Holding

The Court held that a hypothetical claim for reimbursement is valid and the appellant is entitled to the rates of the recognized private hospital (Escorts Heart Institute) under Article 21’s guarantee of self‑preservation.

Summary

Surjit Singh, a Deputy Superintendent of Police, underwent emergency bypass surgery in London while on leave and claimed Rs 3 lakh reimbursement. The State of Punjab initially refused, later paying Rs 40,000 based on AIIMS rates. Singh appealed, seeking reimbursement at the higher rates of Escorts Heart Institute, a hospital recognized by the State for open‑heart surgery. The Supreme Court examined whether a hypothetical claim—assuming Singh had gone to Escorts in India—could be entertained under the reimbursement policy and whether Article 21’s right to life includes a right to self‑preservation that permits bypassing the medical‑board procedure. The Court held that such a hypothetical claim is valid and that the right to self‑preservation is a necessary concomitant of the right to life, allowing Singh to claim the Escorts rates, adjusted for the amount already paid. Consequently, the appeal was allowed and the difference was ordered to be paid within two months.

Issues considered

Whether a hypothetical claim for medical reimbursement is permissible under the State of Punjab's reimbursement policy.
Whether the right to life under Article 21 of the Constitution includes a right to self‑preservation that justifies obtaining emergency treatment without prior medical‑board approval.

Legislation cited

Constitution of Indias. Article 21

Subjects

Right to lifeArticle 21Self‑preservationMedical reimbursementHypothetical claimState employee benefitsEmergency medical treatment

Judgment

SURJIT SINGH A
v.
STATE OF PUNJAB AND ORS.

JANUARY 31, 1996

[MADAN MOHAN PUNCHHI AND K. VENKATASWAMI, JJ.] B

Constitution of illdia, 1950: Article 21

Right to life-Held self preservation is 11ecessa1y concomitant of 1ight
w~ C
Service Law :

Medical reimbw>ement-State of Punjab-Reimbursement policy--
Recognition of p1ivate identified hospitals for treatment-Employee-Visit to
England on leave-Hea1t problenr-{Jndergoing bye-pass surgery to save him- D
self without submitting himself for medical examination as per policy-Gaim
for reimbursement-State making payment as per rates prevalent in All India
" fllstitute of Medical Scimces-Employee's hypothetical claim for reimburse-
ment on the basis of rates prevalent in Escorts-Held pem1issible as right to
self preservation is part of right to life.
E
The State of Punjab in its policy regarding reimbursement of medi-
cal expenses to its employees recognised certain identified private hospi-
tals including Escorts Heart Institute, New Delhi for treatment of certain
diseases including open heart surgery. The appellant, a Deputy Superin-
tendent of Police in Punjab, during his visit to England, while on leave, fell F
ill due to his heart problem and to save himself is said to have undergone
a bye-pass surgery in Humana Hospital, Wellington London. On his return
to India he claimed reimbursement for Rs. 3 lacs spent on bis medical
treatment which was refused as the Department was of the opinion that
his case was not that of an emergency but a planned visit to England to·
have himself medically treated without submitting _himself for medical G
examination as required under the policy. The appellant filed a writ
petition before the Punjab and Haryana High Court. No documentary
evidence was tendered to show that his was a case of emergency requiring
instant operation and treatment. However, the State paid to the appellant
the expenses incurred by him on the rates prevalent in the all India H
1095
1096 SUPREME COURT REPORTS
J
[1996] 1 S.C.R.

A Institute of Medical Science (AIIMS) i.e. Rs. 30,000 for bye-pass surgery
and Rs. 10,000 for Angiography. The High Court disposed the petition
accordingly.

The appellant _preferred appeal before this Court claiming payment
on the basis of rates prevalent in the Escorts Heart Institute in place of
B that of AIIMS contending that he may be considered to have been treated
in the Escorts, more so, when he is being treated to have been operated
upon in AIIMS without actually having been so and had a choice to go
either to the AIIMS or Escorts or Christian Medical College, Ludhiana or
Appollo Hospital, Madras.
c On the question whether the hypothetical claim of the appellant for
medical reimbursement was valid :

Allowing the appeal, this Court

D HELD : 1. hypothetical claim of the appellant for medical reimbur-
sement is valid. In the circumstances of the case he cannot be said to be
far too wrong in choosing Escorts amongst the three recognised hospitals
for open heart surgery. As he has brought down his claim to the rates •
prevalent in the Escorts in place of that of AIIMS further reference to
emergency treatment etc. would not be necessary. It would hypothetically
E have to be assumed that the appellant was in India, had not subjected
himself to Medical Board Examination, and had gone on his own to
Escorts and got himself operated upon for bye-pass surgery.
v
2. Self preservation of one's life is the necessary concomitant of the
right to life enshrined in Article 21 of the Constitution of India, fundamen-
F tal in nature, sacred precious and inviolable. The importance and validity
of the duty and right to self-preservation has a species in the right of self
defence in criminal law, Centuries ago thinkers of this Great Land con-
ceived of such right and recognised it.

