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Smart Summary

Factual and Procedural Background

The respondent, an employee of the District and Sessions Court, Balotra (Rajasthan), proceeded on leave to Uttaranchal where he suffered a heart ailment. While returning to Balotra, he became seriously ill and was admitted to the Escort Heart Institute, New Delhi, where he underwent bypass surgery. He sought full reimbursement of the medical expenses from the State of Rajasthan.

Under the Rajasthan Civil Services (Medical Attendance) Rules, 1970, the State sanctioned only ₹50,000, the ceiling then prescribed. Aggrieved, the respondent filed Civil Writ Petition No. 2611 of 2006 before the Rajasthan High Court. A learned Single Judge allowed the petition and directed full reimbursement. The State’s intra-court appeal (DB Civil Special Appeal No. 749 of 2007) was dismissed by a Division Bench on 5-9-2007. The State of Rajasthan sought special leave to appeal to the Supreme Court, leading to the present decision.

Legal Issues Presented

  1. Whether Rule 6 or Rule 7 of the Rajasthan Civil Services (Medical Attendance) Rules, 1970 governs reimbursement when a government servant falls ill while outside Rajasthan.
  2. Whether a government servant can claim full reimbursement for treatment at a recognised out-of-state hospital (Escort Heart Institute, New Delhi) even when the required treatment is available within Rajasthan.
  3. Whether the earlier Rajasthan High Court decision in Shankerlal v. State of Rajasthan (2000) 3 WLC 585 (Raj) was correctly decided.

Arguments of the Parties

Appellant (State of Rajasthan)

  • Rule 6(1) specifically covers employees who fall ill while on leave or otherwise outside Rajasthan, limiting reimbursement to the scale applicable within Rajasthan.
  • Rule 7 applies only where the requisite treatment is unavailable in any government hospital within Rajasthan, which is not the case for heart surgery.
  • The High Court erred in applying Rule 7 and in relying on Shankerlal.

Respondent

  • Escort Heart Institute is included in Appendix II to the Rules (recognised hospitals), thus treatment there should qualify under Rule 7.
  • Because the Institute is recognised, full reimbursement ought to follow, consistent with Shankerlal.

Table of Precedents Cited

Precedent Rule or Principle Cited For Application by the Court
Shankerlal v. State of Rajasthan & Ors.
(2000) 3 WLC 585 (Raj)
Held that full reimbursement was permissible under Rule 7 for treatment at Escort Heart Institute. Overruled; Supreme Court held the case misapplied Rule 7 and does not state the correct law.
State of Punjab v. Ram Lubhaya Bagga
(1998) 4 SCC 117
Government may reasonably limit medical benefits in line with available financial resources. Cited to justify the State’s power to restrict reimbursement to the ceiling fixed under the Rules.

Court's Reasoning and Analysis

1. The Court compared the text and purpose of Rules 6 and 7. Rule 6(1) expressly covers government servants who “fall ill” while outside Rajasthan on duty or leave, granting only the benefits they would receive within the State. Rule 7, by contrast, is triggered only when the needed treatment “is not available in any government hospital in the State,” which was not alleged here because heart-surgery facilities exist in Rajasthan.

2. Because the respondent’s circumstances fell squarely within Rule 6, reliance on Rule 7 by both the Single Judge and the Division Bench was erroneous. Consequently, the High Court’s dependence on Shankerlal, which had applied Rule 7 in similar circumstances, was misplaced.

3. Invoking State of Punjab v. Ram Lubhaya Bagga, the Court reaffirmed the State’s authority to frame rules that limit reimbursement in accordance with fiscal capacity. The statutory ceiling of ₹50,000, uniformly applied, could not be displaced by judicial orders absent statutory violation.

Holding and Implications

Appeal Allowed; High Court judgments set aside; respondent’s writ petition dismissed.

Immediate Effect: The respondent is not entitled to reimbursement beyond ₹50,000 under Rule 6. However, as the excess amount had already been paid (pursuant to the now-overruled High Court view) and the respondent has since retired, the State is directed not to recover that sum, nor amounts similarly paid to other employees under the erstwhile Shankerlal interpretation.

Broader Implications: The Supreme Court expressly overrules Shankerlal, clarifying that Rule 6 governs illnesses occurring outside Rajasthan where treatment is available within the State. Future claims for out-of-state treatment will be confined to the limits fixed by Rule 6, unless the disease is demonstrably not treatable in Rajasthan and the certification procedure under Rule 7 is followed.

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    State Of Rajasthan v. Mahesh Kumar Sharma .

    H.L Gokhale, J.— Leave granted. This appeal by special leave by the State of Rajasthan is preferred against the judgment dated 5-9-2007 of a Division Bench of the High Court of Judicature for Rajasthan at Jodhpur in DB Civil Special Appeal No. 749 of 2007 dismissing the appeal filed by the appellant against the judgment and order passed by a learned Single Judge of that Court dated 12-9-2006 in Civil Writ Petition No. 2611 of 2006.

