The Karnataka Excessive Court docket just lately dominated that medical reimbursement can’t be denied solely attributable to a change within the title of a hospital when it stays the identical authorized entity.
On this case, Dr S Doddagoudar, an affiliate professor at a authorities institute within the Haveri district, challenged the endorsements issued in July and August 2024 by the Larger Training Division and Suvarna Arogya Suraksha Belief, rejecting his medical reimbursement declare of Rs 13,95,464. The rejection occurred as a result of the hospital the place he was handled was not included within the checklist of personal hospitals eligible for reimbursement claims.
The professor’s counsel argued that the hospital was certainly on the checklist of eligible for reimbursement, however in 2021, it modified its title from Kasturba Medical Faculty Hospital, Manipal, to Kasturba Hospital, Manipal. He submitted that this alteration had not been mirrored within the authorities’s checklist of hospitals. The opposing authorities counsel argued that solely the hospitals showing on the checklist might be thought-about.
Within the September 10 order, Justice Suraj Govindaraj of the Dharwad bench famous, “It’s evident that if therapy is availed from an unrecognised hospital, reimbursement will not be permissible. Nonetheless, within the current case… the authorities have didn’t replace the title, leading to rejection of reimbursement claims. The hospital stays the identical authorized entity, and the title change was duly recorded underneath the Karnataka Non-public Medical Institutions Act.”
The courtroom acknowledged that to reject the declare for reimbursement merely on account of the title not having been up to date for a similar hospital can be “arbitrary and legally unsustainable”, because the authorities must have up to date the checklist.
“The respondent authorities have been obligated to confirm the request and replace the recognised checklist after following the due process. Their failure to take action can’t prejudice the petitioner,” stated the courtroom, because it quashed the earlier orders by the state on this matter and directed to rethink the difficulty inside six weeks.