G Ga1Uda Purana Chapter 16, Verses 17, 18, 20 and 22, referred to.

3. The appellant therefore had the right to take steps in self preser-
vation. He did not have to stand in queue before the Medical Board, the
manning and assembling of which, bare-facedly, makes its meetings dif-
ficult to happen. The appellant also did not have to stand in queue in the
H government hospital of AIIMS and could go elsewhere to an alternate
SURJITSINGHv. STATE 1097

hospital as per policy. When the State itself has brought Escorts on the A
recognised list, it is futile for it to contend that the appellant could in no ·
event have gone to Escorts and his claim cannot on that basis be allowed,
on suppositions. In the facts and circumstances, had the appellant
remained in India, he could have gone to Escorts like many others did, to
save his life. But instead he had done that in London incurring consider-
B
able expense. The doctors causing his operation there are presumed to
have done so as one essential and timely. On that hypothesis, it is fair and
just that the respondents pay to the appellant, the rates admissible as per
Escorts within two months subject to adjustment of Rs. 40,000 already paid
to him.
c
Sadhu R Pell v. State of Punjab through Secretary Health and Family
Welfare, Punjab, Civil Secretariat, Chandigarh and Ors., C.W.P. No. 13493 of
1992 decided by Punjab & Haryana High Court on 6.10.1993; approved.

KL. Kohli v.State of Punjab & Ors., C.W.P. No.18562 of1992 decided
on 10.5.1995; Mohan Duggal v. State of Punjab & Ors., C.W.P. No. 260 of D
1995 decided on 30.5.1995; Prem Singh Gill v. State of Punjab and Ors.,
C.W.P. No. 5669/94 decided on 4.9.1994 by Punjab and Haryana High
Court; Terlok Chandra v. The State of Punjab etc., (1995) III Punjab Law
Reporter 529 and Mrs. Surya Pandit v. State of Punjab and Ors., (1995) III
Punjab Law Reporter 682, referred to. E
CIVIL APPELLATE JURISDICTION: Civil Appeal No. 2489 of
1996.

From the Judgment and Order dated 18.4.95 of the Punjab &
Haryana High Court in W.P. No. 6703 of 1994. F
P .N. Puri for the Appellant.

G.K. Bansal for the Respondents.

The Judgment of the Court was delivered by : G
PUNCHHI, J. Leave granted.

Is the hypothetical claim of the appellant for medical reimbursement
valid in the facts and circumstances of this case is the straight question
which falls for determination in this appeal. H
/

J
1098 SUPREME COURT REPORTS (1996] 1 S.C.R.

A The appellant, Surjit Singh (now retired) while posted as a Deputy
Superintendent Police, Anandpur Sahib, Distt. Ropar, Punjab developed a
heart-condition on 22-12-1987 and that very day went on a short leave
extending it uptill 10-1-1988, on medical grounds. It remains unclarified on
the record of this case as to what steps the appellant took thereafter to
meet his ailment. However, six months later he obtained leave from his
B superiors from 15-6-1988 to 8-9-1988 and went to England to visit his son.
It is the case of the appellant that while in England, he fell iH due to his
heart problem and as an emergency case, was admitted in Dudley Road,
Hospital Brimingham. After diagnosis he was suggested treatment at a
named alternate place. Thus to save himself the appellant, got himself
C admitted and operated upon in Humana Hospital, Wellington, London for
a Bye-Pass Surgery. He claims to have been hospitalised from 25-7-88 to
4-8- 88. A sum of Rs. 3 lacs allegedly on his treatment at London, borne
by his son.

