Central government employees can't be denied medical reimbursement: Supreme Court

The Supreme Court on Friday said that a central government employee during service or after retirement can't be denied the reimbursement of bill.

Published: 14th April 2018 03:56 AM  |   Last Updated: 14th April 2018 03:56 AM   |  A+A-

hospital, medical, doctor, bill, medicine, treatment

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By IANS

NEW DELHI: The Supreme Court on Friday said that a central government employee during service or after retirement can't be denied the reimbursement of bill merely on the ground that during a medical emergency he took treatment from a private hospital which is not in the list of the Central Government Health Scheme (CGHS) empanelled hospitals.

"The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order", said the bench of Justice R.K.Agrawal and Justice Ashok Bhushan in their judgement.

Speaking for the bench, Justice Agrawal held: "Can it be said that taking treatment in Speciality Hospital 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 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", the court said.

It is a settled legal position that the employee during his lifetime in service or after his retirement is "entitled to get the benefit of the medical facilities and no fetters can be placed on his rights", the court said.

It further said that the speciality 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.

The court also took note of "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, ...."

Directing 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", the court said: "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 one month."

It also directed the setting up of "Committee for grievance redressal of the retired pensioners consisting of Special Directorate General, Directorate General, 2 (two) Additional Directors and a specialist in the field which shall ensure timely and hassle-free disposal of the claims within a period of seven days."

"We further direct the concerned Ministry to take steps to form the Committee as expeditiously as possible," the court said.

The court order came on a petition by a retired central government official who had taken treatment from two private hospitals and sought the reimbursement of medical bills.

The government had initially refused to reimburse the bill saying that implant of CRT-D device was not required.

The court said: "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 on 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."

Holding that the CGHS approach in the instant case was "very inhuman", the court said: "This is hardly a satisfactory state of affairs. The relevant authorities are required to be more responsive and cannot in a mechanical manner deprive an employee of his legitimate reimbursement."

The Central Government Health Scheme (CGHS), the court said was propounded with a purpose of providing health facility scheme to the central government employees so that they are not left without medical care after retirement.

AThe bills were initially declined on the grounds that both the hospitals were not on the panel of CGHS. But later a part of two bills were reimbursed.

The court on Friday directed the reimbursement of the balance amount but making its clear that its order was limited to this case alone.

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Comments(7)

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  • Sanjay Kumar

    It should be generalized for the all government employees of the country if treatment is taken by the employee. As we knew the condition of government hospital are at the verge of collapse.These forced rules are only to deprive the patient to get treatment timely and properly
    16 days ago reply
  • Vishnukumar Ramchandra Patil

    For retired persons the benefits must be extended without asking any letters or request and then it must be intimated to the concerned for objections if any To give any request from the retied person is not reasonable if he does not know what is to be requested and to whom it is to be given because there is no communication between him /her how he will come to know the recent changes if any it is duty of Administrative to intimate it on the LAST KNOWN ADDRESS or ON THROUGH SMS on given MOBILE if any
    26 days ago reply
  • Vishnukumar Ramchandra Patil

    This is not taken care of in BSNL Pune SINCE LAST more than two years Medical Reimbursement bills are neither paid nor bobjections are raised. Secondly since Retirement no allowance is paid or added in PENSION amount. Thirdly they are expecting retired persons to give letters on many issues it is astonished how they are expecting to request for getting any benefit and how they would come to know what is to write and to whom.It must be be suo motu given benefit and asked after giving benefit if any one has objection then it should be sorted out but it must be implemented suo motu without harrshing the retired person
    27 days ago reply
  • Anjaneyan

    Notably
    1 month ago reply
  • nirmal nair

    can u kindly provide the case no. in order to obtain a copy of the judgment. thanks
    1 month ago reply
  • k.c.setty

    As observed central govt. pensioners ( CGHS card holders) and residing outside of CGHS wellness centers are being subjected to lot of troubles. Such as indifferent behavior of CGHS doctor/staff
    1 month ago reply
  • Inder Jit Gupta

    In the light of the Supreme Court Judgement that a Central Govt. Employee if falls ill can get treatment from any Govt or private hospital and can get his money reimbursed
    2 months ago reply