Medical Reimbursement – Denial for treatment in OPD for chronic kidney disease – Illegal
The wife of the petitioner had taken treatment for chronic kidney disease from 2014 to 2016 in the hospital at Rohtak (approved hospital) and in Appollo Hospital, New Delhi.
However, the reimbursement in Appollo Hospital was denied on two grounds – the said hospital was approved till 2013, the treatment was taken after the said period and that, the OPD treatment was not “emergency”.
The learned Single Judge allowed the writ petition on the ground that when the treatment was not denied, when it was essential for life saving and the disease was listed as chronic, the ground for rejection was not tenable.
The question of inducting as ‘indoor’ or ‘outdoor’ depends on the decision of the doctors. If the doctors have taken decision for giving treatment without admitting the patient in the hospital, denial of medical expenses that the treatment was given as ‘outdoor patient’ is not justified. The distinction between indoor and outdoor patient for denial of medical reimbursement is not based on reasonable classification.
The disease being chronic in nature, the treatment even if taken in OPD cannot be termed as not falling “emergency treatment” particularly when the disease relating to renable requires treatment.
Judgment dated 27.1.2025 of the Punjab and Haryana High Court in LPA-174-2022 (O&M) of State of Haryana and another Vs. Manoj Jain and others
