving an unpaid balance of ₹4,20,766 without assigning any reasons.The claim pertained to emergency medical treatment of the petitioner's wife, Smt. Poonam, who was admitted in a critical condition at Indraprastha Apollo Hospital, Sarita Vihar, Delhi, in August 2014. During the emergency surgery, her uterus and gallbladder were removed and a hernia operation was also performed. Given the life-threatening condition of the patient, the petitioner had no time to approach an empanelled hospital or obtain prior approval.After submitting the medical bills to the Sub Divisional Officer (Civil), Karnal, objections were raised on the ground that the hospital was not empanelled and that an emergency certificate was required. The petitioner promptly obtained the emergency certificate from the Civil Surgeon, Karnal, and resubmitted the claim.Despite repeated representations and removal of objections, the authorities delayed the matter for years. Ultimately, vide order dated 18.05.2020, only ₹43,005 was sanctioned, without giving the petitioner any opportunity of hearing or explaining the basis for denial of the remaining amount.Counsel for the petitioner argued that the treatment was bona fide, genuine, and life-saving in nature and emergency circumstances justified treatment at a non-empanelled hospital and denial of reimbursement without reasons amounted to arbitrariness. The prolonged delay since 2014 caused severe financial hardship and mental agony.Reliance was placed on Supreme Court judgments including Shiva Kant Jha v. Union of India and State of Punjab v. Mohinder Singh Chawla, to contend that medical reimbursement cannot be denied on technical grounds in emergency cases.State defended the impugned order, contending that Apollo Hospital was not empanelled at the relevant time and reimbursement was granted strictly as per Haryana Medical Reimbursement Policy, at PGIMER/AIIMS rates.Rejecting the State's stand, the High Court observed that the factum of treatment and genuineness of bills were not in dispute and the patient was admitted in a serious condition at odd hours, leaving no real choice to seek treatment at an empanelled hospital.Relying on Paschim Banga Khet Mazdoor Samity v. State of West Bengal and Shiva Kant Jha v. Union of India, the Court reiterated that reimbursement cannot be denied merely because treatment was taken in a non-empanelled hospital during an emergency.The Court further held that forcing patients to adhere rigidly to PGIMER/AIIMS rates in emergency situations is unrealistic, especially when such institutions are overburdened and inaccessible in urgent circumstances."Undoubtedly, PGIMER and AIIMS are premier government institutions equipped with advanced infrastructure and medical expertise; however, they are often overburdened with critically ill patients, resulting in long waiting periods. In such circumstances, the exigencies of the situation may compel a patient or attendant to seek alternative treatment options, as was the case here, particularly when the petitioner was residing at a distant location from PGIMER," it added.The Court also took serious note of the extraordinary delay of several years in processing the petitioner's claim, observing that such callousness aggravated the violation of the petitioner's constitutional rights and caused avoidable mental agony."The authorities cannot escape liability by hiding behind procedural technicalities when the delay itself has compounded the hardship of the petitioner, thereby aggravating the infringement of his rights under Article 21," said the judge.Allowing the writ petition, the High Court directed the respondents to reimburse the remaining amount of ₹4,20,766 and pay interest at 6% per ...

Article 21 | Medical Reimbursement Can't Be Denied For Emergency Treatment At Non-Empanelled Hospital: Punjab & Haryana High Court

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Article 21 | Medical Reimbursement Can't Be Denied For Emergency Treatment At Non-Empanelled Hospital: Punjab & Haryana High Court

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