Jural Exploitation of Healthcare Professionals and Institutions in the PM-RAHAT Scheme - Dr Rajeev Joshi

The announcement of the Prime Minister – Road Accident Victims' Hospitalisation and Assured Treatment (PM-RAHAT) Scheme was hailed as a monumental step toward eliminating financial barriers in emergency trauma care. Notified vide Ministry of Road Transport and Highways (MoRTH) S.O. 2015(E) on May 5, 2025, the scheme promises cashless emergency treatment of up to ₹1,50,000 per victim for up to 7 days, covering stabilization periods of 24 to 48 hours across designated hospitals.

However, a rigorous analysis of implementation metrics reveals a stark dissonance between policy intent and ground reality. By examining national road accident statistics alongside operational metrics and recent judicial orders, this article explores the structural bottlenecks, financial disincentives, and severe jural exploitation faced by healthcare providers in India under this executive framework.

The Coverage Deficit: Policy Promise vs. Ground Reality

India records between 4.6 lakh and 5.1 lakh road traffic accidents annually, resulting in over 1.7 lakh fatalities. Despite these staggering numbers, official data presented in Parliament (Lok Sabha Unstarred Question No. 1965, answered July 30, 2026) indicates that as of July 31, 2026, only 22,481 road-accident victims had received benefits under the PM-RAHAT scheme.

This translates to a beneficiary coverage rate of less than 5% of annual accident victims. The structural reasons for this massive shortfall include:

The e-DAR Verification Bottleneck: Reimbursement is contingent on police verification through the Electronic Detailed Accident Report (e-DAR) system within a strict 24- to 48-hour window. Procedural delays and non-response from law enforcement accounted for 16.3% (3,674 cases) of unapproved or stalled claims.

Exclusion of Pre-Hospital Fatalities: Over 50% of road traffic fatalities occur on-site or during transit before reaching a hospital, meaning "brought dead" cases never enter the scheme's reimbursement architecture.

Low Hospital Adoption: India possesses roughly 43,000 to 45,000 hospitals, yet PM-RAHAT relies on an initial empanelment

base of around 18,887 facilities automatically carried over from Ayushman Bharat (AB PM-JAY). This leaves approximately 80% of hospitals un-empanelled.

Data Transparency Failures: Highlighting systemic delay, the Supreme Court of India issued notice to MoRTH on October 16, 2026 (S. Rajaseekaran v. UOI, Diary No. 39789/2026) for failing to comply with directives mandating the annual publication of road accident statistics within six months of each calendar year.

Financial Pathways in Non-PM-RAHAT Cases

For the vast majority of accident victims not covered during PM-RAHAT's initial rollout, treatment costs fall into four main pathways:

Out-of-Pocket Expense (OOPE): Families pay out-of-pocket or rely on personal insurance. If the offending vehicle has valid Third-Party (TP) insurance, medical expenses are recovered through long-drawn Motor Accident Claims Tribunals (MACT) litigation.

Absorption by Public Hospitals: Government hospitals absorb the costs of emergency cases under existing state health allocations or free emergency care mandates without generating PM-RAHAT claims.

Statutory Stabilization Mandates (Unreimbursed Private Care): Under Section 134(a) of the Motor Vehicles Act, all hospitals are legally mandated to provide immediate emergency stabilization. Many non-empanelled private hospitals stabilize and quickly transfer patients to government facilities once transportable to avoid unrecoverable bills.

Rejection & Procedural Delays: When claims are stalled due to lack of timely police authentication, hospitals either shift billing onto the family or write off the loss.

Protection Granted to Hospitals and Good Samaritans

To eliminate traditional excuses given by hospitals for refusing emergency cases, statutory frameworks outline clear legal duties:

While statutory provisions mandate immediate care, the economic reality for these facilities is unsustainable. With only ~20% of hospitals empanelled, 80% of hospitals bear the legal liability without adequate scheme access. Reaching less than 5% of accident victims exposes the systemic gaps of PM-RAHAT. Rather than an effective safety net, this structure functions as political optics while exposing medical professionals to unnecessary jural exploitation.

The Core Culprit: Unrealistically Low Package Tariffs & Fund Disconnect

A critical point of contention is the quantum of financial relief disbursed. Official data reveals that ₹10.56 Crore was disbursed across 22,481 victims, yielding an average payout of ₹4,697 (~₹5,000) per case.

