Medical reimbursement cannot be denied solely for undergoing emergency treatment at a non-recognized specialized hospital.

The applicant’s ten-year-old son was diagnosed with a brain tumor (Posterior Fosa Intra Cranial Sol/Ependymoma WHO Grade-II)

Following a preliminary check-up at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, doctors advised specialized medical and surgical intervention

Due to the emergency nature of the ailment, the son underwent surgery at Paras Hospital, Gurgaon, a facility equipped with advanced neuro-surgery technology

The applicant submitted medical bills totaling approximately Rs. 30 lakhs for reimbursement under the J Civil Services (Medical Attendance-cum-Allowance) Rules, 1990

The Deputy Commissioner, Badgam, rejected the claim via order dated 06-10-2023

The applicant challenged this rejection, asserting that the emergency treatment was necessary and that technicalities like the lack of a referral certificate should not defeat a claim involving life-threatening situations

1. Whether medical reimbursement can be denied solely on the ground that treatment was obtained at a specialized hospital not approved or recognized by the State

2. Whether procedural requirements, such as the absence of a referral certificate, can override the constitutional right to health and medical treatment in emergency situations

The court primarily relied on the fundamental right to life and health guaranteed under Article 21 of the Constitution of India, establishing the State’s constitutional obligation to provide medical facilities

It applied the principle from Shiv Kant Jha v. Union of India (2018), which held that courts must be liberal in reimbursement cases and that treatment in non-recognized hospitals is not a valid sole ground for denial

The court further cited State of Punjab v. Mohinder Singh Chawla (1992) and State of Punjab v. Ram Lubhaya Bagga (1998), which emphasize that the government must bear the expenditure for a servant's treatment and cannot show rigidity in reimbursement matters

Additionally, the court referenced Rule 6 of the J Civil Services (Medical Attendance-cum-Allowance) Rules, 1990, regarding the powers of the competent authority to consider surgical treatments

The Tribunal reasoned that the right to medical reimbursement is an integral part of the right to life under Article 21

It observed that the preservation of human life is of paramount importance and the State has a mandatory duty to bear the expenses of treatment for its employees or their dependents in specialized hospitals, provided the treatment is genuine

The court criticized the respondents' rigidity, noting that in emergencies, procedural hurdles like referral certificates should not supersede substantial justice

While the State argued that treatment was available locally within the U.T., the Tribunal held that if the treatment was emergent, the status of the hospital (recognized vs. non-recognized) becomes secondary to the factum of the treatment itself

However, the court noted that the petitioner must still prove the genuineness of the medical bills and the procedures undergone

The court ordered the respondents to assess the factum of treatment and the genuineness of the medical bills, rather than rejecting the claim on technical grounds

The applicant was directed to cooperate by submitting all requisite documentation

The competent authority is mandated to pass a speaking order within eight weeks from the date of the service of the court order