Isabella Mariam

The High Court of Punjab and Haryana, Single Bench of Justice Sandeep Moudgil, has held that the State cannot mechanically cap medical reimbursement at notified PGI/AIIMS rates when a retired government employee undergoes certified life-saving emergency treatment at a non-empanelled private hospital. Observing that self-preservation of life is an inviolable concomitant of Article 21, and that the right to health extends meaningfully into retirement, the Court directed the State to pay the remaining reimbursement amount along with interest, finding that empanelment status alone cannot justify substantially curtailing a constitutionally grounded medical claim.

A retired Chief Engineer from the Irrigation and Water Resources Department, Government of Haryana, suffered a serious medical emergency in January 2018 while at Hisar. His condition deteriorated and he fell into a coma, following which he was shifted on medical advice to a private specialty hospital in Gurugram and admitted to the Emergency ICU. He was diagnosed with viral meningoencephalitis and remained hospitalized for approximately ten days, incurring a total bill of ₹3,54,647. The emergency was certified by the competent Civil Surgeon.

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The petitioner submitted his reimbursement claim with all supporting documents, including an essentiality certificate. The State processed the claim under its reimbursement policy and sanctioned only ₹1,38,422, calculated at PGI/AIIMS rates applicable to treatment taken in non-empanelled hospitals. The balance was declined without a speaking order, and the calculation sheet was obtained only through a Right to Information application.

The petitioner invoked Articles 226/227 of the Constitution, contending that the curtailment violated Articles 14 and 21. The State defended the restriction as consistent with its governing policy framework.

The Court addressed the core constitutional question of whether the State could restrict medical reimbursement to notified rates in a case of admitted emergency, observing that the matter "strikes at the heart of Article 21 of the Constitution of India and the evolving doctrine of the right to health" and that the Constitution "does not contemplate a hierarchy where executive memoranda supersede fundamental rights."

On the question of self-preservation, the Court observed that "it is important to bear in mind that self preservation of one's life is the necessary concomitant of the right to life enshrined in Article 21 of the Constitution of India, fundamental in nature, sacred, precious and inviolable. The principle that a person possesses both a duty and a right to preserve one's own life finds clear expression in the doctrine of private defence recognised in criminal jurisprudence."

Drawing from ancient Indian thought, the Court referenced verses from Chapter XVI of the Garuda Purana, stating that "long before the evolution of modern legal systems, thinkers of this ancient land had articulated and affirmed this principle" and that the verses present "the sanctity of life and the imperative of protecting oneself." Among the verses cited, the Court noted "विना देहेन कस्यापि च पुरुषार्थो न विद्यते। तस्माद् देहं धनं रक्षेत्" — meaning that without the body one cannot obtain the objects of human life, and therefore protecting the body is paramount. It further recorded the verse "शरीररक्षणोपायाः क्रियन्ते सर्वदा बुधैः" — meaning the wise always undertake protective measures for the body.

On the mechanical application of rate ceilings, the Court recorded that such an approach "transforms a constitutional entitlement into a bureaucratic concession" and that "the right under Article 21 is not a right to partial survival but a right to meaningful preservation of life and dignity." It further stated that restricting reimbursement by applying institutional rate ceilings "amounts to penalizing the citizen for choosing survival over procedure."

On the limits of executive policy, the Court observed that "policies are instruments of governance, they are not fetters upon justice" and that "social security in old age is not an act of grace, it is a constitutional expectation flowing from the idea of a welfare State."

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The Court directed: "The calculation sheet dated 17.05.2018 (Annexure P-9), insofar as it limits reimbursement to ₹1,38,422/-, is not sustainable in law and is hereby quashed. The respondents are directed to reimburse the remaining amount of ₹2,16,225/- to the petitioner within four weeks from the date of receipt of a certified copy of this judgment."

"The amount shall carry interest @ 9% per annum from 25.01.2018 (the date of discharge) till actual payment. The State Government should consider revisiting the existing medical reimbursement policy to incorporate a mechanism for full or substantially reimbursement in certified life-threatening emergencies, even when treatment is taken in a non-empanelled hospital."

Advocates Representing the Parties

For the Petitioner: Mr. D.R. Bansal, Advocate

For the Respondents: Mr. R.D. Sharma, Deputy Advocate General, Haryana

Case Title: Rama Kant Sharma v. State of Haryana and Another

Case Number: CWP-257-2019

Bench: Justice Sandeep Moudgil