The Karnataka High Court.
Credit: PTI Photo
Bengaluru: The Karnataka High Court has directed the Suvarna Arogya Suraksha Trust (SAST) to reconsider a medical reimbursement claim filed by an assistant court officer, who was treated at a non-empanelled hospital after being referred by an empanelled hospital.
Justice Hemant Chandanagoudar cited the exception clause in the state government’s medical reimbursement order to support the decision.
B Nagabhushana, an assistant court officer at the high court, had his medical claim rejected after receiving treatment for pulmonary hypertension with connective tissue disease (CTD) and interstitial lung disease (ILD) at the privately owned Mazumdar-Shaw Medical Centre, following a referral from the Sri Jayadeva Institute of Cardiovascular Sciences and Research.
Nagabhushana’s claim for Rs 2,63,764 was rejected by SAST on January 23, 2023, on the grounds that it didn’t meet the emergency circumstances defined in the government order dated November 5, 2014.
However, Nagabhushana argued that the 2014 order allows reimbursement under exceptional circumstances, especially when a government hospital refers a patient to a non-empanelled private hospital.
The court ruled that Nagabhushana is entitled to reimbursement under Clause 5, Paragraph 3 of the November 5, 2014, order, which permits reimbursement when a recognised government hospital refers a patient to a specialist.
The court directed SAST to reconsider the claim within two months, subject to submission of all required documents.