Dat State of Punja Punjab and others SUS v. itioner
Case Details
CWP-295 29586-2017 1 N THE HIGH COURT OF PUNJA IN TH AT CHANDIGA DIGARH NJAB AND HARYANA 212 Devi Ansuia Devi CWP-29586-2017 CW , 2025 Date of Decision: August 21, 2025 Dat State of Punja Punjab and others SUS VERSUS itioner .....Petitioner .....Responden ondents CORAM: HON'BLE MR. JUSTICE HA HARPREET SINGH BRAR Present : Ms. Ekta Thakur with Ms. Shikh . Shikha, Advocate for the petitioner. njab. Mr. Vikas Arora, DAG, Punjab. Mr. PIP Singh, Advocate for resp or respondent No.2. Mr. Nikhil Sehrawat, Advoca . Advocate for respondent No.3. alwar, vocate for Mr. Ashwani Talwar, **** HARPREET REET SINGH BRAR, J. (Oral) 1. The present writ petition has be 6/227 has been filed under Article 226/227 of the Consti Constitution of India with a prayer for ure of er for issuance of writ in the nature of mandamus d mus directing the respondents to con edical to consider and release the medical reimburseme rsement of Rs.12,80,213/- as approved 1) ed on 30.05.2017 (Annexure P-1) along with in ith interest @ 18% per annum on dela on delayed payments. 2. Learned counsel for the petition at the petitioner inter alia contends that the husband of t d of the petitioner was employed in ffice, yed in the Ayurvedic Unani Office, Gurdaspur, ru pur, run by State of Punjab and as pe s and as per Punjab Govt. Employees and Pensioner He ner Health Insurance Scheme (PGEP red as PGEPHIS, hereinafter be referred as ‘scheme’), the husband of the petitioner edical tioner was entitled to the medical reimburseme rsement. Unfortunately, husband of erious nd of the petitioner suffered serious PUNEET CHAWLA 2025.08.28 11:15 I attest to the accuracy and integrity of this document CWP-295 29586-2017 2 injuries in a s in a motor vehicular accident an ted at ent and initially he was treated at Amandeep H eep Hospital, Pathankot on 09.12.201 ion of .12.2016. Thereafter, the condition of husband of d of petitioner deteriorated and ref na on nd referred to DMC, Ludhiana on 17.12.2016. 016. In spite of providing best tr f the best treatment, the husband of the petitioner die ner died on 30.12.2016 at DMC Hosp udden Hospital, Ludhiana. Due to sudden demise of hu of husband of petitioner, as she wa ld not he was in shock and grief could not submit the c the claim of medical reimbursemen lause sement within 30 days under Clause 11.6 of Schem Scheme. 3.
Legal Reasoning
Learned counsel for the petition itially etitioner further submits that initially her claim wa im was rejected, however, vide Anne doned Annexure P-3, delay was condoned for submissio mission of claim of medical reimburs ounds rsement on humanitarian grounds and her claim r claim for medical reimbursement eafter, ment was recommended. Thereafter, the medical dical reimbursement was approved, h aid an oved, however she was only paid an amount of R t of Rs.4,46,884/- instead of Rs.12 t any Rs.12,80,213/-, further without any interest on a t on account of delay in releasing edical easing the amount towards medical reimburseme rsement only for the reason that husba reated t husband of the petitioner was treated in a non-emp empanelled hospital. 4. On the other hand, learned co No.3 ed counsel for the respondent No.3 submits that t s that the claim of husband of petitione tled in etitioner was considered and settled in accordance w ance with the scheme. Further, refers heme refers to Clause 11.6 of the scheme and submits bmits that the petitioner is only entitl at the entitled to the reimbursement at the rates applica applicable either CGHS rates and d for and petitioner is not entitled for reimburseme rsement as the treatment has been lled s been taken from non-empanelled private hospi hospital, as such, the amount deter of the t determined strictly in terms of the PUNEET CHAWLA 2025.08.28 11:15 I attest to the accuracy and integrity of this document CWP-295 29586-2017 3 scheme has has already been reimbursed and p e writ and prays for dismissal of the writ petition. 5. In rebuttal, learned counsel for n the sel for the petitioner relies upon the judgment of nt of Hon’ble Supreme Court in Shi n of Shiva Kant Jha Versus Union of India passed ssed in Writ Petition (C) No.694 018, .694-2015, decided on 13.04.2018 wherein it w n it was held that during the treatm nelled treatment from the non-empanelled hospital, if l, if based on genuine reasons, the of the s, the medical reimbursement of the amount spen t spent on the treatment is required t arned uired to be released. Further, learned counsel subm l submits that urgency in admitting t im of tting the patient in hospital, claim of petitioner can ner cannot be denied because the hosp at that e hospital is not empanelled, as at that point of tim of time the preservation of the hum mount e human life was of the paramount consideration eration. 6. I have heard learned counsel f ed the nsel for the parties and perused the record with th with their able assistance. 7. It is not in dispute that unfortun tioner nfortunately husband of the petitioner had met with t with an accident and remained adm pitals. d admitted in two different hospitals. The controv ontroversy involved in the present nt of resent case is of non-payment of differential m ntial medical reimbursement because ained ecause the petitioner had remained admitted in p ed in private hospitals which were not ion of ere not empanelled. The condition of the husband band of the petitioner was serious and ency. us and it was the case of emergency. It is not the ot the case of the respondents that nd of s that the claim of the husband of petitioner is s not supported by the hospital edical spital record. The claim for medical reimburseme rsement ought not to be dismissed imant issed merely because the claimant underwent tr ent treatment and admitted in a non s, the a non-empanelled. In such cases, the PUNEET CHAWLA 2025.08.28 11:15 I attest to the accuracy and integrity of this document CWP-295 29586-2017 4 test of essent essentiality and emergency comes into if the es into play, which dictates that if the medical proc l procedure was undergone by the cla on the the claimant in an emergency, on the advice of a d of a doctor based on medical record, t same cord, the reimbursement for the same must be mad e made. Not only is the preservation but it ation of human life instinctive, but it also forms a rms a part of Article 21 of the Constit ore, it onstitution of India, and therefore, it shall always r lways retain the highest priority. 