Medical reimbursement cannot be denied for emergency treatment at a non-empanelled hospital.

The petitioner, a retired employee of the respondent-University, incurred medical expenses of ₹6,87,100 for emergency COVID-19 treatment.

After initial treatment at hospitals in Hisar, he was referred to Shree Aggarsain International Hospital, Delhi, where he was admitted to the emergency ward and treated in the ICU, including with ventilator support, for 21 days.

The petitioner submitted his medical records and bills for reimbursement, and the Civil Surgeon’s Verification Certificate dated 19.02.2021 recorded that the treatment had been undertaken in an emergency.

The University rejected full reimbursement by order dated 25.11.2021, relying on the State Government’s COVID-19 treatment-rate instructions dated 25.06.2020 and the hospital’s non-empanelled status.

It reimbursed ₹3,16,093 and declined the balance of ₹3,71,007.

The petitioner challenged the rejection under Articles 226 and 227 of the Constitution.

Whether reimbursement of medical expenses may be denied merely because treatment was obtained at a non-empanelled hospital, when the treatment was medically essential and undertaken in an emergency to preserve the petitioner’s life?

Whether the petitioner was entitled to reimbursement of the balance amount of ₹3,71,007, along with interest, after receiving partial reimbursement of ₹3,16,093?

The Court applied the constitutional protection of the right to life under Article 21, holding that preservation of human life and access to timely emergency medical treatment must receive the highest priority.

It relied on Surjit Singh v. State of Punjab and Others, (1996) 2 SCC 336, which recognizes that a claimant who obtains treatment at an alternative or non-approved hospital in order to save life cannot be denied reimbursement solely on that ground.

The Court also considered the State’s COVID-19 treatment-rate directions issued under Section 2 of the Epidemic Diseases Act, 1897, but held that such rate restrictions and the absence of hospital empanelment could not defeat a genuine emergency claim where the tests of essentiality and emergency were satisfied.

The medical record established that the petitioner suffered from a serious, life-threatening COVID-19 condition involving acute respiratory distress, critically low oxygen saturation and other complications.

He was referred from hospitals in Hisar to a Delhi super-speciality hospital, admitted through the emergency ward, treated in the ICU and placed on ventilator support.

These circumstances demonstrated that the treatment was both medically essential and undertaken in an emergency for preservation of life.

Applying Article 21 and the principle in Surjit Singh, the Court held that the University could not reject full reimbursement merely because the hospital was non-empanelled.

The State could not reasonably expect a critically ill patient to delay or forego life-saving treatment to comply with empanelment requirements.

The Court quashed the order dated 25.11.2021 rejecting the petitioner’s claim for full reimbursement.

The University was directed to pay the balance medical reimbursement of ₹3,71,007 within eight weeks of receiving the certified copy of the judgment.

It was further directed to pay interest at 6% per annum on the balance amount, calculated from the date of filing of the writ petition, i.e., 15.12.2025, until actual payment.