Can you claim medical reimbursement for treatment in non-empanelled hospital? Punjab and Haryana High Court answers

Can you claim medical reimbursement for treatment in non-empanelled hospital? Punjab and Haryana High Court answers

4 min readNew DelhiFeb 2, 2026 01:23 PM IST

The Punjab and Haryana High Court has directed an organisation concerned to reimburse over Rs 20 lakh to a retired employee for the emergency heart transplant of his son, observing that preservation of human life is “instinctive” and retains the “highest priority”.

Justice Harpreet Singh Brar was hearing the man’s plea, whose son died during a heart transplant surgery in a non-empanelled hospital after no donor was available at empanelled hospitals, seeking full reimbursement of Rs 20.30 lakh.

Justice Harpreet Singh Brar found that the petitioner’s son died the next day of his surgery in a non-empanelled hospital. (image is enhanced using AI)

“Not only is the preservation of human life instinctive, but it also forms a part of Article 21 of the Constitution of India; therefore, it shall always retain the highest priority,” the court observed.

Background

  • According to the prosecution, the petitioner, a retired employee of the organisation concerned, had a son who was diagnosed with major heart disease since birth and was advised to undergo heart transplantation.
  • It was palce don record that the petitioner initially got his son admitted to approved and empanelled hospitals.
  • However, when no donor was found, he was admitted to another hospital, which was not empanelled by the organisation concerned.
  • The said hospital found a suitable donor, and the surgery was conducted in August 2023. However, his son died and was declared dead on the next day of surgery, as confirmed by the death certificate supplied by the prosecution.
  • The petitioner applied for medical reimbursement of Rs 20.30 lakh, but the organisation concerned reimbursed only Rs 10.08 lakh.

Findings

  • The claim for medical reimbursement should not be dismissed only because the claimant underwent treatment in a non-empanelled hospital.
  • The test of “essentiality and emergency” is important and considerable in these cases as it dictates that if the medical procedure was undergone by the claimant in an emergency, on the advice of a doctor based on his medical record, to save his life, the reimbursement for the same must be made.
  • The petitioner’s son underwent heart transplantation, which was necessary at that moment to save his life and is confirmed by the medical record provided, and therefore, the test of essentiality and emergency stands satisfied in the present case.
  • The state bears the obligation to ensure the availability of timely medical care to those in need.
  • The citizens cannot be expected to refrain from availing timely care because of the non-empanelment of the hospital.
  • The conduct of the state does not satisfy the criteria of fairness and reasonableness and violates the fundamental rights provided under Article 21 of the Constitution.
  • The corporation concerned is directed to reimburse the entire medical claim of Rs 20.30 lakh to the petitioner, within a period of four weeks, excluding an amount of Rs 10.08 lakh, which has already been released to him.

Arguments

  • The petitioner’s counsel, advocate Ketan Antil, argued that his client’s son was operated on under emergency circumstances and his treatment was taken from a non-empanelled hospital, as no donor was available in the empanelled hospital.
  • Antil further submitted that his client made a representation to reimburse the full amount of the medical claim, but in the August 2025 order, it was held that the medical reimbursement of Rs 10.08 lakh had been rightly released without recording any reason for the said order.
  • He claimed that the order is illegal, discriminatory and against the settled law.
  • On the other hand, the organisation concerned’s counsel, advocate Vikrant Pamboo, submitted that they have rightly reimbursed the medical claim of Rs 10.08 lakh after considering all the material available on record.

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Richa Sahay is a Legal Correspondent for The Indian Express, where she focuses on simplifying the complexities of the Indian judicial system. A law postgraduate, she leverages her advanced legal education to bridge the gap between technical court rulings and public understanding, ensuring that readers stay informed about the rapidly evolving legal landscape.

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