Supreme court Judgement for reimbursement of medical claims under the Central Government Health Scheme

Expeditious settlement of reimbursement of medical expenses to pensioner within one month of submission of Bill’s for treatment in Private Hospital





Shiva Kant Jha

…. Petitioner(s)


Union of India

…. Respondent(s)



R.K. Airawal, J.

1) The jurisdiction of this Court has been invoked by the petitioner herein by filing this writ petition against the alleged unfair treatment meted out to several retired government servants in their old age and their state of affairs pertaining to reimbursement of medical claims under the Central Government Health Scheme (CGHS).

2) Brief facts:

The petitioner herein is a CGHS beneficiary (retired pensioner) having a CGHS Card valid for whole life for medical treatment in Private Ward. The petitioner herein submitted two sets of his Medical bills under the Central Government Health Scheme (CGHS) for reimbursement on account of his treatment done in November, 2013 in the Fortis Escorts Hospital, New Delhi for Rs. 9,86,343/- for his cardiac ailments involving the implant of CRT-D device and two sets of bill amounting to Rs. 3,98,097/- for his treatment at Jaslok Hospital, Mumbai for cerebral stroke and paralytic attack.

(b) The petitioner herein submitted the first Bill on 02.01.2014 and the second Bill (two) on 19.07.2014 to the authority concerned. The first Bill was considered by the Technical Standing Committee in May 2014 and the claim was rejected without informing him of the reasons for rejection. The case was again considered by the Standing Committee on 10.07.2014 and was rejected on the ground that CRT-D implant was not required. Aggrieved of the above, the petitioner herein filed a representation before the Secretary, Ministry of Health & Family Welfare. The said representation was again considered by the Standing Committee on 15.01.2015 and was rejected for the reason that “Prior approval for such device implant was not sought”. Again, in fourth attempt, the petitioner herein approached the Director General of the CGHS. After presenting the memorial to the Director General of the CGHS, the government credited an amount of Rs. 4,90,000/- in the petitioner’s Bank Account, however, he was never heard on any point nor any speaking order was ever communicated to him.

(c) In the second set of Bills of the Jaslok Hospital, the petitioner’s claim was curtailed to the tune of Rs. 94,885/-, being just one-fourth of the claim and no opportunity of being heard was granted to the petitioner. Thus, the petitioner herein was denied an amount of Rs. 4,96,343/- from the first claim and Rs. 3,03,2 12/- from the second set of claim. In other way, out of the total bills amounting to Rs.13,84,440/-, the petitioner herein was paid Rs. 5,84,885/-, meaning thereby, the petitioner herein was denied Rs. 7,99,555/-. To both the hospitals, the petitioner had to pay out of his personal resources. However, this Court, vide order dated 01.02.2016, directed the respondent-State to pay a sum of Rs. 3,00,000/- to the petitioner as an interim relief.

(d) Aggrieved by the decision of the CGHS in not allowing the medical bills in full, the petitioner herein has filed this writ petition under Article 32 of the Constitution of India claiming that he being in late 70s of his age, needs money to meet the needs for his survival.

3) Heard the petitioner-in person and Ms. Binu Tamta, learned counsel for the respondent-State.

Rival contentions:

4) The petitioner in person contended before this Court that over several years, several retired government servants, in their old age, have suffered and even died due to unfair treatment meted out to them by the CGHS and its controlling Ministry, the Ministry of Health and Family Welfare, in discharge of their duties. The petitioner contended that the impugned CAG’s Report with regard to “Reimbursement of Medical Claims to the Pensioners under CGHS” have also expressed the indifference against the pensioners. He further contended that every 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.

The petitioner in-person finally contended that this Court may exercise its jurisdiction under Articles 32 and 142 of the Constitution so that the fundamental rights of the petitioner under Articles 14 and 21 are protected and promoted by reimbursing his medical expenditure already incurred by him under genuine emergency and also to frame some guidelines for effective implementation of the claims of the pensioners under the CGHS.

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Source :

Reimbursement of medical claims under the CGHS

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