IMPORTANT POINT
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.

JUDGMENT :

K.V.JAYAKUMAR, J .

The present O.P.(CAT) is preferred against the order of the Central Administrative Tribunal in O.A. No.530 of 2017 dated 19.09.2018, whereby the following claims of the petitioner have been allowed by the Tribunal.

“i. Quash Annexure A6 letter issued by the 2^nd respondent.

ii. Declare that the applicant herein is fully entitled to be reimbursed the entire amount of medical expenses sustained by him for the Renal Transplantation of his wife, Smt.K.S.Beena.

iii. Direct the respondents to sanction and disburse the entire medical expenses incurred by the applicant for the Renal Transplantation of his wife Smt.K.S.Beena at Amritha Institute of Medical Science & Research Centre, Edappally, Kochi, as per the medical bills submitted by him.

iv. To grant such other reliefs as may be prayed for and the court may deem fit to grant, and

v. Grant the cost of this Original Application.”

2. Facts of the case in brief are as follows: Wife of the respondent/petitioner Sri.M.B.Viswanathan Nair was a Kidney patient. She was taken to Amrita Institute of Medical Sciences and Research Centre, Edappally, on 22.02.2013 on account of renal failure. She underwent kidney transplantation in Amrita Hospital. Thereafter, the respondent/petitioner, submitted all the bills for claiming refund of medical expenses incurred in connection with the treatment for an amount of Rs.8,21,966/-.

3. The contention of the petitioners was that the employees of Central Government and their family members are permitted to avail medical facilities in any of the hospitals recognized by the State Government subject to the condition that they will be reimbursed the medical expenditure at rates fixed by the Government under CGHS Rules/CS (MA) Rules, 1944 or the actual expenses incurred, whichever is less. The approved package of Central Government Health Scheme (CGHS) for the treatment of Renal Transplantation & Dialysis is only Rs.1,43,000/- and which has been sanctioned.

4. The tribunal noticing the rival contentions of the counsel for the parties and allowed the claim, placing reliance on the decision reported in State of Punjab and Others Vs. Mohinder Singh Chawla (JT 1997 (1) SC 4160), Surjit Singh Vs. State of Punjab (AIR 2006 SC 1388) and Narendar Pal Singh Vs. Union of India and Others (1998 Lab IC 1861) allowed the full reimbursement to the claimant. Impugning the said order the Union of India and its officers preferred this O.P.(CAT).

5. The sole question involved in this case is that whether a claim of reimbursement be denied to Government employee or his family members on the grounds that the hospital in which he was treated is not recognized by the Government or the amount claimed is more than the package? In Shiva Kant Jha Vs. Union of India (2018 KHC 6285) the Honourable Apex Court held that right to medical claim cannot be denied merely because name of the hospital is not included in the Government Order. It was observed that real test must be the factum of treatment supported by records duly certified by Doctors/hospitals concerned. It was made clear that survival of the person is the prime consideration, and the law does not require that prior permission has to be taken in such situation. Paragraph Nos.13, 14 and 15 of the Shiva Kant Jha’s case (supra) are extracted hereunder:

“13) 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. It is acceptable to common sense, that 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