Medical reimbursement for mental health treatment cannot be denied: HC

Ranchi: Emphasizing that the treatment of mental health needs to be treated on a par with physical healthcare, the Jharkhand High Court recently held that one cannot be denied reimbursement for expenses incurred to get mental health treatment.

The HC bench comprising Justice Ananda Sen ruled that excluding psychiatric treatment from medical reimbursement schemes violated the Mental Healthcare Act, of 2017 and therefore, no reimbursement policy could capriciously exclude psychiatric care.

"...there cannot be any discrimination in respect of reimbursement of expenses made by a person suffering from physical illness and mental illness. Clause 6.3(i) of the CPRMS, which denies reimbursement of any expenses incurred by the member for psychiatric treatment is directly in conflict with various provisions of the Mental Healthcare Act, 2017, especially Section 21(4) of the Act. This discrimination made in the CPRMS is not based on any intelligible differential," observed the Court.

"... after promulgation of Mental Healthcare Act, 2017, provision of Clause 6.3(i) of the CPRMS as adopted by the Board, so far as it relates to non-reimbursement of expenses for psychiatric treatment, is in direct conflict with the Act. Thus, I hold and declare that after promulgation of Mental Healthcare Act, 2017 and especially taking into consideration Section 21(4) of the Act, exclusion of psychiatric treatment in CPRMS is rendered nugatory," it further noted.

Also Read: Medical negligence complaint cannot be entertained without opinion of another doctor: Jharkhand HC relief to doctor

As per the latest media report by Live Law, these observations were made by the High Court bench while considering a plea filed by a retired executive of Bharat Coking Coal Limited (BCCL), a subsidiary of Coal India Limited (CIL). After his claim for reimbursement of expenses incurred on psychiatric treatment for his wife was rejected citing Clause 6.3(i) of the Contributory Post Retirement Medicare Scheme (CPRMS), he filed a plea before the High Court bench and sought to quash the Office Note dated 26.10.2019 and a letter dated 23.01.2020, through which, his claim was rejected.

Further, the petitioner sought a direction for reimbursement of the amount that had been deducted from his medical bills. It was argued by the petitioner that as a retired executive BCCL, he was entitled to reimbursement for his wife's psychiatric treatment and that mental healthcare should not be treated differently from other medical conditions.

He argued that Clause 6.3(i) of the CPRMS, which excludes psychiatric treatment from reimbursement, was arbitrary, discriminatory, and it violated statutory rights under the Mental Healthcare Act, 2017. 

On the other hand, the respondents argued that CPRMS was a non-statutory scheme and reimbursement was governed strictly by its provisions, which explicitly excluded psychiatric treatment.

However, while considering the matter, the Court found that even though CPRMS was not a statutory scheme, it functioned as a medical insurance cover for retired executives of CIL and its subsidiaries. 

Accordingly, the Court held that after the enactment of the Mental Healthcare Act, 2017, all healthcare policies and reimbursement schemes were required to comply with its provisions. 

At this outset, the Court referred to Section 21(1) and 21(4) of the Act, which mandate that there could not be any discrimination between a person suffering from mental illness and a person suffering from any other physical illness.

"In one line it can be summarized that there cannot be any difference so far as treatment and giving other facilities, between a mentally ill person or a physically ill person. Both of them are kept on the same pedestal so far as treatment is concerned without any discrimination," observed the Court.

Emphasizing that CPRMS was a scheme floated and approved by its Board Meeting, the Court held that state-controlled entities could not adopt policies that contravened parliamentary legislation.

"Coal India Limited and its subsidiary companies are State within the meaning of Article 12 of the Constitution of India. Their action or any resolution, which they adopt cannot be contrary to the provisions of any Statute promulgated by the legislatures, herein the Parliament of India," observed the Court.

"Considering what has been observed above, a patient receiving psychiatric treatment has to get the same benefit similar to a person suffering from physical illness and as the CPRMS provides for giving several benefits to the persons suffering from physical illness, persons suffering from mental illness are also entitled to receive the same benefit without any discrimination. The benefits also and must include reimbursement of medical expenses also," it further noted.

With this observation, the Court set aside the impugned Office Note and letter and directed the Respondents to reimburse the amount of admissible expenses to the petitioner within six weeks of the date of the Order. Further, the bench asked the respondents not to take the defense of Clause 6.3 (i) of the CPRMS.

Accordingly, the Court dismissed the petition.

Also Read: Patient death after gallbladder surgery: HC Clears MBBS Doctor of Malicious ST, SC Act Charges, Quashes IPC 304A