8. Moreover, the State bears a ears an obligation e to ensure the the availability o ility of timely medical care to those in xpect ose in need. As such, it cannot expect the citizens t izens to refrain from availing timely on of imely care, merely for the reason of non-empanel panelment of the hospital. Such cond e does conduct on the part of the State does not satisfy th isfy the criteria of fairness and reasona ounts easonableness and therefore, amounts to a violatio iolation of the fundamental rights e of the ghts enshrined in Article 21 of the Constitution tution of India. Reliance in this regard ments regard can be placed on the judgments rendered by ed by a two Judge bench of the Ho urjit he Hon’ble Supreme Court in Surjit Singh vs. Sta s. State of Punjab and others(1996) aking 996) 2 SCC 336,whereby, speaking through Justi h Justice M.M. Punchhi, the following owing was opined: “8. Th . The policy, providing recognitio eart nition for treatment of open heart surger rgery in the Escorts, specifically cam sion came to be examined by a Division Bench nch of the Punjab and Haryana h in ana High Court at Chandigarh in C.W.P W.P. No. 13493 of 1992 titled as Sa njab Sadhu R. Pall v. State of Punjab throug rough Secretary, Health and Fa ivil Family Welfare Punjab, Civil Secreta cretariat, Chandigarh and others, o 1994(1) SCT 552 552 (P&H) &H). decided on 6.10.1993, where writ herein the claim of the then writ petitio titioner to medical reimbursement w r to ent was accepted when in order to save h ve his life he had got himself operat the erated upon in the Escorts, and the plea of ea of the State that he could be paid IMS paid rates as prevalent in the AIIMS was re s rejected. Special Leave Petition t the tion No. 22024 of 1995 against the PUNEET CHAWLA 2025.08.28 11:15 I attest to the accuracy and integrity of this document CWP-295 29586-2017 5 said d id decision was dismissed by this ther this Court on 2.2.1994. The other judgme dgments of the High Court following all's wing the decision in Sadhu R. Pall's case ar se are : (1) C.W.P. No. 18562 of 1992 K.L. 992 decided on 10.5.95 titled K.L. Kohli v. State of Punjab and oth others, 1995(4) SCT 280 (P&H); (2) C.W.P. No. 260 of 1995, de vi 5, decided on 30.5.1995 titled Ravi Mohan Duggal v. State of Punja unjab and others (DB) (3) C.W.P. No. 5669 of 199 1994 decided on 4.9.94 itled titled Prem Singh Gill v. State of Punj Punjab and others; (4) 1995(4) SCT 816 (P&H) : port ) : 1995 (III) Punjab Law Report 529 titled Tarlok Chander v. Sta . State of Punjab etc. (SB); and (5) 1996(2) SCT 148 (P&H) : 1 rter ) : 1995 (III), Punjab Law Reporter 682 titled Mrs. Surya Pandit v. S SB) t v. State of Punjab and others (SB) xxx xxx xxx xxx 10. It i . It is otherwise important to bear i n of ar in mind that self preservation of one's l e's life is the necessary concomitant d in itant of the right to life enshrined in Article ticle 21 of the Constitution of India red, dia , fundamental in nature, sacred, precio ecious and inviolable. The importan and rtance and validity of the duty and right t ht to self-preservation has a specie e in ecies in the right of self defence in crimin iminal law… 11. Th . The appellant therefore had th self d the right to take steps in self preser eservation. He did not have to stan ical stand in queue before the Medical Board, ard, the manning and assembling o s its ng of which, bare-facedly, makes its meetin eetings difficult to happen. The appe tand appellant also did not have to stand in queu queue in the Government hospital of here tal of AIIMS and could go elsewhere to an an alternate hospital as per poli has policy. When the State itself has brough ought the Escorts on the recognised tend ised list, it is futile for it to contend that th at the appellant could in no event h his nt have gone to the Escorts and his claim aim cannot on that basis be allowe k to lowed, on suppositions. We think to the con contrary…” PUNEET CHAWLA 2025.08.28 11:15 I attest to the accuracy and integrity of this document CWP-295 29586-2017 6 9. In the matter at hand, the husb ained e husband of the petitioner remained admitted in h ed in hospital due to severe injuries on ely he ries on vital organs and ultimately he died. The test he test of essentiality and emergency s ency stands satisfied. 10. Accordingly, the present petitio dents petition is allowed. The respondents are directed t ected to make payment of remaining or the ining medical reimbursement for the medical proc l procedure undergone by husband o iod of band of petitioner within a period of three months onths from the date of receiving a cert a certified copy of this order. 11. Pending miscellaneous applicat stands plication(s), if any, shall also stands
Decision
ed of. disposed of. RAR) (HARPREET SINGH BRAR) JUDGE August 21, 2 P.C t 21, 2025 Whether speaking/reasoned. : Whether Reportable. : Yes/No Yes/No PUNEET CHAWLA 2025.08.28 11:15 I attest to the accuracy and integrity of this document