MURUGESAN Vs. DEPUTY WORKS MANAGER

JUDGEMENT

(1.) The writ petition is directed against the order of the respondent, dated 21.11.2009, by which the respondent has rejected the claim of the petitioner for reimbursement of the amount spent by him for medical treatment 'coronary angiogram' undergone by him on the ground that the treatment does not find a place in the list of treatments enumerated by the Government under the Scheme.

(2.) It is not in dispute that the petitioner, who is a member of the Scheme, has undergone the said coronary angiogram in M/s.Vadamalaiyan Hospital at Madurai. When once it is admitted that the petitioner is covered under the Scheme, he is entitled for reimbursement. The said right cannot be denied on the ground that the treatment has not been taken in the empanelled hospitals or on the ground that the nature of treatment is not in the list of treatments given by the Government. The nature of treatment to be obtained/given for a patient is based on the consultation from the doctor, as an expert, and that right, which form part of right to life guaranteed under Article 21 of the Constitution of India, cannot be curtailed by stating that certain kind of treatments alone are eligible for reimbursement.

(3.) This concept as to whether the Government can impose a condition that for the purpose of obtaining medical reimbursement the treatment must have been taken only in the empanelled hospitals or the treatment must be only for such nature of diseases mentioned by the Government has been considered from time immemorial by the Apex Court and in a series of judgments the Apex Court has held that at the time of distress, a patient cannot be expected to instruct his doctor to give a particular treatment and it is ultimately for the doctor to give treatment and not for the patient to suggest. That was the view expressed by the Punjab and Haryana High Court in Sadhu r.Pall v. State of PUnjab - (1994) 1 SLR 283 (P&H). In that case, reimbursement was rejected on the ground that treatment was not taken in any one of the empanelled hospitals. In those circumstances, the Punjab and Haryana High Court has held that in urgency, one cannot expected to sit at home in cool and calm atmosphere for getting medical treatment in a particular hospital mentioned in the Government Order. The Division Bench has observed as follows: