1996 (1) TMI 455 - SC - Indian Laws

Supreme Court grants medical reimbursement for emergency treatment based on hospital rates

SURJIT SINGH Versus STATE OF PUNJAB AND OTHERS

SURJIT SINGH Versus STATE OF PUNJAB AND OTHERS - 1996 AIR 1388, 1996 (1) SCR 1095, 1996 (2) SCC 336, 1996 (2) JT 28, 1996 (1) SCALE 648 Issues Involved:1. Validity of appellant's hypothetical claim for medical reimbursement.2. Applicability of State policy on medical reimbursement.3. Determination of reimbursement rates based on recognized hospitals.4. Emergency nature of the appellant's medical treatment.5. Right to self-preservation under Article 21 of the Constitution of India.Issue-wise Detailed Analysis:1. Validity of appellant's hypothetical claim for medical reimbursement:The appellant, a retired Deputy Superintendent of Police, developed a heart condition and subsequently traveled to England for treatment. He incurred expenses for a bypass surgery and sought reimbursement from the State of Punjab. The High Court granted reimbursement based on AIIMS rates, but the appellant sought reimbursement based on rates at the Escorts Heart Institute. The Supreme Court examined whether the appellant's claim, hypothetically treated as having been operated upon at Escorts, was valid under the State's policy.2. Applicability of State policy on medical reimbursement:The State policy dated 25-1-1991 governs the reimbursement of medical expenses for treatments taken abroad or in recognized hospitals outside the Punjab government hospitals. The policy requires prior approval from the Director of Health and Family Welfare and examination by a Medical Board. However, in emergencies, immediate treatment is permissible. The policy recognizes certain hospitals, including Escorts Heart Institute, for specific treatments like open-heart surgery.3. Determination of reimbursement rates based on recognized hospitals:The appellant's claim for reimbursement at Escorts rates was supported by precedents where the High Court allowed reimbursement based on rates at recognized hospitals. The Supreme Court noted that the State policy recognized Escorts for open-heart surgery and that the appellant's hypothetical treatment at Escorts should be reimbursed accordingly. The Court referenced several High Court judgments that supported full reimbursement based on recognized hospital rates rather than AIIMS rates.4. Emergency nature of the appellant's medical treatment:The appellant claimed his treatment in England was an emergency, but no documentary evidence was provided to substantiate this. The State argued it was a planned visit. However, since the appellant reduced his claim to Escorts rates, the Supreme Court did not delve further into the emergency nature. The Court assumed the appellant could have been treated at Escorts under similar conditions.5. Right to self-preservation under Article 21 of the Constitution of India:The Supreme Court emphasized the fundamental right to self-preservation under Article 21, which includes the right to take necessary steps to protect one's life. The Court cited ancient texts and legal principles supporting the right to self-defense and self-preservation. It concluded that the appellant was justified in seeking immediate medical treatment without waiting for Medical Board approval or government hospital queues, given the urgency of his condition.Conclusion:The Supreme Court allowed the appellant's claim for reimbursement based on Escorts rates, acknowledging the right to self-preservation and the State policy recognizing Escorts for open-heart surgery. The appellant was entitled to the difference between the amount already paid and the Escorts rates, to be paid within two months. No interest was granted for the intervening period. The appeal was allowed without any order as to costs.