Bengaluru: Citing the exception clause in a state govt order regarding medical claim reimbursement, Karnataka high court has granted relief to a court employee who received treatment at a non-empanelled hospital.
B Nagabhushana, the petitioner, works as an assistant court officer in the high court. In 2022, he sought treatment for connective tissue disease-associated interstitial lung disease and pulmonary hypertension at Mazumdar Shaw Medical Centre. Initially, he was admitted to a facility of Sri Jayadeva Institute of Cardiovascular Sciences & Research, located on KC General Hospital premises in Malleswaram.
He submitted a medical claim application for reimbursement of Rs 2,63,764 along with the prescription, bills, and discharge summary dated Dec 23, 2022. However, on Jan 23, 2023, Suvarna Arogya Suraksha Trust rejected his claim, saying it wasn’t covered under emergency circumstances as defined in the govt order (GO) dated Nov 5, 2014. Nagabhushana challenged the same in the high court.
After reviewing the GO, Justice Hemant Chandangoudar pointed out that in this case, the petitioner initially sought treatment at Jayadeva Institute, a govt hospital, and was subsequently referred to a multi-specialty pulmonologist.
The petitioner is entitled to reimbursement of medical expenses under clause 5 of paragraph 3 of the GO which allows govt servants to seek reimbursement of medical expenses at CGHS (Central Government Health Scheme) rates for treatment at a private hospital, provided that a recognised govt hospital had referred the patient to said hospital, the judge observed.
The judge directed Suvarna Arogya Suraksha Trust to consider the petitioner’s claim for reimbursement, subject to him providing a complete set of documents, and to pass an appropriate order within two months.
