Summary
The Supreme Court directed payment of the remaining Rs. 4,99,555 medical reimbursement to a retired CGHS beneficiary treated in genuine emergencies at non-empanelled hospitals, expressly confining that monetary decision to his case. Actual treatment supported by certified records could not be rejected merely on technical grounds or absence of empanelment. The Court also directed committees for pensioners’ claims and grievance redressal, and reimbursement within one month of submission of the relevant claim papers.
Issues
- Whether emergency treatment at non-empanelled hospitals justified denial of the pensioner’s remaining reimbursement.
- What measures should address delays and grievances in pensioners’ medical claims.
Held
- Authorities must verify that treatment actually occurred through records certified by the treating doctors or hospitals. A claim cannot be rejected merely because the hospital is absent from the approved list or on technical grounds once the treatment is established. (¶ 13)
- The petitioner had received genuine emergency treatment when no alternative was available. Survival took precedence over prior permission and empanelment requirements. The direction to pay the remaining Rs. 4,99,555 was expressly confined to this case. (¶¶ 11, 14, 15)
- The Ministry was directed to provide a Secretary-level High Powered Committee meeting monthly for quick disposal of pensioners’ claims and a grievance committee comprising the specified senior medical officials and a specialist, ensuring disposal within seven days. The committees were to be formed expeditiously; reimbursement was to occur within one month after submission of the relevant papers. (¶ 16)
Result
Petition disposed of with a direction to pay the outstanding Rs. 4,99,555, expressly confined to this case, and directions for committees, prompt grievance disposal and reimbursement within one month after submission of relevant claim papers.