Central Administrative Tribunal Principal Bench, New Delhi This the 06^th day of February, 2026 Hon’ble Dr. Anand S Khati, Member (A)

AMIR CHANDRA SHARMA, AGED ABOUT 75 YEARS, S/O SH BHAGMAL SHARMA R/O H. NO. B-404 IFS, APARTMENT SECTOR 54, GAWAL PAHARI, GURGAON,- 122003.

...Applicant (By Advocate: Ms. Geetanjali Mohan)

Versus

1. UNION OF INDIA, THROUGH SECRETARY, M/O HEALTH AND FAMILY WELFARE, 545-A, NIRMAN BHAWAN, NEW DELHI-110011.

2. THE DIRECTOR CGHS M/O HEALTH AND FAMILY WELFARE, 545-A, NIRMAN BHAWAN, NEW DELHI-

110011.

3. ADDITIONAL DIRECTOR M/O HEALTH AND FAMILY WELFARE, SOUTH ZONE CGHS WELLNESS CENTRE BUILDING, SECTOR-8, R.K.

PURAM, NEW DELHI.

...Respondents (By Advocate: Mr. Jalaj Agarwal)

ORDER (ORAL)

Hon’ble Dr. Anand S Khati, Member (A)

In the present Original Application, filed under Section 19 of the Administrative Tribunals Act, 1985, the applicant has prayed for the following relief(s):

“a) Direct the Respondents to reimburse the balance amount of Rs. 4,19,750/- along with 12% interest from October 2021 till the actual date of payment in view of the law laid down by the Apex court and Delhi High Court within 15 days from the date of the order. 1 b) Pass such other and further order which this Hon'ble Tribunal may deem fit and proper in the facts and circumstances of the present original application.”

2. Highlighting the facts of the case, learned counsel for the applicant submits that the applicant is a retired IPS officer of the 1965 batch. His wife, Mrs. Naina Sharma, is a CGHS beneficiary by virtue of being his spouse and is entitled to medical benefits under the Central Government Health Scheme of the Ministry of Health and Family Welfare, Government of India. She submits that in August 2021, the wife of the applicant suffered a sudden medical emergency at her residence on 22.08.2021, requiring immediate hospitalization. In view of the emergent condition, she was taken to Fortis Hospital, Gurgaon, where she remained admitted from 22.08.2021 to 27.08.2021. Fortis Hospital raised a bill of ₹4,66,000/-, which was paid at the time of treatment. The treating doctor issued a certificate certifying that she was brought to the hospital under emergency conditions. In September 2021, the applicant submitted a claim for reimbursement along with all requisite medical documents and the emergency certificate to CGHS Wellness Centre No. 92, Sector-55, Gurgaon. The claim was forwarded to CGHS Headquarters on 15.09.2021 for processing. Thereafter, without any prior intimation or communication, an amount of ₹46,276/- was credited to the applicant’s bank account on 18.10.2021 against the total claim of ₹4,66,000/-. No reasons were assigned for restricting the reimbursement to the said amount, nor was any speaking order issued by the considered authority. Aggrieved by the arbitrary and unexplained partial reimbursement, the applicant preferred an appeal dated 23.07.2022 to the Secretary, Ministry of Health and Family Welfare, seeking reconsideration of his claim in accordance with CGHS rules. The said appeal, as well as a subsequent reminder dated 21.12.2022, remained unanswered. The applicant submits that as per CGHS Circular dated 16.06.2021, prior referral or permission from a CGHS Wellness Centre is not required in cases of medical emergencies. She further submits that the actual bill submitted by the applicant reimbursable is Rs. 3,55,106.37/- out of which Rs. 46,250/- has been paid and the remaining amount is still payable.

3. Learned counsel for the applicant relies upon the judgment of the Hon’ble Supreme Court in Shiva Kant Jha v. Union of India (2018) 16 SCC 187, highlighting para 17, which reads as under:

“17. It is a settled legal position that the government employee during his lifetime 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