Central govt employees can’t be denied medical reimbursement: SC
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 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 specialised 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 technical 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, 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.”
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.