Medical Claim Cannot Be Denied Solely For Having Undergone Emergency Treatment In A Hospital Not Prescribed In Govt Order: J&K&L High Court

The facts of the instant case were that the deceased, while performing his duties, got seriously ill and was shifted to Government Medical College Hospital, Jammu in the year 2009. Since his health condition continued to deteriorate, he was shifted to Apollo Hospital, New Delhi in the Emergency Wing where doctors attended him and he was advised certain tests to be carried out. On the basis of tests conducted on him, the deceased was diagnosed as suffering from blood cancer.

Since the family of the deceased did not have enough resources to get him treated in the Apollo Hospital at New Delhi, he came to be shifted to the All India Institute of Medical Sciences, New Delhi (AIIMS) in a serious condition where he came to be admitted in the Emergency Wing, where the petitioners felt that the response of the doctors towards the deceased was not good, as such, finding no alternative the deceased was shifted back to Apollo Hospital, New Delhi for chemotherapy.

Adjudicating upon the matter, Justice Nargal observed that it is an admitted position that the husband of petitioner No. 1 has undergone the treatment for blood cancer from Apollo Hospital as is evident from the medical bills.

Explaining the "BSNL Employees Medical Reimbursement Policy" which squarely covered the instant case, Justice Nargal observed that it is emphatically clear that by virtue of clause 2.2.0, an employee (including retired employee) and his/her dependants shall be entitled to reimbursement of expenses at the approved rates at all hospitals recognized from time to time by the management.

"The aforesaid Scheme also provides for recognized hospitals/nursing homes and clause 2.2.2 provides that in emergency cases, the reimbursement would be allowed for treatment in non-recognized hospital with the approval of CGM for field office employees and concerned Director of BSNL Board for C.O. employees", the bench underscored.

Vouching for a liberal application of the scheme the bench maintained that the respondents have to keep in mind that the technicality of the rules and regulations are not required to be followed just in a mechanical manner so as to frustrate the very purpose of the Scheme. Each case has to be examined on its own facts before taking any final decision and it goes without saying that to preserve health and medical aid in furtherance of the self preservation is a part of right of life as envisaged under Article 21 of the Constitution of India and in the present case, the petitioners are held entitled for medical reimbursement of their expenses, said the court.

Fortifying the adopted position the bench found it worthwhile to record the observations of Supreme Court in Shiv Kant Jha Vs. Union of India reported as 2018,

"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".

Allowing the petition the court directed the respondents to process the medical bills of the deceased and release the same in favour of the petitioners within a period of two months from the date the copy of this order is served upon respondents in respect of which all the bills required have already been submitted by the petitioners besides completing all the medical formalities.

Case Title : Bimla Ji Bhat & Ors Vs Union of India.

Citation : 2022 LiveLaw (JKL) 176

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