Reimbursement valid in emergencies even at unapproved hospitals: HC

The Punjab and Haryana High Court has ruled that it does not matter for medical reimbursement purposes whether a hospital is approved in life-or-death emergencies. The assertion came as Justice Jasgurpreet Singh Puri held an employee entitled to “balance amount of Rs 10 lakh”.

The issue before the Bench was whether the petitioner, admitted in an emergency condition for liver transplant to a Chennai hospital, was entitled to the grant of full medical reimbursement, even though the healthcare institution was “unapproved”.

Justice Puri was told that the petitioner, who was working as a Junior Engineer with the Haryana State Agriculture Marketing Board, was initially under treatment at the Institute of Liver and Biliary Sciences, New Delhi. An empanelled hospital, it was approved by the respondent board.

His daughter was identified as a donor, but was later deemed unfit for donation. As such, liver transplant could not take place at the New Delhi hospital. Subsequently, the petitioner sought a liver transplant at the Chennai hospital, where a compatible donor was available.

His counsel contended donors and the donees were put on a national portal for correlating their vitals for donation. He was informed by the Chennai hospital that a donor was compatible as far as the vitals and other medical conditions were concerned. As such, the petitioner had no option but to rush to the institute for transplantation.

“The facts suggest that the petitioner actually got treatment of liver transplant from Chennai, and he has been discharged from the hospital, and as per the counsel for the petitioner, he is medically well now,” Justice Puri observed.

The petitioner underwent the transplant under emergency conditions and sought full reimbursement of the treatment cost. The board contested the claim, citing its medical reimbursement policy, which restricted payments for treatments at unapproved hospitals.

The court noted that the petitioner acted diligently by initially seeking treatment at an approved hospital. However, the unavailability of a suitable donor compelled him to shift to an unapproved facility in an emergency to save his life.

“In the entire scenario, the petitioner, in order to save his life, had gone to the hospital at Chennai in an emergency condition, which is an unapproved hospital, for the purpose of liver transplantation and saved his life,” the court observed.

Citing previous rulings, the court asserted that "the law did not require prior permission in a situation where the survival of the person was the prime consideration.”