1 S.B.Civil Writ Petition No.1856/2007 Dr.Jitendra Raj Bhandari v. State of Rajasthan & Ors. Date of Order :: 27 th March, 2008 HON'BLE MR.JUSTICE GOVIND MATHUR Mr. Trilok Joshi, for the petitioner. Mr. R.Dave, for the respondents. .... By this petition for writ, the petitioner is claiming for reimbursement of medical expenses incurred for undergoing Coronary Artery Bypass Grafting X 3. The noticeable facts of the case are that the petitioner retired from service of Government of Rajasthan on 30.4.2002. He undergone Coronary Artery Bypass Surgery at Tongia Heart & General Hospital, Jaipur on 7.4.2007. For the purpose a sum of Rs.1,15,000/- incurred and the petitioner claimed reimbursement of the same from Government of Rajasthan as per Government Order No.F.1(5)FD/Rules/98 dated 21.11.2001. The claim of the petitioner came to be rejected by the Treasury Officer (Rural), Jodhpur on 7.7.2005 on the count that the Hospital where the petitioner undergone the treatment was not a hospital 2 enlisted in the approved list of the Government of Rajasthan. While assailing validity of decision of the Government of Rajasthan, the contention of counsel for the petitioner is that the petitioner undergone a specialised treatment that was not available in Government Hospital and, therefore, whatever expenses incurred should have been reimbursed. The respondents, while contesting the claim of the petitioner, urged that the treatment undergone by the petitioner was available with the Government Hospitals including Sawai Man Singh Hospital, Jaipur but the petitioner choose to get himself treated at private hospital which was not enlisted with approved list, thus, the reimbursement of medical expenses was rightly denied. Considered the rival contentions advanced by counsel for the parties. The Governor of Rajasthan by an order dated 21.11.2001 introduced para 4B in the Rajasthan State Pensioners Medical Concession Scheme, that reads as follows:- “4B(i)A pensioner and the members of his family, as defined in sub-para (5) of para 3 of the Scheme, shall 3 also be entitled for grant of financial assistance in respect of the following specialised treatments taken in a Government hospital within the State of Rajasthan:- ------------------------------------------------------ S. Name of Specialised Scale of Assistance No. treatment 1 2 3 ------------------------------------------------------ 1. By-pass Surgery 80% of the hospital expenses or Rs.1.20 lacs which ever is less 2. Open-Heart Surgery 80% of the hospital expenses or Rs.1.20 lacs which ever is less 3. Valve-Replacement 80% of the hospital expenses or Rs.1.20 lacs which ever is less 4. Implantation of 80% of the cost of pace Pacemaker maker including its accessories of Rs.28000/- whichever is less 5. Angioplasty/ 80% of the hospital Balloonplasty expenses or Rs.40,000/- which ever is less ------------------------------------------------------ (ii)The procedure for getting specialised treatment and claiming financial assistance shall be same as provided in para 4A of the scheme except that the constitution of Medical Board and sanction of Principal, College/Director, Medical & Health shall not be necessary.” (c)In case a pensioner takes treatment of Angioplasty/Balloonplasty in recognised hospitals outside the state, he/she may be allowed 80% of the expenditure incurred of Rs.40,000/- whichever is less.” 4 From perusal of the provision referred above, it is apparent that in the event of open heart surgery or by-pass surgery, a retired government servant is entitled for 80% of the hospital expenses or Rs.1.20 lacs, whichever is less. The rate prescribed above is for the government hospitals within the State of Rajasthan. It is true that the petitioner has not undergone treatment in a government hospital but the factum of undergoing treatment is not at all disputed. In event of getting treatment at a government hospital such as Sawai Man Singh Hospital, Jaipur, the petitioner would have been entitled for reimbursement of expenses as per the provision referred above. A Division Bench of this Court in the case of Anil Kumar Surolia v. State of Rajasthan & Ors., 2005(3) WLC 396, held that even if required treatment was available at Sawai Man Singh Hospital, Jaipur or other approved hospitals in State of Rajasthan, the employee was indeed entitled to medical reimbursement if he had got the treatment else where necessitated on account of circumstances beyond control. In State of Rajasthan & Ors. v. Syed Manzoor Ali, 2006 WLC (Raj.) UC 704, a Division Bench of this Court held as under:- 5 “14.No doubt, the chose to his wife treated in a private hospital. Had he received treatment in a government hospital, say SMS Hospital, Jaipur, he would have indisputably been entitled to reimbursement of expenses. We see no reason why following the ratio of the decisions in Surjit Singh, Ram Lubhaya Bagga and Mohan Lal Jindan, he should be denied reimbursement at the rates applicable in the government hospital merely because he preferred to get the treatment in a private hospital. The foundational facts of the respondent's claim being not in dispute, we are of the view, the respondent should be allowed reimbursement of expenses incurred by him at the rate prescribed for government hospitals for treatment of his wife.” In the instant matter too the claim of the petitioner regarding undergoing treatment at a private hospital has not been disputed, thus, he is certainly entitled for reimbursement of expenses incurred by him at the rate prescribed for the government hospitals as per clause 4B of the Rajasthan State Pensioners Medical Concession Scheme. The petitioner is required to receive 80% of the total hospital expenses i.e. 80% of the sum of Rs.1,15,000/-. The petition for writ is disposed of accordingly. ( GOVIND MATHUR ),J. Kkm/ps.