Safiya Malik

The High Court of Kerala Single Bench of Justice Harisankar V. Menon directed the State government to reimburse a government school teacher for the medical expenses he incurred for his daughter’s treatment for a rare spinal condition at a non-empanelled private hospital in Coimbatore, after noting that the required treatment facility was not available in Kerala. Relying on Supreme Court decisions on medical reimbursement, the Court found that once the fact of treatment is established through records, reimbursement cannot be refused on technical grounds such as the hospital not being empanelled. It set aside the government communications rejecting the claim and directed the competent authority to disburse the quantified admissible amount within six weeks of receiving the judgment.

The petitioner, a Higher Secondary School Teacher in a Government school in Palakkad, approached the High Court challenging the refusal of the State Government to reimburse medical expenses incurred for the treatment of his daughter, who was diagnosed with Adolescent Idiopathic Scoliosis – Type 6. The petitioner submitted representations seeking prior sanction for treatment outside the State, stating that such treatment was not available in Government hospitals in Kerala. A certificate issued by the District Medical Officer confirmed that the required facility was not available locally.

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The daughter underwent treatment at a hospital in Coimbatore. The Government tentatively decided to accord ex post facto sanction as a special case and sought verification of the admissible amount at Government rates. However, subsequent communications rejected reimbursement on the ground that the treatment was taken in a non-empanelled private hospital outside Kerala, relying on a Finance Department circular restricting reimbursement for treatment in private hospitals.

The Court recorded that the petitioner’s daughter was suffering from “a rare disease” which “progresses rapidly, and if not treated in the appropriate stage, would lead to a situation where the patient would have to lead the balance of her life with the assistance of others.”

Referring to Shiva Kant Jha v. Union of India, the Court recorded:“It is a settled position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services or Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds.”

The Court also recorded the observation in State of Punjab v. Mohinder Singh Chawla: “It is now settled law that right to health is integral to the right to life. Government has a constitutional obligation to provide health facilities. If the government servant has suffered an ailment which requires treatment at a specialised approved hospital and on reference whereat the government servant had undergone such treatment therein, it is but the duty of the State to bear the expenditure incurred by the government servant. Expenditure, thus, incurred requires to be reimbursed by the State to the employee.”

The Court further stated, “In such circumstances, I am of the opinion that the petitioner, a father, cannot be faulted for carrying out the treatment through a hospital at Coimbatore.” It also noted that “The petitioner's request for reimbursement as regards the treatment of his daughter ought to have been sympathetically considered, especially in the light of the decision taken…This is especially so when there was no facility for carrying out the treatment within the State of Kerala or at least in the Government hospitals in Kerala,”

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The Court stated, “this writ petition would stand allowed, setting aside the orders at Exts.P11 and P14. There will be a direction to the competent among the respondents to act on the basis of Ext.P9 and effect reimbursement of the amount quantified by Ext.P10, as expeditiously as possible, at any rate, within a period of six weeks from the date of receipt of a copy of this judgment.”

Advocates Representing the Parties

For the Petitioners: Sri P. Nandakumar, Smt. Amrutha Sanjeev, Shri Vivek Vijayakumar

For the Respondents: Smt. Sylaja S.L., Government Pleader

Case Title: XXX  v. State of Kerala & Ors.

Neutral Citation: 2026: KER:8298

Case Number: WP(C) No. 380 of 2023

Bench: Justice Harisankar V. Menon