CWP 899/06 //1// In the High Court of Judicature for Rajasthan Jaipur Bench ** Civil Writ Petition No.899/2006 Gopal Das Kothari Versus State & (3) Ors. Date of Order ::: 09/01/09 Hon'ble Mr. Justice Ajay Rastogi Mr. Ravi Shanker Sharma, for petitioner Mr. Nasir Ali Naqvi, AAG, for respondent State Petitioner retired while serving as Sr Divisional Clerk (Treasurer Office) Jhalawar on attaining age of superannuation on 01/09/89 and is a member Rajasthan Pensioner's Medical Concession Scheme and residing in district Jhalawar. As alleged in petitioner, on 12/01/2004, he felt heart attack besides chest pain, thereby his family members took him to Govt. Hospital, Kota where he was referred to Jaipur but on account of he being in a critical state of his health, he was admitted in Intensive Care Unit Tongya Heart Hospital on 13/01/04 and cardiac heart surgery was operated and after discharge from Tongya Heart Hospital, submitted medical bills incurred of Rs.1,51,625/- as is evident from letters dt.02/03/05 (Ann.1) forwarded by Collector (Treasurer) vide letter dt.03/05/05 but his claim was finally rejected vide letter dt.28/05/05 (Ann.3). Hence this petition. In reply to writ petition, it has been CWP 899/06 //2// inter-alia averred that petitioner is not entitled to reimbursement of his medical bills on the premise that the patient undertook treatment in private Hospital (supra) which is not recognized & approved by Government. Counsel submits that petitioner is a retired Government servant and a member of Rajasthan State Pensioners Medical Concession Scheme and in a critical condition, when he was not provided proper medical care in Govt. Hospital, he was immediately taken to private Hospital where he was surgically operated; for which the bills were submitted in accordance with medical Scheme; as such very rejection of bills for reimbursement on the premise that Tongya Hospital is not recognized/approved by Government, cannot be sustainable under law. However, Counsel for respondents submits that since petitioner has not been operated and medically treated in recognized hospital, is not entitled for medical reimbursement and placed reliance upon DB decision in State of Rajasthan Vs. Mithulal Gupta (Special Appeal (Writ) 858/07 decided on 24/03/08 (Per Hon. R.M.Lodha, J.). I have considered contentions of both the parties and with their assistance, pondered over material on record. This fact remain undisputed CWP 899/06 //3// that because of his condition having been deteriorated, he was taken to Tongya Hospital (supra) in an emergent situation, and was medically treated and surgically operated for CABG on being diagnosed, for which he incurred expenses as is evident from letters (Ann.1 to 3). In State Vs. Mithulal Gupta (supra) this Court while dealing with such like controversy and taking note of Para 4E of Pensioners' Medical Scheme, observed ad infra: “11. The Counsel for the respondent then submitted that in any case the petitioner was entitled to the reimbursement to the extent of Rs.1,20,000/- as per the then existing rule 4B. Rule 4B provides the scale of assistance to the extent of 80% of hospital expenses or Rs. 1,20,000/- which is less in the case of bye-pass surgery if the treatment is taken in a Government hospital within the State of Rajasthan. The petitioner did not choose to avail of the specialised treatment in SMS Medical College and Hospital although angiography was done there but instead without any reference from that hospital went to Escort Hospital, New Delhi on his own. Having not chosen to have the specialisted treatment in a Government hospital within the State of Rajasthan, the scale of assistance provided in the CWP 899/06 //4// para 4B of the Rules for treatment in such hospitals cannot be applied. The case of petitioner is covered by para 4E of the Scheme and according to that provision, scale of assistance is limited to Rs.44,000/- being 80% of general award charges of All India Institute of medical Sciences, New Delhi.” In instant case, petitioner took treatment from a hospital in State of Rajasthan, which is not recognised hospital duly approved by Government. Paras 4A of Pensioner medical concession scheme take note of treatment of disease not available in Government Hospital in the State of Rajasthan and so also para 4B is in respect of specialised treatment taken in Government hospital within State of Rajasthan. Para 4G deals with treatment of disease other than heart ailment in recognised hospital outside the State being entitled to AIIMS as per rates prescribed therein. No provision has been brought to the notice of this Court in regard to cases where treatment of heart ailment has been undertaken by a member of pensioners medical scheme from a hospital within State of Rajasthan which is not a recognized hospital. At the same time, Para 4-E(a) & (b) of the Scheme deals with treatment of heart ailment in recognised hospital outside the State (with or CWP 899/06 //5// without the recommendation of the of the medical Board and thus makes him entitlement for payment of medical expenses as per Schedule chart referred to therein. It would be appropriate that in absence of any provisions to the contrary, in such cases, where members of the Scheme undertake treatment from a hospital which is not recognised by Government within State of Rajasthan, atleast be made entitled to claim reimbursement under para 4-E of the Scheme. Consequently the writ petition succeeds and is hereby allowed. Rejection letter dt. 28/05/2005 (Ann.3) is hereby quashed & set aside. Respondents are directed to make payment of medical bills raised by petitioner in terms of Rule 4E of the Scheme with interest @ 9% p.a., from the date of presentation of bills till actual payment. The respondents may ensure compliance of this order within three months. No costs. (Ajay Rastogi), J. K.Khatri/p.5/899CW064E-0901Raj.doc