- Bookmark
- Share
- CaseIQ
Suman Rakheja v. State Of Haryana And Another
Factual and Procedural Background
The appellant, widow of a deceased government servant, incurred medical expenses of Rs 6,01,166 for her husband’s treatment at Apollo Hospital, New Delhi, which was then a private, unrecognised hospital. The State rejected her reimbursement application because the hospital was not approved. [1]
After hearing both parties, the Court granted leave and considered the appeal against that refusal. [2][3]
Legal Issues Presented
- Whether the appellant was entitled to reimbursement for emergency treatment obtained at a private hospital that was not recognised or approved by the State. [1][4]
- What proportion of the medical expenditure was reimbursable. [4][5]
Arguments of the Parties
Appellant’s Arguments
- The appellant relied upon Sant Prakash v. State of Haryana, where reimbursement was granted because emergency circumstances required immediate hospital admission. [4]
- Her husband had suffered a paralytic stroke caused by blood clotting in the brain and therefore had to be rushed to the private hospital in an emergency. The discharge certificate recorded the emergency nature of the case. [4]
- She sought the same relief granted in Sant Prakash: reimbursement of 100% of medical expenses at AIIMS rates and 75% of expenditure exceeding those rates. [4]
Table of Precedents Cited
| Precedent | Rule or Principle Cited For | Application by the Court |
|---|---|---|
| Sant Prakash v. State of Haryana CWP No. 588 of 1998 (P&H) | In an emergency requiring immediate hospital admission, the patient was entitled to reimbursement of 100% of medical expenses at AIIMS rates and 75% of expenditure exceeding those rates. [4] | The Court granted the appellant reimbursement on the same basis. [5] |
Court’s Reasoning and Analysis
The Court accepted the relevance of Sant Prakash because the appellant’s husband had required emergency treatment, as supported by the discharge certificate. [4]
Applying the reimbursement formula used in that case, the Court held that the appellant was entitled to 100% reimbursement at AIIMS rates and 75% of expenditure exceeding those rates. [4][5]
Holding and Implications
APPEAL ALLOWED. The appellant is entitled to reimbursement of 100% of medical expenses calculated at AIIMS rates and 75% of the expenditure exceeding those rates. No costs were awarded. [5][6]
The direct effect is that the State must reimburse the appellant according to this formula. The opinion states no broader implications or new precedential rule. [5][6]
Order
1. Leave granted.
2. Heard counsel for the appellant as well as the counsel for the respondents.
3. The appellant is the wife of a deceased government servant who had undergone treatment in the Apollo Hospital, New Delhi, which was a private hospital and which was not recognised/approved at that time. For the treatment in that hospital the appellant incurred expenses to the tune of Rs 6,01,166 and the appellant, by way of an application prayed for reimbursement of the medical expenses incurred, but the same was declined by the State, on the ground that the hospital wherein the appellant's husband had undergone the treatment was not an approved hospital.
4. Counsel for the appellant submitted that in similar case (Annexure P-4) i.e by the order of the High Court of Punjab and Haryana in Sant Prakash v. State of Haryana CWP No. 588 of 1998 (P&H) wherein in an emergency case the patient had to be immediately admitted in hospital, the relief has been granted. In the present case also the appellant's husband had to be rushed to the private hospital because he had developed a paralytic stroke on the left side of the body, as there was blood clotting on the right side of the brain and therefore, was admitted in an emergency condition in the hospital. In the present case the discharge certificate also shows that the case was an emergency one. In Sant Prakash case CWP No. 588 of 1998 (P&H) the Division Bench held that the petitioner therein would be entitled to 100% medical expenses at the AIIMS rates and 75% of the expenditure in excess thereto.
5. In the result, in this appeal also, the appellant herein would be entitled to get the refund of the amount of 100% medical expenses at the AIIMS rates and 75% of the expenditure in excess thereto.
6. In the result, the appeal is allowed. No costs.
Alert