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IN THE HIGH COURT OF JUDICATURE AT BOMBAY
G.S.KULKARNI, ADVAIT M.SETHNA
Anirudh Prataprai Nansi, a voluntary retired Central Government employee (Pensioner) Andheri (West), Mumbai – Appellant
Versus
Union of India, through the AS & DG – Respondent
Judgment :
G.S. Kulkarni, J.
1. Rule, made returnable forthwith. Respondents waive service. By consent of the parties, heard finally.
Preface
2. The case is a peculiar case, namely, of a dispute arising from the reimbursement of expenditure incurred by the petitioner on a serious medical treatment of a “heart transplant”. This medical condition is certainly not a routine affair for the hospitals much less for the Central Government hospitals or those under the Central Government Health Scheme.
3. The petitioner is a senior citizen. He is a pensioner, who obtained a voluntary retirement from the post of Assistant Commissioner, Central Excise and Customs, Pune. This is the second occasion for the petitioner to approach this Court on the cause of action as pursued in this petition.
4. The issue which arises for consideration is whether in the inescapable and pressing situation the petitioner, having undergone a heart transplant at a private hospital, could the petitioner be denied and/or not given full reimbursement of the medical expenses incurred by him for such major treatment. The question is also as to whether the rigors of normal rule of medical reimbursement should make a way for the
The denial of medical reimbursement for a heart transplant due to CGHS guidelines was unconstitutional, emphasizing individual health rights in critical situations.
Emergency medical treatments require reimbursement even if provided by non-empanelled facilities, prioritizing the necessity of treatment over technical compliance with prescribed rates.
In emergency medical situations, full reimbursement of medical expenses is mandated regardless of any imposed ceiling limits, emphasizing the right to timely medical treatment.
Denial of reimbursement for emergency medical treatment under CGHS violates constitutional rights and undermines the scheme's welfare purpose.
The right to medical reimbursement for government employees cannot be denied due to hospital non-recognition or exceeding package limits if treatment necessity is established.
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