D On return to India, the appellant on 6-11-1988 submitted a Bill for
medical reimbursement claiming that very sum, in the office of the Senior
Superintendent of Police, Ropar which was forwarded to the Director
General of Police, Punjab, Chandigarh and the Home Department of the
State of Punjab. Some correspondence took place between the appellant
and the department. As per office requirements some more certificates
E were sent by the appellant in support of his case. Vide letter dated 21-1-93,
the Department however expressed its inability to sanction the bill for
medical reimbursement. This led to the appellant moving the High Court
of Punjab and Haryana at Chandigarh in writ jurisdiction. As required by
the High Court, the State responded by filing its counter affidavit. At the
F time of hearing the Assistant Advocate General for the State of Punjab
made a statement to the effect that the State was ready to pay to the
appellant the expenses incurred for Bye-Pass Surgery and Angiography on
the rates prevalent in the All India Institute of Med.ical Sciences, New
Delhi (for short 'AIIMS'). Applying that yardstick, as suggested, a sum of
Rs. 30, 000 on account of Bye-Pass Surgery and a sum of Rs. 10,000 for
G Angiography was thus ordered by the High Court to be paid to the
appellant within six weeks. The writ petition on 18-4-1995 was disposed of
on such terms. The said sum, as claimed by the State stands paid to the
appellant.

H The appellant challenging the orders of the High Court disposing of
SURJJT SINGH v. STATE 1099

the writ petition in such manner now pitches before us his claim to payment
on the basis of rates prevalent in the Escorts Heart Institute and Research
Centre (for short 'Escorts'), reducing his high claim to the expenses
incurred for medical treatment in London. There is an inkling to that effect
in the appellant's rejoinder affidavit in the High Court but it appears that
this aspect of the matter was not dilated upon. The claim for such adoption
of rates is now made in reiteration.

The parties counsel agree that there is a policy regarding reimburse-
ment of medical expenses framed by the State on 25-1- 1991, which has
duly been circulated in all the wings/officers of the State. It's operative
(
portion, so far relevant, is reproduced below :

"Subject : Re-imbursement of medical expenses-Policy regarding

Sir/Madam,

In supersession of Punjab Government letter No. 7/7/85-
3HBV/13855 dated 27-5-1987, the President of India is placed to
lay down the following policy for reimbursement of medical expen-
ses incurred on medical treatment taken abroad and in hospitals
other than the hospitals of the Govt. of Punjab (Both outside and
in the State of Punjab) :

(i) All categories of employees whether retired or serving of All
India Service/State Govt. Judges of Punjab and Haryana High
Court/M.L.As/Ex M.L.As will be governed by this policy.

(ii) The persbn who is in need of medical treatment outside India
' or in any hospital other than the Govt. of Punjab (both outside
and in the State of Punjab) as the case may be may make an
application for getting treatment in these hospitals direct to the
Director, Health and Family welfare 2 months advance, duly
recommended by the C.M.0/Medical Supdt. indicating that the
treatment for the disease mentioned is not available in the Hospital
of the Govt. of Punjab. In case of emergency duly authenticated
by C.M.O./Medical Supdt. the application can be made 15 days in
advance.

(iii) Director, Health and Family Welfare, Punjab will place the
application of the concerned employee before the Medical Board
r
)

1100 SUPREME COURT REPORTS [1996] 1 S.C.R.

within 15 days on the receipt of application. In case of emergency,
if immediate meeting of Medical Board, cannot be convened, such
application may be circulated to all the members of the Medical
Board and decision taken thereof.

(iv) The Medical Board shall consist of the following officers : J
(i) Director, Health and Family Welfare, Punjab - Chairman

(ii) Director, Research and Medical Education, Punjab - member

(iii) Specialist of the desired line of treatment from PGJ Chan-
digarh or AIIMS, New Delhi - Member

(iv) Senior most specialist from Medical Colleges, Patiala, Amrit-
sar and Faridkot - Member

-
(v) Dy. Director/Asst!. Director, J/c of the P.M.H. Branches office
of the director Health and Family Welfare - Member Secy"
..
(vi) xxxx

(vii) xxxx

(viii) xxxx
·-
(ix) xxxx

(x) xxxx

(xi) xxxx

(xii) The Health Dept!. in consultation with Director Research &
Medical Education will prepare a list of diseases for which
specialised treatment is not available in Punjab Govt. Hospitals
and indicate the Institutions/Hospitals/Clinics of repute where
necessary treatment is available. This list will, however be subject
to variation in future.
.(
On 8-10-1991, the above policy has further been explained in so far
the choice of the hospitals is concerned :

"Policy for reimbursement of medical expenses incurred on medi-
SURJITSINGHv. STATE 1101

cal treatment taken abroad and in hospitals other than those of A
the Government of Punjab, both within and outside the State was
laid down. However, as per the 12th item of these instructions, a
list of those diseases for which specialised treatment wa.s not

- available in the Government hospitals was to be prepared m
addition to identifying medical institutions/hospitals/clinics of
repute where such specialised treatment was available.

