Delhi High Court says Employee is Entitled to Medical Reimbursement for Emergency Treatment at Non-Empanelled Hospital
A Single Judge Bench of the Delhi High Court, led by Justice Jyoti Singh, ruled in favor of a petitioner seeking medical reimbursement for treatment received at a non-empanelled hospital under the Central Government Health Scheme (CGHS). The court held that the petitioner, who was severely injured in an accident, was entitled to reimbursement despite not being admitted to a hospital listed under the CGHS, as the admission was made during an emergency.
Background of the Case:
The petitioner, Seema Mehta, has been employed at a school since 2000. On September 18, 2013, she was involved in a serious accident that resulted in a severe head injury. Initially, she was admitted to Guru Tegh Bahadur Hospital in Shahdara but was later referred to Sir Ganga Ram Hospital due to the critical nature of her injury. She underwent a major brain surgery and required prolonged treatment, with multiple admissions before being discharged in January 2014.
Despite her medical expenses totaling approximately Rs. 5.85 lakh, Mehta’s claim for reimbursement was denied by the school and the Directorate of Education (DoE), as the hospital she was treated at was not empanelled under the CGHS.
Court’s Ruling:
The petitioner, aggrieved by the rejection of her claim, approached the Delhi High Court. The counsel for the petitioner argued that both the DoE and the school were responsible for reimbursing her medical expenses, as the school is government-aided and receives grants from the Delhi government. The counsel further emphasized that the petitioner was admitted to the hospital in an emergency, and the denial of reimbursement based on the hospital’s non-empanelment under CGHS was unjust.
The DoE’s counsel countered that several CGHS-empanelled hospitals were available, and since Mehta did not seek treatment from them during the emergency, her claim should not be reimbursed. They also pointed out that the medical certificate was issued years after the accident and that the petitioner had been terminated from her job following disciplinary proceedings.
The court, however, found that the petitioner’s admission to Sir Ganga Ram Hospital was due to a medical emergency and that the emergency certificate issued by the hospital was authentic. The court referred to previous rulings, including the Supreme Court’s judgment in Shiva Kant Jha v. Union of India and the Delhi High Court’s decision in Union of India v. Joginder Singh, which emphasized that medical claims for emergency treatment should not be denied merely because the hospital was not empanelled under CGHS.
Court’s Conclusion:
The court noted that the petitioner’s serious head injury required immediate medical attention, and the denial of reimbursement would be unjust. The court also highlighted that the authenticity of the emergency certificate was not disputed and that the delay in issuing the certificate did not invalidate the claim.
In its final ruling, the court directed the respondents to reimburse the petitioner’s medical expenses of Rs. 5.85 lakh within six weeks. Additionally, the petitioner was entitled to interest at 6% per annum from the date her claim was rejected until the payment was made.
