Rajasthan HC Orders University to Reimburse Rs. 8.90 Lakh Medical Claim for COVID-19 Treatment at Delhi Hospitals
The Rajasthan High Court held that the University of Rajasthan could not deny reimbursement for a retired employee's COVID-19 treatment at non-recognised Delhi hospitals, including AIIMS and Sri Gangaram Hospital, and directed payment within four weeks with 6% interest.
The Rajasthan High Court at Jaipur has allowed a writ petition filed by Anupama Prasad, directing the University of Rajasthan to reimburse a medical claim of Rs. 8,90,000 arising from her father's treatment at hospitals in Delhi during the COVID-19 pandemic. Justice Rekha Borana, sitting singly, held that denying reimbursement on the ground that the hospitals were non-recognised and located outside the State “cannot be sustained in law” given the conditions that prevailed during the pandemic. The University is required to pay within four weeks, and the reimbursable amount will carry interest at 6% per annum. The order settles the claim of the family of a retired Associate Professor who died after prolonged illness in November 2021.
The Claim and the University's Refusal
The petitioner's father retired on 31 October 2000 from the post of Associate Professor in the Zoology Department of the University of Rajasthan. During the COVID-19 pandemic he was admitted to several hospitals in Delhi, including AIIMS and Sri Gangaram Hospital, and died on 18 November 2021 after prolonged illness.
Anupama Prasad raised a medical reimbursement claim for Rs. 8,90,000 on 27 July 2022. The University rejected the claim by letter dated 17 August 2022. The stated ground was that the treatment had been taken in a non-recognised hospital outside the State of Rajasthan.
In its reply before the Court, the University advanced three distinct objections. First, it said no documentary evidence had been placed on record proving that the father was suffering from COVID-19; the documents instead showed admission to the Urology Department for a urinary stone and age-related ailments. Second, the petitioner had not shown that the requisite treatment was unavailable within Rajasthan or that a referral had been obtained from SMS Hospital on the recommendation of a Medical Board. Third, the University argued it was not the petitioner's case that an emergent situation existed that compelled the father to be admitted at the nearest hospital.
The Settled Legal Position on Non-Recognised Hospitals
Justice Borana turned first to the legal framework governing reimbursement for treatment at non-recognised hospitals. She referred to the earlier single-bench decision in Rama Prasad Sharma v. State of Rajasthan & Ors., S.B. Civil Writ Petition No. 7469/2016, decided on 21 January 2022, which laid down that reimbursement for treatment taken in a non-recognised hospital cannot be denied outright. The rate payable in such cases is what would have been applicable for similar treatment in recognised government hospitals.
On the question of whether an emergent situation could independently justify reimbursement for out-of-State treatment in an unrecognised facility, the Court relied on the Division Bench ruling in State of Rajasthan & Ors. v. Tikam Chand Maloo, D.B. Special Appeal Writ No. 1124/2015, decided on 15 May 2018. The Division Bench had held that “in an emergent situation, if the Govt. employee took treatment outside the State that too in unrecognized hospital, as per Rules then also, he is entitled for reimbursement of the medical expenses which are scheduled under the Rules.”
How the Bench Applied the Law to the COVID-19 Facts
Justice Borana found on a bare perusal of the record that the father had undergone treatment at various hospitals in Delhi during the COVID-19 pandemic. She treated it as an universally accepted fact that during the pandemic the immediate availability of medical care was of paramount importance. Patients during that period were compelled to seek treatment at the nearest available hospital regardless of whether it was recognised or situated within the State, owing to the then prevailing circumstances.
Against this factual backdrop, the University's objection that no emergent situation existed was rejected. The Court did not accept that the absence of a formal referral from SMS Hospital or a Medical Board recommendation could bar reimbursement when the patient was hospitalised during the peak of a public health emergency that removed ordinary choice from both patients and their families.
Applying the ratio from Rama Prasad Sharma and Tikam Chand Maloo, the Court concluded that the petitioner was entitled to reimbursement to the extent permissible under the Rajasthan Civil Services (Medical Attendance) Rules, 2008 or under whichever rules specifically govern employees of the University of Rajasthan.
Order
The writ petition was allowed. The respondent authorities — the State of Rajasthan, the University of Rajasthan, and the Deputy Registrar (Accounts & Finance) of the University — were directed to reimburse the medical claim to the extent permissible under the applicable Rules within four weeks from the date of receipt of the order. The Court further directed that the reimbursable amount shall carry interest at 6% per annum. The stay petition and any pending applications were disposed of.