The Government has now prepared a list of those diseases for
B

which the specialised treatment is not available in Punjab Govern-
•'
ment hospitals but is available in certain identified private hospi-
I tals, both within and outside the State. It has, therefore, been C
decided to recognise these hospitals for the treatment of the
disease mentioned against them in the enclosed list for Punjab
Government employees/pensioners and their dependents. The
terms and conditions contained in letter under reference will
remain applicable, Government can, however, revise the list, in D
future.

Therefore it has been decided to recognise those hospitals for the
'
treatment of diseases mentioned against them in the enclosed list
issued with the concurrence of the Finance Department dated
11-9-1991 which is as under : E
Open Heart Surgery: Escorts Heart Institute, New Delhi ; Christian
Medical College, Ludhiana ; Appollo Hospital, Madras.

The purport of the above policy is that the Escorts stands duly recognised
by the State for treatment of its employees for open heart surgery, apart F
from the other two institutions i.e. Christian Medical College. Ludhiana
and Appollo Hospital, Madras. The Finance Deptt's concurrence signifies
its willingness to entertain reimbursement bills in variables depending on
where treatment is received.

There has been a factual dispute as to whether the appellant went to G
the Dudley Road Hospital, Brimingham as an emergency case and whether
he was operated upon in Human Hospital, Wellington, London in that
condition. Except for the bare word of the appellant, no documentary
evidence in support of such plea had been tendered by him before the High
Court, or even before us, to show that his was a case of emergency H
1102 SUPREME COURT REPORTS [1996] 1 S.C.R.

A requiring instant operation and treatment. The State of Punjab on the other
·hand has countered before the High Court, as also here, that the case of
the appellant was no that of an emergency but a planned visit to England
to have himself medically treated under the care of his son, without
submitting himself as per policy, for examination before the Medical
Board. This plea or the appellant may have been required to be examined
B in thorough detail had he stuck to his original claim for medical expenses
incurred in England. Since he has now brought down his claim to the rates
prevalent in the Escorts in place of that of AIIMS, further reference to
emergency treatment etc. would not be necessary. It would hypothetically
have to be assumed that the appellant was in India, had not subjected
C himself to Medical Board examination, and had gone on his own to the
Escorts and got himself operated upon for Bye-Pass Surgery. The point to
be considered is whether his claim is admissible under the policy keeping
in view the string of judgments of the High Court in that regard, as well as
on the Factum that the State has already conceded re-imbursement to the
D appellant on hypothetical basis as if treated in AIIMS.

The policy, providing recognition for treatment of open heart surgery .
in the Escorts, specifically came to be examined by a division bench of the
Punjab and Haryana High Court at Chandigarh in C.W.P. No. 13493 of
1992 titled as Sadhu R. Pall vs. State of Punjab through Secretary Health and
E Family Welfare Punjab, Civil Secretariat, Chandigarh and others decided on
6-10-1993, wherein the claim of the then writ petitioner to medical reim-
bursement was accepted when in order to save his life he had got himself
operated upon in the Escorts, and the plea of the State that he could be
paid rates as prevalent in the AIIMS was rejected. Special Leave Petition
F No. 22.024 of 1995 against the said decision was dismissed by this Court on
2-2-1994. The other judgments of the High Court following the decision in
Sadhu R Pall's case are :

(1) C.W.P. No. 18562 of 1992 decided on 10-5-95 titled K.L. Kohli
G v. State of Punjab and others (DB);

(2) C.W.P. No. 260 of 1995, decided on 30-5-1995 titled avi Mohan
Duggal v. State of Punjab and Others (DB);

(3) C.W.P. No. 5669 of 1994 decided on 4-9-94 titled Prem Singh Gill
H v. State of Punjab and Others;
SURJIT SING!-! v. STATE 1103

(4) 1995 (III) Punjab Law Reporter 529 titled Tar/ok Chander v. The A
State of Punjab etc. (SB); and

(5) 1995 (III), Punjab Law Reporter 682 titled Mrs. Swya Pandit v.
State of Punjab and othe1' (SB)

