Reimbursement Of Medical Claim Undertaken By Retired Pensioner In Emergency Cannot Be Denied Merely Because Hospital Is Not Empaneled: Delhi HC

While dismissing an appeal against the CAT’s order directing reimbursement of the balance amount against a claim for the expenditure of Rs 2.6 lacs incurred by a retired pensioner of the Central Government on medical treatment at VIMHANS Hospital, the Delhi High Court held that the State is under an obligation to ensure the timely medical treatment to a person in need and a negation of the same amounts to a violation of Article 21 of the Constitution.

A Division Bench of Justice V. Kameswar Rao and Justice Anoop Kumar Mendiratta observed that “the executive instructions need to be applied than rejecting the claim on technical ground of undertaking treatment in a non-empaneled hospital, since the CGHS/State is responsible to ensure proper medical treatment in an emergent condition and further cannot escape the liability, if the treatment undertaken is genuine”.

Senior Advocate Syed Abdul Haseeb appeared for the Petitioner, whereas, Advocate Padma Kumar S appeared for the Respondent.

Going by the background of the case, the Respondent retired as Senior Carpenter, and as a pensioner, he was availing the CGHS facility. In the year 2017, Respondent was diagnosed with a neuro case and accordingly underwent surgery at VIMHANS Hospital. Thereafter, Respondent submitted medical bills amounting to Rs 2.6 lacs for reimbursement along with the emergency certificate. However, he was reimbursed only an amount of Rs 31.5 thousand. The Respondent thereafter approached the Central Administrative Tribunal (CAT) which directed the Petitioners to reimburse the balance amount to the Respondent against his claim.

After perusing the doctor’s prescription, the High Court found that the Respondent was advised Gamma Knife Radiosurgery as an emergency treatment’ apart from other treatment, and therefore, merely because the Respondent was conscious and oriented at the time of admission at VIMHANS cannot lead to an inference that his claim of being admitted in an emergency, is false.

From a perusal of the medical records, the High Court noted that there existed continued emergent conditions for undertaking the treatment by Respondent at VIMHANS, as advised at Mata Chanan Devi Hospital.

“Merely because the respondent was suffering from the ‘Right Sided V1V2 Region Trigeminal Neuralgic’ for past four months, does not lead to an inference that the medical condition did not require emergent treatment, which was undertaken as a last resort by the respondent as advised”, added the Court.

The Bench also observed that the medical claim for treatment undertaken in emergency should not be denied for reimbursement merely because the hospital is not empanelled, and any denial of claim by the authorities in such cases only adds to the misery of the Government servant by further forcing him to resort to Court of law.

Therefore, keeping in view the emergency certificate and the treatment papers filed by the Respondent, the High Court upholds the findings of CAT which directed for reimbursement of retired pensioner’s medical bills amounting to Rs 2.6 lakh.

Cause Title: Union of India and Anr. v. Joginder Singh [Neutral Citation Number: 2023: DHC: 3138-DB]

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