Rajeev Vyas. vs State of M.P. and others.

In this petition filed under Article 226 of the Constitution, the challenge is made to the impugned orders dated 15-01-2015 (Annexure P/5) and 05-02-2015 (Annexure P/6) whereby the claim of reimbursement is rejected by the respondents.

The core issue in this case is whether the petitioner is entitled to get the benefit of medical reimbursement when, admittedly, the treatment was taken from an unrecognized hospital of Nagpur.

Learned counsel for the petitioner contended that the respondents have framed Medical Reimbursement Rules (Annexure P/7). Although, the petitioner did not fulfill the requirement of Rule 9 of the said rules, in view of emergent situation, the petitioner is entitled to get medical reimbursement as per Rule 11 (3) of the said rules.

Prayer is opposed by the respondents by contending that the petitioner did not follow the conditions of the rules and there was no such emergency. Hence, the claim was rightly rejected.

Parties confined their arguments to the extent indicated above.

I have heard the parties at length and perused the record.

Rule 9 of the said rules reads as under:-

"VERNACULAR MATTER OMITTED"

A plain reading of this rule shows that in normal cases, a specific procedure is prescribed for referring the patient for treatment to a different hospital, which may be situated outside the state. Admittedly, the petitioner has not fulfilled the requirement of this provision. Rule 11 of the said rules reads as under:-

"VERNACULAR MATTER OMITTED"

The petitioner has placed heavy reliance on Sub-rule 3 aforesaid. It is noteworthy that under the said rules, the respondents have published the names of 27 recognized hospitals of national repute, which are situated in different parts of the country. Admittedly, the petitioner has not taken treatment from the said recognized hospitals. The treatment as projected by Shri Ghanshyam Sharma was relating to hip replacement.

In the opinion of this Court, considering the nature of ailment, it cannot be said that there was an extreme emergency because of which the petitioner could not follow the procedure laid down in Rule 9 and 11 of the said rules quoted hereinabove.

It is apt to mention here that this Court in cases of emergency permitted the claimants to get the amount refunded under the rules but it is apposite to remember that such directions were issued in cases of sudden emergency. In 2014 (2) MPHT 245 (Dr. Kirti Saxena vs. State of M.P. & others), this Court opined that the petitioner suffered heart attack because of which she was immediately admitted in Bhopal Memorial Hospital and Research Center. After considering the other judgments on this point, this Court held that in emergent cases, the treatment can be taken from a different hospital than the hospital which are recognized. The petitioner is unable to show that there was any such emergency or it was a special case to attract Rule 11 (3) aforesaid. Thus, I find no reason to disturb the impugned orders and issue directions as prayed for by the petitioner.

The petition is devoid of merits and is hereby dismissed. No cost.