All the aforementioned judgments of the High Court have a common B
factual basis, i.e. each recipient of the relief from the High Court had in
fact been treated in the Escorts and had borne expenses. The other
common factor is that the High Court believed each writ petitioner plead-
i ing emergency to go to Escorts in the given fact situation. But this factor
by itself is not the core of the views of the High Court. Hypothetically, the C
appellant says, he too may be considered to have been treated in the
Escorts, more so, when he is being treated to have been operated upon in
A!IMS without actually having been so, and had a choice to go either to
the AIIMS or Escorts or Christian Medical College, Ludhiana or Appollo
Hospital, Madras. The appellant in these circumstances cannot be said to
be far too wrong in choosing the Escorts amongst the three recognis_ed D
hospitals for open heart surgery available in the North, the AIIMS being
governmental and the other two being private hospitals. The division bench

. in Sadhu R. Pall's case observed as follow :

"The respondents appear to have patently used excuses in refusing E
full reimbursement, when the factum of treatment and the urgency
for the same has been accepted by the respondents by reimbursing
the petitioner the expenses incurred by him, which he would have
incurred in the AIIMS New Delhi. We cannot loose sight of factual
situation in the AIIMS New Delhi, i.e. with respect to the number
'
of patients received there for heart problems. In such an urgency F
one cannot sit at home and think in a cool and calm atmosphere
for getting medical treatment at a particular hospital or wait for
admission in some Government medical institute. In such a situa-
tion, decision has to be taken forthwith by the person or his
attendants if precious life has to be saved." G
· We share the views afore-expressed.

It is otherwise important to bear in mind that self preservation of
one's life is the necessary concomitant of the right to life enshrined in
Article 21 of the Constitution of India, fundamental in nature, sacred, H
1104 SUPREME COURT REPORTS [1996] 1 S.C.R.

A precious and inviolable. The importance and validity of the duty and right
to self-preservation has a species in the right of self defence in criminal
law. Centuries ago thinkers of this Great Land conceived of such right and
recognised it. Attention can usefully be drawn to versus 17, 18, 20 and 22

B
in Chapter 16 of the Garuda Purana (A Dialogue suggested between the
Divine and Garuda, the bird) in the words of the Divine :
J
17. Vinaa dehena kasyaapi can- Without the body how can one
purushaartho na vidyate las- obtain the objects of human
maaddeham dhanam life? Therefore protecting the
rakshetpunyakarmaani saad- body which is the wealth, one
c hayat should perform the deeds of
merit.

18. Rakshayetsarvadaatmaanamaa One should protect his body
tmaa sarvasya bhaajanam Rak- which is responsible for every-·
shane yatnamatishthejje thing. He who protects himself
D vanbhaadraani pashyati by all efforts, will see many
auspicious occasions in life.
-
,.

E
20. Sharirar akshanop aayaah
kriyante sarvadaa budhaih Nee-
chanti cha punastyaagamapi
The wise always undertake the
protective measures for the
body. Even the persons suffer-
-
kushthaadiroginah ing from leprosy and other dis-
eases do not wish to get rid of
the body

22. Aatmaiva yadi naat- If one does not prevent what is
F maanamahitebhyo nivaarayet unpleasent to himself, who else
Konsyo hitakarastasmaadaat- will do it ? Therefore one should
maanam taarayishyati do what is good to himself.

The appellant therefore had the right to take steps in self preserva-
tion. He did not have to stand in queue before the Medical Board, the
G manning and assembling of which, bare-facedly, makes its meetings difficult
to happen. The appellant also did not have to stand in queue in the
government hospital of AIIMS and could go elsewhere to an alternate
hospital as per policy. When the State itself has brought the Escorts on the
recognised list, it is futile for it to contend that the appellant could in no
H event have gone to the Escorts and his claim cannot on that basis be
SURJITSINGHv. STATE 1105

allowed, on suppositions. We think to the contrary. In the facts and A
circumstances, had the appellant remained in India, he could have gone to
the Escorts like many others did, to save his life. But instead he has done
that in London incurring considerable expense. The doctors causing his
operation there are presumed to have done so as one essential and timely.
On that hypothesis, it is fair and just that the respondents pay to the
appellant, the rates admissible as per Escorts. The claim of the appellant
B
having been found valid, the question posed at the outset is answered in
the affirmative. Of course the sum of Rs. 40,000 already paid to the
appellant would have to be adjusted in computation. Since the appellant
did not have his claim dealt with in the High Court in the manner it has
been projected now in this Court, we do not grant him any interest for the c
intervening period, even though prayed for. Let the difference be paid to
the appellant within two months positively. The appeal is accordingly
allowed. There need be no order as to costs.

T.N.A. Appeal allowed.

r

'