Medical Reimbursement Being Instrument Of Social Welfare Should Receive Purposive Interpretation: Punjab & Haryana High Court
The Punjab & Haryana High Court was considering writ petitions revolving around the issue of reimbursement pertaining to non-empaneled private hospitals
Justice Sandeep Moudgil, Punjab & Haryana High Court
The Punjab & Haryana High Court has held that medical reimbursement, being an instrument of social welfare, its provisions should receive purposive interpretation and should not be defeated through technicalities.
While observing that rejecting reimbursement solely on the ground of nonempanelment would amount to placing policy procedure above human survival, the High Court has asked the committee constituted under the chairmanship of Addl. Director Health Services to consider individual claims of State employees and pensioners on the issue of reimbursement in cases where emergency treatment was availed from non-empanelled private hospitals.
The High Court was considering a bunch of writ petitions revolving around the issue of reimbursement in cases where emergency treatment was availed from non-empanelled private hospitals merely on the ground that such hospitals did not form part of the approved panel under the prevailing policy.
The Single Bench of Justice Sandeep Moudgil stated, “Long waiting periods, overcrowding, paucity of beds and the pressing urgency accompanying critical illness often compel patients and their attendants to seek immediate treatment at the nearest available medical facility, irrespective of its empanelment status. In such circumstances, to reject reimbursement solely on the ground of nonempanelment would amount to placing policy procedure above human survival.”
“Accordingly, this Court directs the Committee so constituted to examine the cases of the petitioners individually and a conscious, well-reasoned decision shall be taken in each matter within a period of four weeks from the date of receipt of a certified copy of this order”, it ordered.
Senior Advocate Sunil K. Nehra represented the Petitioner, while State Counsel Deepak Balyan represented the Respondent.
Reasoning
The Bench, at the outset, observed, “At the very threshold, this Court deems it apposite to observe that the right to health and medical care is firmly recognised as an integral facet of the right to life guaranteed under Article 21 of the Constitution of India as recognised by the Apex Court in “State of Punjab v. Mohinder Singh Chawla 1997 (1) SCT 716”, observing that the State is constitutionally obligated to bear medical expenses of its employees, the right to health being integral to life itself.”
The Bench noted that the reimbursement structure adopted by the State, pegged substantially to PGI rates, appears to proceed on the assumption that employees and pensioners would ordinarily avail treatment from premier government institutions such as PGI and other State-run hospitals. “There can be no quarrel with the proposition that such institutions are centres of excellence and provide world-class healthcare facilities. Yet, constitutional adjudication cannot proceed divorced from lived realities. Accessibility to these institutions, both physical and practical, remains a serious impediment for a vast section of employees, particularly in moments of medical emergency”, it added.
Holding that no useful purpose would be served by keeping the petitions pending, the Bench mentioned that medical reimbursement policies ought to be interpreted in a manner that advances the cause of human welfare rather than defeats it through technicalities.
The Court held, "Medical reimbursement, being an instrument of social welfare, should therefore receive a humane and purposive construction, consistent with the constitutional vision of a just and caring society", and also held, "Medical reimbursement policies ought to be interpreted in a manner that advances the cause of human welfare rather than defeats it through technicalities."
The Bench thus disposed of the writ petitions with a direction to the respondents to examine the individual claims of each petitioner independently and sympathetically. Considering that the State had constituted a committee under the chairmanship of Addl. Director Health Services, with the Deputy Director of the Medical Reimbursement Branch and the Nodal Officer (Empanelled Hospitals) as members thereof, the Bench directed the Committee so constituted to examine the cases of the petitioners individually.
“It is further directed that in cases where any amount is found payable to the petitioners, the same shall carry interest at the rate of 6% per annum from the date the amount became due till the date of its actual realisation”, it clarified.
Cause Title: Swati Yadav v. State of Haryana (Case No.: CWP-16778-2024)
Appearance
Petitioner: Senior Advocate Sunil K. Nehra, Advocate VirenNehra
Respondent: State Counsels Deepak Balyan, R.D. Sharma