Supreme Court

Shiva Kant Jha Vs. Union of India (UOI)

MANU/SC/0369/2018

13.04.2018

Civil

Right to medical claim cannot be denied merely because name of hospital is not included in Government Order

The jurisdiction of present Court has been invoked by the Petitioner by filing present 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). Aggrieved by the decision of the CGHS in not allowing the medical bills in full, the Petitioner has filed instant 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.

It is a settled legal position that, the 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. 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. 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 right to medical claim cannot be denied merely because the name of the 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. Clearly, in the present case, by taking a very inhuman approach, the officials of the CGHS have denied the grant of medical reimbursement in full to the Petitioner forcing him to approach this Court.

The Central Government Health Scheme (CGHS) 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. It was in furtherance of the object of a welfare State, which must provide for such medical care that the scheme was brought in force. In the facts of the present case, it cannot be denied that the writ Petitioner was admitted in the above said hospitals in emergency conditions. Moreover, the law does not require that prior permission has to be taken in such situation where the survival of the person is the prime consideration. The doctors did his operation and had implanted CRT-D device and have done so as one essential and timely.

In the present view of the matter, Supreme Court is of opinion that, the CGHS is responsible for taking care of healthcare needs and well being of the central government employees and pensioners. In the facts and circumstances of the case, treatment of the Petitioner in non-empanelled hospital was genuine because there was no option left with him at the relevant time. Therefore, Respondent-State is directed to pay the balance amount of Rs. 4,99,555 to the Writ Petitioner.

Tags : Reimbursement Medical claim Entitlement

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