Medical Reimbursement For Central Govt Employees Cannot Be Denied

Medical reimbursement for central government employees cannot be denied in a specialty hospital “solely on the ground that the said Hospital is not included in the Government Order,” the Supreme Court has said.

The Supreme Court has ruled that a central government employee cannot be refused reimbursement for medical bills, either during service or after retirement, on the grounds that during a medical emergency he took treatment at a private hospital that is not on the list of Central Government Health Scheme (CGHS) empanelled hospitals.

“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.”

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.

The Supreme Court bench also said that specialty hospitals provide treatment for specific ailments and patients avail of them only to ensure necessary and safe treatment.

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.”

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.”