In a landmark judgment that reinforces the primacy of human life over procedural limitations, the Delhi High Court, presided over by Justice Jyoti Singh, ruled in favor of the petitioner, Seema Mehta, ordering medical reimbursement for treatment received at a non-empanelled hospital during a critical medical emergency. The Court unequivocally held that denying reimbursement on procedural grounds under such circumstances would contravene established legal principles and fundamental rights.

The petitioner, Seema Mehta, had been employed at a government-aided school since August 2000. On September 18, 2013, she suffered severe head injuries in a road accident and was initially admitted to Guru Tegh Bahadur (GTB) Hospital. However, due to the critical nature of her condition, she was referred to Sir Ganga Ram Hospital (SGRH) on September 19, 2013, where she underwent a major brain surgery. Her treatment extended over multiple hospitalizations, culminating in her discharge on January 11, 2014.

Despite incurring ₹5,85,523 in medical expenses, her claim for reimbursement was rejected by both the school and the Directorate of Education (DoE) on the grounds that SGRH was not empanelled under the Central Government Health Scheme (CGHS). Aggrieved, the petitioner sought relief through a writ petition.

Represented by Counsel Sunil Kumar and Rekha Bhardwaj, the petitioner argued that:

1. Emergency Conditions Supersede CGHS Rules: The petitioner’s admission to SGRH was necessitated by life-threatening injuries and was supported by an emergency certificate issued by the hospital’s Department of Neurosurgery.
2. Established Legal Precedents: Relying on Supreme Court and High Court rulings, including Shiva Kant Jha v. Union of India (2018) and Union of India v. Joginder Singh (2023), it was asserted that emergency medical claims could not be denied solely because the hospital was not empanelled under CGHS. The petitioner’s counsel emphasized that “preservation of human life is of paramount importance,” and procedural limitations should not hinder life-saving medical care.
3. Aided School Responsibility: As a government-aided institution receiving grants from the Government of NCT Delhi (GNCTD), the school was jointly liable with the DoE to reimburse the petitioner’s medical expenses.

The Directorate of Education and the school, represented by counsel Latika Choudhary and Niharika Tanneru, contended that:

1. Availability of Empanelled Hospitals: The petitioner had the option of seeking treatment at CGHS-empanelled hospitals but failed to do so.
2. Procedural Delays: The emergency certificate, issued in 2017, came four years after the incident, raising doubts about the urgency of the claim.
3. Employment Status: The petitioner was terminated following major penalty proceedings, and her termination was under challenge before the Delhi School Tribunal, complicating the reimbursement claim.

Justice Jyoti Singh focused on the core question: Can medical reimbursement be denied solely because the treatment was not availed at a CGHS-empanelled hospital during an emergency?

1. Authenticity of Emergency: The Court found that the petitioner’s condition warranted immediate medical attention, as evidenced by the emergency certificate issued by the Vice Chairman and Senior Consultant, Department of Neurosurgery at SGRH. This certificate was undisputed and validated the life-saving nature of the treatment.
2. Rejection Based on Procedural Grounds: Citing Shiva Kant Jha v. Union of India, the Court reiterated that procedural technicalities must not override the need for urgent medical care. It observed, “Right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment.”
3. Precedence and Human Rights: The judgment heavily referenced Article 21 of the Constitution, which guarantees the right to life. The Court underscored that denying timely medical reimbursement in emergencies violates this fundamental right.
4. Delayed Certificate Irrelevant: The Court rejected the argument regarding the delayed issuance of the emergency certificate, stating that no evidence challenged the certificate’s authenticity.

The Court directed the respondents to disburse the full medical reimbursement of ₹5,85,523 to the petitioner within six weeks. Additionally, an interest of 6% per annum from December 14, 2017 (the date of claim rejection), until the date of actual payment, was awarded. Justice Singh remarked that the respondents’ stance was “wholly misconceived and cannot be accepted.”

In the words of the Court, “The State is under an obligation to ensure timely medical treatment to a person in need, and a negation of the same would be a violation of Article 21 of the Constitution of India.”

Case Title: SEEMA MEHTA versus GNCT OF DELHI AND ORS

Case No: W.P.(C) 10708/2019 & CM APPL.46118/2022

Bench: Justice Jyoti Singh