Judicial Analysis Court Copy Headnote Facts Arguments Court observation

2026 Supreme(Online)(CAT) 5295

CENTRAL ADMINISTRATIVE TRIBUNAL
Om Prakash VII, Judicial Member
Mahesh Chandra Pachauri – Appellant
Versus
Union Of India – Respondent
Original Application No. 1099 of 2017

Advocates:
For the Appellants/Petitioners: Anil Kumar Singh
For the Respondents: Ajay Kumar Rai

Medical reimbursement for life-threatening illnesses cannot be denied solely due to the lack of prior hospital approval or technical procedural lapses where the factum of treatment is established and the medical necessity is evident, adhering to the principle of welfare-based health care for employees.

Headnote:(A) Railway Medical Rules - Medical Reimbursement - Claim for expenses incurred in private hospital without prior permission - Patient suffering from life-threatening cancer - Held, the right to medical reimbursement cannot be denied on technical grounds when treatment is legitimate - Emergency nature of chronic illness necessitates continuous treatment - Failure to obtain recurring permission does not disentitle applicant from reimbursement when treatment is medically necessary and genuine.

(B) Administrative Law - Right to Health - Medical reimbursement is a welfare right - Authorities should not adopt a mechanical or inhuman approach in processing legitimate claims for medical care for retired employees.

Facts of the case:
The applicant, a retired railway employee, sought reimbursement for medical expenses incurred for his wife’s cancer treatment at a private hospital. Despite initial referrals, subsequent treatment at the same specialized hospital was denied full reimbursement by the respondents on the ground that prior permission was not obtained for the extended period. The applicant challenged the rejection order, citing the emergency nature of the illness and the necessity of continued care.

Findings of Court:
The Court held that the respondents were arbitrary in denying reimbursement for the applicant's treatment costs. The Court emphasized that once a serious illness like cancer is recognized, the continuity of treatment at a specialized facility is a medical necessity, and technical requirements for prior permissions cannot override the fundamental right to health care, especially when part of the treatment had already been acknowledged and reimbursed.

Issues: Whether the denial of medical reimbursement for treatment in a private hospital without prior permission in a case of chronic life-threatening illness is arbitrary and unjustified.

Ratio Decidendi: In emergency or life-threatening situations, medical reimbursement cannot be denied on technical grounds like lack of prior permission, as the decision for treatment vests with medical experts and the state has a welfare obligation to provide care for its employees.

Result: Original Application allowed; impugned order quashed.

Table of Content
1. summary of facts concerning medical treatment reimbursement claims for retirees. (Para 1 , 2 , 3 , 4)
2. contentions regarding whether cancer treatment constitutes an emergency without prior hospital permission. (Para 5 , 6 , 7)
3. court’s reasoning on medical necessity overriding technical procedural requirements for reimbursement. (Para 8 , 9 , 10 , 11 , 12 , 13 , 14)

O R D E R

The present O.A has been filed by the applicant under section 19 of Administrative Tribunal Act, 1985 seeking following reliefs:-

(i) Hon’ble Tribunal court may kindly be pleased to quash the order dated 08.03.2017.

(ii) Hon’ble Tribunal court may kindly be pleased to direct the respondents to reimburse the Rs. 5,22,235 spent by the applicant in the treatment of his wife in Dharmsheela Hospital New Delhi in between 10.06.2014 to 31.09.2016 in accordance with Indian Railway Establishment Code Vol-1, Chapter 6, Section 647 (1) note (2) forthwith with interest.

(iii) Issue other and further order or directions; which this Hon’ble Court may deem fit and proper in the facts and circumstances of the case.

(iv) Award of the cost of the OA to the applicant”.

2. The brief facts of the case are that the applicant was posted as Junior Engineer (Works) at Railway Station Bad, North Central Railway, Agra, and retired on 31.10.2014. During his tenure, his wife fell seriously ill and upon medical investigation, was diagnosed with breast cancer. Due to the emergent nature of the illness, the applicant, without obtaining prior permission from the Railway Medical Officer, admitted his wife to a private hospital where she underwent treatment and surgery. However, certain medicines were provided by the Divisional Medical Officer and the respondents also reimbursed an amount of approximately Rs. 27,000/- towards her treatment. Subsequently, it was found that the cancer had spread to her throat and lungs. Thereafter, the applicant got his wife treated at Railway Hospital, Mathura, but as her condition did not improve, she was referred by the Railway doctors to Central Hospital, New Delhi, and thereafter to Dharmshila Cancer Hospital, New Delhi. When the condition of the applicant’s wife stabilized, the applicant submitted a representation dated 25.03.2015 to respondent No. 4, enclosing all medical bills incurred for her treatment. He also submitted another representation dated 14.05.2015. Till date, the applicant had incurred expenses amounting to Rs. 3,61,758/- on her treatment. Thereafter, he submitted another representation dated 19.10.2016 along with additional bills. Unfortunately, the applicant’s wife subsequently expired. As his representations remained undecided, the applicant filed Original Application No. 1342 of 2016, which was disposed of vide order dated 21.01.2016 with a direction to the respondents to decide his representation by passing a reasoned and speaking order. Upon non-compliance with the said order, the applicant filed Contempt Petition No. 82 of 2017. In compliance with the Tribunal’s order dated 21.01.2016, the respondents passed the impugned order dated 08.03.2017. Aggrieved thereby, the applicant has filed the present Original Application.

3. Per contra, learned counsel for the respondents has filed counter affidavit wherein it has been stated that the applicant’s wife, Smt. Sudha Pachauri, was initially referred by the Central Hospital, NR/NDLS, to Dharmshila Hospital, New Delhi on 10.06.2014, where she was treated and discharged on the same day. Thereafter, she continued her treatment at Dharmshila Hospital on her own, without consulting the Railway Hospital and without obtaining prior permission or informing the competent Railway medical authorities. Since the treatment in the private hospital was taken without prior approval, only a limited amount of Rs. 24,510/- was reimbursed on 27.06.2017 on a sympathetic basis, covering the expenses incurred during the referred treatment. The remaining expenses were not reimbursed as th

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2026 Supreme(Online)(CAT) 5295

CENTRAL ADMINISTRATIVE TRIBUNALOm Prakash VII, Judicial MemberMahesh Chandra Pachauri – AppellantVersusUnion Of India – RespondentOriginal Application No. 1099 of 2017

CENTRAL ADMINISTRATIVE TRIBUNAL
Om Prakash VII, Judicial Member
Mahesh Chandra Pachauri – Appellant
Versus
Union Of India – Respondent
Original Application No. 1099 of 2017