Sub-Economic Rates: PM-RAHAT package rates are largely derived from AB PM-JAY elective schedules. These flat, bundled rates cover less than 40% to 60% of actual operational costs for complex poly-trauma management (e.g., emergency neurosurgery, continuous ICU ventilation, blood products, and advanced implants).

Absorbing Financial Losses: For private nursing homes and mid-sized hospitals, accepting uninsured or scheme-referred trauma patients under capped government tariffs often results in severe financial hemorrhaging. Consequently, many opt out of empanelment, leading to early inter-hospital transfers ("dump and transfer") to overstretched public medical colleges once basic stabilization is achieved.

The MVAF Architecture: Under Section 164B of the Motor Vehicles Act, 1988, the scheme draws from the Motor Vehicle Accident Fund (MVAF), capitalized through general insurance third-party (TP) premium contributions (a 0.5% to 1.0% levy generating ₹250 Cr to ₹550 Cr annually). However, when average payouts hover at ₹5,000, the fund sits on unutilized surpluses while hospitals absorb actual multi-thousand-rupee clinical costs.

Jural Exploitation: Judicial Mandates vs. Financial Realities

The concept of jural exploitation in this context stems from the asymmetrical collision between absolute legal duties imposed upon doctors and the systemic absence of financial or administrative support.

The Judicial Mandate: Absolute Duty of Care

Indian jurisprudence has consistently established that preserving human life overrides all procedural or financial considerations:

Pt. Parmanand Katara v. Union of India (1989): The Supreme Court of India held that the obligation of a doctor and hospital to preserve human life is total, absolute and paramount. The Court ruled that every injured citizen has a legal right to immediate medical aid, and no hospital or medical professional can refuse emergency treatment on grounds of awaiting police clearance, medico-legal formalities, or upfront financial deposits.

Constitutional Imperative: This obligation is anchored firmly in Article 21 of the Constitution (Right to Life). Subsequent rulings, such as Paschim Banga Khet Mazdoor Samity (1996), reinforced that a failure by medical facilities to provide timely emergency care constitutes a violation of fundamental rights.

Recent Judicial Orders & Administrative Scrutiny

In S. Rajaseekaran v. Union of India (Order dated October 16, 2026, Diary No. 40407/2026), the Supreme Court examined the newly framed "Compensation to Victims (Interim Relief) Scheme, 2026", notified under Section 164A of the MV Act following earlier judicial warnings against executive delay. While Clause 6 outlines procedural steps for electronic filing, e-DAR uploading within 90 days, and insurer settlement within 30 days, the Apex Court highlighted major implementation gaps:

The Uninsured Vehicle Void: The Scheme applies exclusively to insured motor vehicles where authorized insurers pay interim relief. It leaves victims of uninsured vehicles without a clear mechanism for interim compensation, prompting the Court to direct the Union Government to address this exclusion.

Mandatory Gazette Publication: The Court emphasized that as a statutory scheme under Section 164A, Section 212 of the MV Act mandates formal Gazette publication and wide public awareness campaigns.

The Insurance Burden: Do Hospitals Carry the Investigative Onus?

Reimbursement of expenses under the scheme is handled by insurance companies. Under statutory design, a hospital's immediate legal duty is strictly medical—stabilizing life during the "Golden Hour" without conditioning care on financial deposits or insurance pre-qualification. The responsibility for investigating the accident, logging vehicle details, and identifying the insurer belongs exclusively to the Investigating Officer (Police) via the e-DAR portal. Hospitals are only required to upload clinical summaries and emergency bills via TMS 2.0.

However, when police verification stalls (accounting for over 16% of administrative delays) or when an offending vehicle is uninsured, hospitals face unrecoverable bills for emergency care. Shifting this investigative or financial burden onto treating physicians compounds their exposure to jural exploitation.

The Penal Trap and Asymmetric Risk

While the Supreme Court mandates immediate emergency stabilization under threat of severe legal consequences—including criminal negligence charges under Section 106 of the Bharatiya Nyaya Sanhita (BNS) / Section 304A IPC, professional license revocation by the National Medical Commission (NMC), and heavy civil damages—the state fails to guarantee administrative execution:

The Legislative Void: Section 134(a) vs. Law Commission Report 201

It is vital to recognize a fundamental structural weakness in how emergency medical treatment is mandated in India. The obligation placed on doctors to treat accident victims stems primarily from Section 134(a) of the Motor Vehicles Act, 1988, read alongside executive schemes like PM-RAHАT.

