Absence of prior medical board referral cannot bar reimbursement for emergency life-saving treatment at empanelled hospitals.

The petitioner, an employee of TSECL, traveled to Kolkata on 10.01.2023 with prior station leave permission on medical grounds to assist a relative.

Upon arrival, he suffered acute chest pain and was admitted to Rabindranath Tagore International Institute of Cardiac Sciences.

He was diagnosed with double vessel coronary artery disease and underwent coronary angiography followed by PTCA with stenting on 13.01.2023.

Upon returning, he submitted medical reimbursement bills totaling ₹3,45,505.

The respondents and the Standing Medical Board rejected the claim through a letter dated 02.01.2025, primarily because the petitioner lacked a prior referral certificate and because the treatment was available locally at AGMC & GBP Hospital, Agartala.

1. Whether the denial of medical reimbursement solely due to the absence of a prior referral certificate from the Standing Medical Board is legally sustainable in cases of emergency.

2. Whether the availability of similar treatment within the state justifies the rejection of a reimbursement claim for emergency treatment obtained at an empanelled hospital outside the state.

The court relied on the Government of Tripura Memorandum dated 22.12.2022, which allows ex-post facto approval for treatment in enlisted hospitals outside the state in cases of emergency or acute illness arising during authorized stay outside the state.

It applied the principle from *Shiva Kant Jha v. Union of India*, which establishes that the right to medical claim cannot be denied on technical grounds like the lack of a prior referral if the treatment is genuine.

It further cited *Surjit Singh v. State of Punjab*, affirming that the right to self-preservation is a facet of the Right to Life under Article 21 of the Constitution.

Previous High Court of Tripura precedents (WP(C) 1479/2017) which held that pre-condition referrals are directory and not mandatory in emergencies.

The court reasoned that coronary artery blockage constitutes a life-threatening emergency necessitating immediate intervention and that waiting for a formal referral from Agartala while in Kolkata would have been "impracticable" and "onerous".

The court noted that the petitioner was already outside the state with valid permission when the ailment occurred.

It rejected the respondents' plea regarding local availability of treatment, noting that the petitioner did not bypass local facilities by choice but was compelled by circumstances.

By referring to the medical documents and discharge summary, the court confirmed the factum of treatment was undisputed.

Consequently, the technical requirement of a referral certificate was deemed directory rather than mandatory for emergency situations.

It held that the petitioner is entitled to reimbursement as his case fell under the emergency exception provided in the 22.12.2022 guidelines.

The respondents were directed to examine and process the medical bills dated 10.04.2023 within two months, failing which they must pay interest at 9% per annum from the date of the judgment until payment.