    2. The facts giving rise to the present appeal are thus: the respondent was an employee working in the District and Sessions Court at Balotra, Rajasthan. He had gone to Uttaranchal on leave where he suffered a heart ailment. On his way back to Balotra, he suddenly fell ill and got admitted in Escort Heart Institute in New Delhi and was operated for bypass surgery. He claimed the reimbursement of the full medical expenses from the State of Rajasthan. The State Government accepted his request to a limited extent and granted him reimbursement up to an amount of Rs. 50,000 which was permissible as per the Rules. The respondent felt aggrieved and hence filed a writ petition which was allowed by the learned Single Judge and the appeal therefrom was dismissed by the Division Bench and hence this appeal by special leave by the State of Rajasthan.

    3. The Division Bench as well as the Single Judge have relied upon a judgment of a Division Bench of the Rajasthan High Court viz. Shankerlal v. State of Rajasthan (2000) 3 WLC 585 (Raj). What had happened in that case was that the wife of the appellant had similarly gone along with him outside Rajasthan where she had suffered a heart problem. She was taken to Escort Heart Institute in New Delhi where she was operated. The reimbursement of the expenditure of her surgery was declined by the Government. She filed a writ petition which was allowed by the Division Bench.

    4. The learned counsel for the appellant points out that the Division Bench of the High Court had erred in relying upon Rule 7 of the Rajasthan Civil Services (Medical Attendance) Rules, 1970 as against Rule 6 thereof. He points out that Rule 6 of those Rules is the relevant rule which applies to a situation where an employee goes outside the State and falls sick. Rule 7 deals with a situation where a government servant is not in a position to obtain the necessary medical treatment for the disease in the State of Rajasthan which is a different situation and in which case he is permitted the treatment in the hospitals which are mentioned in Appendix 11 of the Rules. Rule 6(1), according to him, is the relevant rule which reads as under:

    “6. Medical attendance and treatment outside Rajasthan.—(1) A government servant including members of his family posted to a station or sent on duty or spending leave or otherwise at a station outside Rajasthan in India and who falls ill shall be entitled to free medical attendance and treatment as an indoor and outdoor patient in a hospital maintained by the Central Government or other State Government on the scale and conditions which would be admissible to him under these Rules, had he been on duty or on leave in Rajasthan.”

    5. As stated above, Rule 7 deals with the treatment of a disease for which treatment is not available in the State of Rajasthan. Certainly it cannot be contended and it is not so contended by the respondent that treatment for a heart surgery is not available in the State of Rajasthan. The learned counsel for the respondent contended that Escort Heart Institute, New Delhi has been included in Appendix 11 by the Office Memorandum dated 25-8-1989 and has been approved and recognised by the State of Rajasthan. Rule 7(1) itself points out that such institute can be approached for surgery but only for which treatment is not available in Rajasthan.

    6. Rule 7(1) reads as under:

    “7. Treatment of a disease for which treatment is not available in the State.—(1) A government servant and the members of his family suffering from a disease for which treatment is not available in any government hospital in the State shall be entitled to medical attendance and treatment to the extent indicated in sub-rule (2) of this rule in a hospital/institution outside the State recognised by the Government, provided that it is certified by the Principal of a Medical College/Director of Medical & Health Services on the basis of opinion of the authorised medical attendant to the effect that the treatment of a particular disease from which the patient is suffering is not available in any government hospital in the State and it is considered absolutely essential for the recovery of the patient to have treatment at a hospital outside the State.”

    7. This being the position, in our view, the learned Single Judge as well as the Division Bench and the earlier Division Bench which decided Shankerlal case (2000) 3 WLC 585 (Raj) erred in relying upon Rule 7(1) and granting full reimbursement of the expenses which were incurred by the employee concerned while taking treatment in Escort Heart Institute, Delhi.

    8. In this connection it will be profitable to refer to the judgment of a Bench of three Judges of this Court in State of Punjab v. Ram Lubhaya Bagga (1998) 4 SCC 117 where the Bench has laid down that the Government would be justified in limiting the medical facilities to the extent it is permitted by its financial resources. In the instant case, the Government has formulated the necessary rules permitting the reimbursement of medical expenses in certain situations and up to a certain limit. The Government has been reimbursing the necessary expenditure as permitted by the Rules uniformly. It will, therefore, not be proper for a government employee or for his relatives to claim reimbursement of medical expenses otherwise than what was provided in the Rules.

    9. In the circumstances, we allow this appeal and set aside the judgment rendered by the Division Bench as well as by the Single Judge. The writ petition filed by the respondent will stand dismissed.

    10. Although this appeal is being allowed, we are informed that the respondent has already been paid the amount which was directed under the judgment dated 12-9-2006 of the Single Judge in January 2008 and that the respondent has subsequently retired from the service. It is clear that the reimbursement was done in view of the then prevalent interpretation of the relevant rules in Shankerlal case (2000) 3 WLC 585 (Raj). This being the position, in the facts and circumstances of the case, the appellant Government will not recover the amount which has been paid to the respondent, nor will the Government recover any amount which has been similarly paid to other employees seeking such medical reimbursement under Shankerlal (2000) 3 WLC 585 (Raj) judgment which was prevalent so far. However, it is now made clear that the judgment in Shankerlal case (2000) 3 WLC 585 (Raj) does not lay down the correct law, and stands overruled. The legal position as explained hereinabove shall apply hereafter.

    11. The appeal is allowed and disposed of accordingly. However, there shall be no order as to the costs.

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    Comments

    State Of Rajasthan v. Mahesh Kumar Sharma .
    (Mar 2, 2011)