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2025 Supreme(Online)(CAT) 12761
CENTRAL ADMINISTRATIVE TRIBUNAL
Mrs. Urmita Datta, sen, Mr. Suchitto Kumar Das, Member (A)
Shri Amson – Appellant
Versus
Union of India – Respondent
OA/351/1293/2023
For the Applicants: Mr. G.B. Kumar, Ms. V. Devi
For the Respondents: Mr. R. Kumar
Pensioners are entitled to medical reimbursement under Central Services (Medical Attendance) Rules, and denial on technical grounds is unjust.
Headnote:(A) Administrative Tribunals Act, 1985 - Central Services (Medical Attendance) Rules, 1944 - Medical reimbursement claims - Claim for reimbursement of medical expenses incurred for treatment of the applicants’ father was rejected on grounds that CS (MA) Rules are not applicable to pensioners - Tribunal held that the denial of reimbursement on this basis is unjust, as judicial precedents affirm pensioners' rights under these rules - Respondents are directed to process reimbursement claim within 90 days. (Paras 12)
(B) Right to Health - The decision by authorities on reimbursement claims must be based on sound discretion and justice, as fundamental human rights include timely medical assistance. The court emphasized that the ultimate decision on treatment lies with medical professionals. (Paras 9)
(C) Issues addressed - Whether a retired employee residing in a non-CGHS area is entitled to medical reimbursement despite having received a fixed medical allowance, and the assessment of eligibility under the CS(MA) rules. (Paras 10, 12)
Findings of Court:
The Tribunal finds substance in the applicants’ claims and holds that the administrative body cannot deny the right to medical reimbursement arbitrarily. (Paras 12)
Result: Application granted with directions for reimbursement.
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| 1. (Para 2 , 3 , 8 , 9 , 10 , 11 , 12 , 13) |
ORDER
Per: Hon’ble Mr. Suchitto Kumar Das, Member (A):
The applicants have approached this Tribunal under Section 19 of the Administrative Tribunals Act , 1985 praying for the following relief(s):
“A) (i) An order be passed setting aside the impugned letter dated 27/03/2023 issued by the office of the respondent No. 8 whereby returned back the medical reimbursement claim of the father of the applicants in original with the remarks as per the Office Memorandum dated 29/09/2016 issued by the respondent No. 1 that Central Services (Medical Attendance) Rules, 1944 are not applicable to pensioners till date and all consequent order/orders passed by the respondent No. 8.
(ii) An order be passed directing the respondent No. 8 to immediately reimburse the applicants an amount of Rs. 29,06,535/- incurred by the father of the applicants on his treatment of Left Temporoparietal Gilobastomia at Apollo Hospital, Chennai with 12% interest in terms of the claim application dated 12.12.2022 submitted before the respondent No. 8 in terms of the Central Service (Medical Attendance) Rules, 1944
B) An order be passed directing the respondent authorities to transmit the original records of the case before this Hon'ble Court so that after perusing the same, conscionable justice may be rendered to the applicant giving them regular appointment.
C) Any other relief or reliefs, order or orders, direction or directions, as your Honour deem fit and proper.”
2. Facts, as narrated by the applicants in the O.A, are as follows:
In the year 1987 the father of the applicants was appointed as Graduate Trained Teacher under the respondent No. 8. and had superannuated from service on 31/07/2018. In October 2019, the father of the applicants developed severe pain in his head and was admitted to G.B. Pant Hospital, Port Blair. After conducting several tests, the attending Doctor was not able to diagnose the reasons for the headache in January 2020. The father of the applicants was taken to Apollo Hospital, Chennai for further advanced treatment. On 09/01/2020 the father of the applicant was discharged from the said hospital which advised to shift the father of the applicants to Apollo Proton Hospital, Chennai for further treatment. On 10/01/2020 the father of the applicants was operated for Left Temporoparietal Glioblastoma and on 11/03/2020 he was discharged from the Apollo Proton Cancer Centre, Chennai. The total expenditure incurred on the treatment of the father of the applicants on and from 09/01/2020 at Apollo Proton Caner Centre, Chennai was Rs. 29,06,535/-. On 08/06/2020 and 15/06/2020 the mother of the applicants being a government servant made two separate applications before the respondent No. 7 for medical reimbursement of the treatment of the father of the applicants. Vide memo dated 12/10/2020 the office of the respondent No. 7 informed the mother of the applicants that the reimbursement of medical claim is not admissible as per the Central Service (Medical Attendance) Rules 1944 and in accordance with the instruction contained in the Govt. of India, Ministry of Health & family Welfare letter dated 29.09.2020. On 27/10/2020 the father of the applicants succumbed to death. On 28.02.2021 the mother of the applicants retired from service. Thereafter the mother of the applicant approached different authorities. Respondent No. 7 vide letter dated 11/10/2022 returned the said medical claim and advised her to pursue the case with the parent department of the father of the applicant i.e. the Directorate of Education As per the advice of the respondent No. 7, on 15/12/2022 the applicant No. 1 submitted the medical reimbursement claim of the father of the applicants to respondent No. 8. Vide letter dated 27/03/2023 issued by the office of the respondent No. 8, the claim of the applicants was rejected with the remarks that Central Services (Medical Attendance) Rules, 1944 are not applicable to pensioners ti
