Reimbursement of Medical Treatment in non-empanelled hospitals to CG Employees and Pensioners – Supreme Court Judgment [WP (Civil) No. 694 of 2015]

Subject : Medical Treatment facilities to Central Government Employees
and Pensioners

“13) It is a settled legal position that the Government employee during
his life time or after his retirement is entitled to get the benefit of
the medical facilities and no fetters can be placed on his rights. It
is acceptable to common sense, that ultimate decision as to how a
patient should be treated vests only with the Doctor, who is well
versed and expert both an academic qualification and experience gained.
Very little scope is left to the patient or his relative to decide as
to the manner in which the ailment should be treated. Specialty
Hospitals are established for treatment of specified ailments and
services of Doctors specialized in a discipline are availed by patients
only to ensure proper, required and safe treatment. Can it be said that
taking treatment in Specialty Hospitals by itself would deprive a
person’ to claim reimbursement solely on the ground that the said
Hospital is not included in the Government Order. The right to medical
claim cannot be denied merely because the name of the hospitals is not
included in the Government Order. The real test must be the factum of
treatment. Before any medical claim is honoured, the authorities are
bound to ensure as to whether the claimant had actually taken treatment
and the factum of treatment is supported by records duly certified by
Doctors/Hospitals concerned. Once, it is established, the claim cannot
be denied on technical grounds. Clearly, in the present case, by taking
a very inhuman approach, the officials of the CGHS have denied the
grant of medical reimbursement in full to petitioner forcing him to
approach this Court. 

 

16) Further, with regards to the slow and tardy pace of disposal of MRC
by the CGHS in case of pensioner beneficiaries and the unnecessary
harassment meted out to pensioners who are senior citizens, affecting
them mentally, physically and financially, we are of the opinion that
all such claims shall be attended by a Secretary level High Powered
Committee in the concerned Ministry which shall meet every month for
quick disposal of such cases. We, hereby, direct the concerned Ministry
to device a Committee for grievance redressal of the retired pensioners
consisting of Special Directorate General, Directorate General, 2 (two)
Additional Directors and 1 (one) Specialist in the field which ‘shall
ensure timely and hassle free disposal of the claims within a period of
7 (seven) days. We further direct the concerned Ministry to take steps
to form the Committee as expeditiously as possible. Further, the above
exercise would be futile if the delay occasioned at the very initial
stage, i.e., after submitting the relevant claim papers to the CMO-I/C,
therefore, we are of the opinion that there shall be a time frame for
finalization and disbursement of the claim amounts of pensioners. In
this view, we are of the opinion that after submitting the relevant
papers for claim by a pensioner, the same shall be reimbursed within a
period of 1 (one) months.”