Kerala HC orders reimbursement of expenses for rare disease treated outside State

The order was issued by Justice Harisankar V. Menon while hearing a petition filed by the patient's father from Palakkad district. He had challenged the State government’s decision to deny reimbursement for his daughter’s treatment expenses.

According to The Times of India, the High Court observed that the petitioner’s request for reimbursement should have been considered sympathetically, particularly since there was no facility in Kerala, including in government hospitals, to treat the specific condition. The Court relied on a certificate issued by the Palakkad District Medical Officer confirming the unavailability of the required treatment within the State.

The petitioner had initially sought prior approval from the government for financial assistance after his daughter was diagnosed with the rare spinal disorder. He specifically informed the authorities that adequate treatment facilities were not available in Kerala. However, without waiting for a formal response, he proceeded with treatment at a hospital in Coimbatore. In 2017, he submitted another application stating that the treatment was ongoing there.

In October 2020, the State government rejected the claim because the treatment was not taken at an empanelled hospital, citing a circular that restricted reimbursement for treatment in private hospitals. A subsequent application was filed in 2022, which was also rejected on similar grounds, prompting the petitioner to approach the High Court.

After examining the records, the Court noted that the petitioner, as a father, could not be blamed for seeking appropriate medical care outside the State when such care was unavailable locally. Accordingly, the bench directed the State government to reimburse the treatment expenses within six weeks.