BENGALURU: When a recognised government hospital refers a patient, who is a government servant, to a non-empanelled private hospital under exceptional circumstances, he/she should be entitled to reimbursement of medical expenses.
The High Court of Karnataka said this while directing the Suvarna Arogya Suraksha Trust of the state government to reimburse the medical bills submitted by a government servant.
Justice Hemant Chandangoudar passed this order while allowing a petition by Nagabhushana B, assistant court officer of the HC, questioning the rejection of his claim by the trust.
The trust issued an order on January 23, 2023, rejecting his medical claim on the grounds that it is not covered under emergency circumstances as defined in the Government Order (GO) of November 5, 2014.
Initially, the petitioner was admitted to Jayadeva Institute of Cardiovascular Sciences and Research on the premises of KC General Hospital at Malleswaram in the city.
He was later referred to Mazumdar Shaw Medical Centre, a private and non-empanelled hospital, according to the GO, for treatment by a pulmonologist. After treatment, the petitioner submitted an application for reimbursement of Rs 2.63 lakh along with prescriptions, bills and the discharge summary issued on December 23, 2022.
He also submitted a representation to the Registrar General of the high court, explaining the emergency circumstances that necessitated treatment at an unrecognised hospital.
The same was communicated by the Registrar General to the trust, which rejected the claim, stating that it is not covered under emergency circumstances as per the GO.
The GO stated that under exceptional circumstances, government servants are entitled to reimbursement of medical expenses incurred at non-empanelled private hospitals, especially when recognised government hospitals refer them to non-empanelled private hospitals for any reason.
Referring to this provision, the court said the petitioner is entitled to reimbursement of medical expenses under Clause 5 of Paragraph 3 of the GO, which allows government servants to seek reimbursement of medical expenses at notified rates, even if treatment was taken in private hospitals, provided they were to referred there by recognised government hospitals.
Therefore, the order issued by the trust rejecting the claim is quashed. Also, the trust has to consider the petitioner’s claim for reimbursement of medical expenses, subject to submission of documents, the court said.