CW 455/08 [1] IN THE HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JAIPUR BENCH S.B. Civil Writ Petition No.455/08 Ram Niwas Chittora Versus State of Raj. DATE OF ORDER : 26/08/2008 HON'BLE MR. JUSTICE AJAY RASTOGI Mrs. Poornima Sharma, for petitioner Mr. M.C. Gupta, Addl. Govt. Counsel, for State *** Petitioner, who is a senior citizen, retired from service while holding the post of Principal, Primary & Secondary Education on 31st December, 2000. He had angina pain in his heart, as alleged, initially went to SMS, Hospital where Doctor advised him for Angiography which was done at SMS Hospital and as per its report, he was advised for bypass surgery. Since he is a retired person and was unable to get medical facilities available in government hospital and being in emergent situation, his family members immediately took him to S.K. Soni Hospital where he was admitted and was operated on 30th October, 2006. After successful operation, he was discharged on 6th November, 2006. Thereafter, he submitted medical bills for reimbursement which was rejected by the respondents vide order Ann.4 dt.16th October, 2007 on the premise that since the petitioner had undertaken treatment from the hospital which is not a recognized hospital and approved by the Government, as such cannot be reimbursed. CW 455/08 [2] This controversy has been examined by the Division Bench of this court in State of Rajasthan Vs. Mithulal Gupta (Special Appeal (writ)-858/07 decided on 24th March, 2008) holding that if the treatment has been undertaken from the hospital being not approved/recognized by the State of Rajasthan, he will be entitled for medical reimbursement as per rates fixed by the State of Rajasthan for government approved hospitals; and thus while dealing with such like controversy as in instant case, 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 CW 455/08 [3] hospital within the State of Rajasthan, the scale of assistance provided in the 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 approved by Government. Paras 4A of Pensioner medical 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 of the Scheme, deals with treatment undertaken by member CW 455/08 [4] of the Scheme from a hospital/institution not recognised by Govt. Thus, this Court considers it proper that in such cases, where the member has taken treatment from a hospital which is not recognised by Government within State of Rajasthan shall also be entitled to claim reimbursement under para 4-E of the Scheme. In view of what has been observed above, instant petitioner is entitled for reimbursement of his medical bills furnished by him, in terms of Rule 4-E of the Scheme. Consequently, writ petition stands allowed. Order (Ann.4) dated 16th October, 2007 rejecting claim of petitioner is hereby quashed and set aside. Respondents are directed to make payment of bills raised 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 two months. No order as to costs. [AJAY RASTOGI], J. FRBOHRA455CW2008 26-8-medreimb.doc