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2002 Supreme(Del) 768

High Court Of Delhi
S.K.SHARMA - Appellant
Versus
UNION OF INDIA - Respondent
Decided On : 05/23/2002

Headnote:Medical Claim - Reimbursement — Whether an ex-government employee can claim reimbursement of medical expenses in the absence of being a member of the CGHS Scheme — A citizen has right for reasonable existence under Article 21 — Retired government official is entitled to the benefit of the CGHS — Duty of the government to make available proper health facilities and the officer should not suffer by virtue of the failure of the Government to extend CGHS scheme to all areas of the country — Government be directed to reimburse the medical expenses to the petitioner — Petition allowed.

       Held:

       It is now settled law that a citizen of this country under the mandate of Article 21 of the Constitution of India does not only have a right for animal existence but a reasonable existence. Health service forms a very important part of existence of an individual. Government servants are provided by the benefit of medical aid as within the limited financial emoluments available to them they would be unable to meet large medical expenses which may arise in certain exigencies. The chances of seeking such medical aid increases as the years go by and a person gets older. In fact the better medical facility back-up is required at that age. It is in these circumstances that a retired Government Officer is entitled to the benefit of the CGHS as he cannot be expected to have large financial capacity after retirement to meet exigencies of medical problems. There is thus force in the contention of learned counsel for the petitioner that the material factor is status of the person as the retired pensioner and not merely being the card holder of the CGHS scheme on payment of some nominal amount. This has also to be appreciated taking into consideration the fact that certain areas are not CGHS areas. After retirement a Government Servant may reside in different parts of the country. It cannot be expected that the Government should discriminate between the officers who happen to stay in one or other parts of the country. It is the duty of the Government to make available proper health facilities and the officer should not suffer by reason of the failure of the Government to extend CGHS scheme to all areas of the country.

       I am thus of the considered view that the petitioner cannot be discriminated against merely because he is not a member of the CGHS scheme as he is staying in a non-CGHS area. The petitioner had made claim in August, 1998 and on the basis of the fact stated therein ex post facto approval could have been granted but instead the claim of the petitioner was rejected. The subsequent letter of the petitioner dated 1.6.99 to make him a card holder has also not evoked any response. The right to appropriate medical assistance cannot be denied on technicalities and flimsy grounds. The petitioner has spent almost 2/3rd of his retiral benefits on the treatment of his wife and himself and that too in a Government recognised hospital for heart diseases. It would be extremely unfair and unjust to deny the petitioner the reimbursement in respect of the same.

SANJAY KISHAN KAUL

( 1 ) THE rights of an ex-Government employee to claim reimbursement of medical expenses in the absence of being a member of the CGHS Scheme has given rise to the present writ petition.

( 2 ) THE petitioner retired from service as Principal chief Conservator of Forests of Mizoram on 30. 9. 1990 and thus served the Indian Forest Services in the Union territory cadre till that date. The petitioner started residing in Bareilly, U. P. after his retirement. The petitioner and his wife both suffered from heart ailments and ultimately approached the Escorts Heart institute, New Delhi which is an institute approved under the Central Government Health Scheme (CGHS) for treating cardiac related diseases. It is stated in the writ petition that in view of the urgency involved, the petitioner without seeking prior approval got his wife admitted for implantation of pace marker which was done on 7. 7. 97. Soon thereafter the petitioner also underwent a by-pass surgery on 16. 7. 97. The petitioner paid for both the services and stated that the amount for the same constituted more than 2/3rd of his retiral benefits.

( 3 ) THE petitioner claimed the reimbursement of the amounts spent of Rs. 1,14,798/- for his wife and rs. 1,80,490/- for himself in August, 1998 and the claim of the petitioner was rejected on 7. 12. 98. The petitioner made another representation on 1. 6. 99 but to no avail. The petitioner thereafter filed the writ petition.

( 4 ) A reading of the rejection letter dated 7. 12. 98 shows that the only ground on which the petitioner s claim has been rejected is by reason of the fact that the petitioner is not covered under the CGHS rules being not part of the scheme. It is further stated in the letter that retired Central Government employees who reside in non-CGHS areas can make a CGHS card for himself and his dependent family members from the nearest centre where the CGHS is operational.

( 5 ) LEARNED counsel for the petitioner has contended that though earlier while in service petitioner was part of the CGHS scheme but since Bareilly falls in non-CGHS area he did not opt to continue as a member of cghs. Learned counsel for the petitioner has referred to a subsequent letter dated 1. 6. 99 addressed by the petitioner to the Ministry of Health requesting for becoming a member of the CGHS to which also there has been no response.

( 6 ) LEARNED counsel for the petitioner has contended that the refusal of the respondents to reimburse the expenses on the ground that he is not a card holder of cghs is violative of Article 14 and 21 of the constitution of India. Learned counsel for the petitioner had contended that it is the status as a central Government pensioner which is the material fact and not being a CGHS card holder specially since the petitioner was residing in Bareilly which is outside the CGHS area. Learned counsel also emphasised on the fact that the medical treatment was at Escorts which is a recognised institute by the Government of India for such treatment.

( 7 ) IN the counter affidavit filed by the respondents it is admitted that Bareilly is not covered by the CGHS scheme and it is stated that since the petitioner had opted for not becoming the beneficiary of CGHS scheme after retirement, he was not entitled to the benefits. The was so stated on the basis that the petitioner had not made payments for becoming beneficiary of the CGHS scheme.

( 8 ) IT is now settled law that a citizen of this country under the mandate of Article 21 of the constitution of India does not only have a right for animal existence but a reasonable existence. Health service forms a very important part of existence of an individual. Government servants are provided the benefit of medical aid as within the limited financial emoluments available to them they would be unable to meet large medical expenses which may arise in certain exigencies. The chances of seeking such medical aid increases as the years go by and a person gets older.














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