Emergency expenses incurred in non-empanelled hospitals entitled to full reimbursement: HC

The Punjab and Haryana High Court held that government employees are entitled to full reimbursement of medical expenses incurred in emergency situations, even if treatment is obtained in non-empanelled hospitals. This ruling came on a petition filed by a retired SDO challenging the denial of full reimbursement for his emergency coronary artery bypass surgery performed at an Indore hospital.

“This court is of the considered view that whenever an employee is suffering from an emergency condition, the entire focus is always on saving the patient’s life. In case there is some pain, the focus is also to relieve the pain. It would be inhuman to say that whenever such like emergency situation arises an employee should keep on searching the list of approved hospitals and should first go to an approved hospital or a government hospital by ignoring the developing pain at the risk of life,” Justice Jasgurpreet Singh Puri asserted.

The petitioner had moved the court seeking the quashing of an order passed Haryana State Agricultural Marketing Board passed on January 29 denying full reimbursement of medical expenses. The Bench, during the course of hearing, was told that the petitioner suffered a cardiac emergency in July 2023 while in Ujjain, Madhya Pradesh.

He was immediately taken to a hospital there before being shifted to a super-specialty hospital in Indore. The petitioner incurred a total cost of Rs 22, 00,040 for the surgery and related treatments, but the Board only sanctioned Rs 5, 36,232, citing its policy that limited reimbursements to PGI-Chandigarh rates for unapproved hospitals.

The court observed the Board’s objection was that full reimbursement could not be granted as a patient treated in an unapproved hospital even in emergency condition was entitled for reimbursement in accordance with the PGIMER rates.

Justice Puri asserted the respondent-board's reliance on a medical policy by making a distinction between approved and unapproved hospitals flagrantly violated the right to life enshrined in Article 21 of the Indian Constitution. The stance directly contradicted the legal principles established by the Supreme Court in the case of “Shiva Kant Jha versus the Union of India”.

Before parting with the judgment, Justice Puri ruled that the petitioner was entitled to Rs.16, 63,808 out of Rs.22, 00,040. “The respondents are directed to pay to the petitioner balance amount of medical reimbursement within a period of three months from today,” the court concluded.