By contrast, the 201st Report of the Law Commission of India (2006) had proposed a comprehensive, binding legislative framework—complete with a statutory Emergency Medical Medicare Fund—to cover not just road accidents, but all acute medical emergencies and obstetric cases. However, neither the Central Government nor state governments enacted the comprehensive Act drafted by the Law Commission.

An executive scheme or a penal directive under Section 134(a) possesses no binding financial or statutory enforcement effect comparable to a dedicated legislative enactment. It imposes a unilateral legal duty on the doctor to treat without creating a reciprocal, legally enforceable statutory guarantee of prompt, full-cost reimbursement from the State. This executive reliance on subordinate notifications rather than substantive parliamentary legislation is the root cause of the financial precarity plaguing medical providers today.

Strategic Interventions for Sustainable Reform

To transition PM-RAHAT from an administrative liability into a functional emergency medical safety net, policymakers must address root economic and legal imbalances:

Uncouple Emergency Tariffs from Elective Rates: Replace flat AB PM-JAY elective packages with a dynamic Cost-Plus Emergency Tariff Model that accounts for the true overhead of 24/7 trauma care, specialized staffing, and intensive surgical inputs.

De-link Police Verification from Initial Reimbursement: Shift the administrative burden of e-DAR tracking away from treating physicians. Hospitals should receive guaranteed baseline payments for initial stabilization upon uploading clinical proof, leaving police verification as an administrative audit for the State Health Agency (SHA).

Establish a Guaranteed Stabilization Pool: Create a "no-questions-asked" emergency buffer funded via the Motor Vehicle Accident Fund (MVAF) to cover the first 48 hours of care across all registered hospitals, eliminating the fear of unrecoverable financial losses.

Institutionalize District-Wise Tracking & Infrastructure: Incorporate suggestions noted by the Supreme Court in S. Rajaseekaran (2026) to mandate quarterly district-wise data reporting by MoRTH and establish dedicated judicial/technological infrastructure for Claims Tribunals to clear pending cases without delay.

Conclusion

If 95% of victims do not derive benefits from the scheme, and 80% of hospitals do not receive reimbursement, PM-RAHAT risks being viewed as political optics rather than substantive reform. To protect both citizens and the medical professionals who carry the sole responsibility of saving lives during golden-hour emergencies, structural functionality and financial protections must be urgently overhauled.

Failing this, healthcare professionals stand exposed to violence by friends and relatives of accident victims—yet another manifestation of jural exploitation, where the State imposes an absolute duty to treat under executive fiat but provides zero protection against attacks or financial ruin.

Healthcare providers are encouraged to participate in PM-RAHAT Lite and submit details of rejected claims to the Medico Legal Society of India so that empirical rejection statistics can be formally represented to the government to drive policy reform. To submit clinical experiences from PM-RAHAT Lite, visit www.medicolegalsociety.in.

References

Ministry of Road Transport and Highways (MoRTH) & National Health Authority (NHA). Parliamentary Data on PM-RAHAT Implementation and Road Accident Statistics (Lok Sabha Unstarred Question No. 1965, Answered July 30, 2026).

Government of India. Notification of the Prime Minister - Road Accident Victims' Hospitalisation and Assured Treatment (PM-RAHAT) Scheme (S.O. 2015(E) dated May 5, 2025).

Supreme Court of India. Record of Proceedings in S. Rajaseekaran v. Union of India & Ors. (Writ Petition (Civil) No. 295/2012, Diary Nos. 39789/2026 & 40407/2026, Order dated October 16, 2026).

Supreme Court of India. Pt. Parmanand Katara v. Union of India (1989 SCR (3) 997).

Supreme Court of India. Paschim Banga Khet Mazdoor Samity v. State of West Bengal ((1996) 4 SCC 37).

Law Commission of India. 201st Report on Medical Treatment after Accidents and During Emergency Medical Condition and Women in Labour (2006).

National Crime Records Bureau (NCRB). Accidental Deaths and Suicides in India (ADSI) Annual Reports.

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