Court Orders State to Reimburse Expenses for Treatment at Non-Empanelled Hospital Due to Lack of Local Facilities
In a landmark judgment, the Kerala High Court has ruled in favor of a government employee, Yusuff A.M., entitling him to reimbursement of medical expenses incurred for his daughter's treatment of a rare disease at a non-empanelled private hospital outside the state. The judgment, delivered by Justice Harisankar V. Menon, emphasizes the state's constitutional obligation to provide healthcare and highlights the right to health as integral to the right to life.
Yusuff A.M., a teacher at the Government Higher Secondary School in Palakkad, had approached the court after the government refused to reimburse the medical expenses for his daughter, who was diagnosed with Adolescent Idiopathic Scoliosis-Type 6. Treatment for this rare condition was unavailable in government hospitals within Kerala, prompting Yusuff to seek urgent medical care at a specialized hospital in Coimbatore.
Despite submitting multiple requests and obtaining prior approval from the government, Yusuff's application for reimbursement was initially rejected on technical grounds, as the treatment was conducted in a non-empanelled hospital. The court, however, deemed this refusal improper, citing the necessity and urgency of the treatment.
The judgment referenced several precedents, including the Supreme Court's rulings in "Shiva Kant Jha v. Union of India" and "State of Punjab v. Mohinder Singh Chawla," which affirm the government's duty to bear medical expenses when local facilities are inadequate. The court also noted the sympathetic consideration extended to Yusuff's case in previous government communications, which recognized the need for reimbursement due to the unavailability of local treatment options.
Justice Menon ordered the state to act on the earlier decision to grant reimbursement, directing the competent authorities to effect payment within six weeks. This ruling reinforces the principle that government employees should not be denied medical claims on technicalities when necessary treatment is sought in specialized hospitals due to the lack of local facilities.
Bottom Line:
Government employees are entitled to reimbursement of medical expenses even if treatment is undertaken in non-empanelled private hospitals, especially when medical facilities for a rare disease are unavailable within the state or government hospitals.
Statutory provision(s): Right to Health, Right to Life, Medical Reimbursement Policies, Government Health Schemes
Yusuff A.M. v. State Of Kerala, (Kerala) : Law Finder Doc id # 2850417
