Medical reimbursement cannot be rejected over hospital name change, Karnataka HC slams govt

Bengaluru: Observing that medical reimbursement could not be rejected simply because a hospital changed its name, the Dharwad bench of the Karnataka High Court recently slammed the State Government for using bureaucratic red tape to deny Rs 14 lakh medical reimbursement to a patient

The petitioner in this case was an associate professor at a government first-grade college in Haveri’s Ranebennur. He was treated at Kasturba Medical College Hospital, Manipal.

However, his medical reimbursement claims were rejected by the State on the grounds that the institute later updated its name to Kasturba Hospital, Manipal.

While considering the plea by the petitioner, the HC bench comprising Justice Suraj Govindraj called the denial "arbitrary and legally unsustainable".

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As per the latest media report by The Times of India, the petitioner submitted that the hospital was on the government's approved list under the Karnataka Government Servants (Medical Attendance) Rules, 1963.

Later, the hospital formally sought a name correction on March 23, 2021, in conformity with the registration certificate issued by the Karnataka Private Medical Establishment Authority, Udupi.

Allegedly, despite the request, the officials failed to update the recognised list and rejected the reimbursement claims. The petitioner submitted that his application was rejected since the updated name had not been incorporated in the government list.

Meanwhile, the counsel for the State Higher Education Department and Suvarna Arogya Suraksha Trust had argued that only hospitals listed under their exact names could qualify and any deviation from this was unacceptable.

While considering the matter, the HC bench comprising Justice Govindraj disagreed with the arguments made by the State counsel. Deccan Herald has reported that Justice Suraj Govindraj observed that the purpose of maintaining a recognised list of private hospitals under Clause (ff) of Rule 3 of the Karnataka Government Servants (Medical Attendance) Rules, 1063, was to ensure that services were availed from vetted and approved institutions, and the said recognition involves inspection and assessment of the hospital’s infrastructure and services.

The bench observed that the hospital had already been vetted and approved.

"It is evident that if treatment is availed from an unrecognised hospital, reimbursement is not permissible. However, in the present case, Kasturba Medical College Hospital, Manipal was an approved institution," observed the HC bench.

"Denial of reimbursement merely on account of non-updated nomenclature, when the entity remains the same, is arbitrary and legally unsustainable. The respondent authorities were obligated to verify the request and update the recognised list after following the due procedure. Their failure to do so cannot prejudice the petitioner," it further noted.

With this observation, Justice Govindraj directed the Higher Education Department to reconsider the reimbursement claim within six weeks.

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