Sushma Ral vs Union Of India & Ors.

The applicant has approached this Tribunal under Section 19 of the Administrative Tribunals Act, 1985, seeking quashing of the impugned order dated 09.06.2025 and a direction to the respondents to reimburse her medical expenses amounting to Rs. 3,96,145/-, along with interest. The reliefs prayed for by the applicant are as under:-

The brief facts of the case are that the applicant is the widow of Late Dinesh Chandra Rai, who was working as a Stenographer at Akashvani, Gorakhpur, and died on 22.05.2021 due to COVID-19. During his illness, he underwent treatment at different hospitals, including BRD Medical College, Gorakhpur, where he was admitted on 16.05.2021 and remained under treatment until his death. The applicant submitted medical bills for reimbursement of the expenses incurred during his treatment. As the claim was not settled, she sought information under the Right to Information Act, 2005, and thereafter pursued the matter through representations and a grievance petition. Vide order dated 14.02.2025, the respondents directed examination of the relevant medical documents. However, by the impugned order dated 09.06.2025, the respondents rejected the claim on the ground that the medical expenses pertained to a period after the retirement date of the applicant’s husband, i.e., 30.04.2021. Aggrieved thereby, the applicant has approached this Tribunal.

Learned counsel for the applicant submitted that the applicant’s husband contracted COVID-19 while in service and continued to receive treatment without any break until his death on 22.05.2021. It was contended that the subsequent treatment was a continuation of the illness contracted during service and, therefore, the medical expenses could not have been rejected merely on the ground that the treatment continued beyond the date of retirement. Learned counsel further submitted that the respondents had failed to properly examine the medical bills and supporting documents, despite the applicant’s repeated representations. Reliance was placed on the judgment of the Hon’ble Supreme Court in State of Punjab & Others v. Mohinder Singh Chawla, (1997) 2 SCC 83, to contend that the State has an obligation to ensure the health of its employees and that the applicant’s genuine medical reimbursement claim deserves consideration in accordance with law.

Per contra, learned counsel for the respondents submitted that the impugned order has been passed in accordance with the applicable rules governing medical attendance and reimbursement. It was contended that the applicant’s husband retired from service on superannuation on 30.04.2021 and had opted for CGHS facilities after retirement. Since the medical treatment in question was undertaken after his retirement, the applicant was not entitled to reimbursement of the said expenses from the respondents under the applicable rules. Learned counsel, therefore, submitted that the Original Application is liable to be dismissed.

In the counter affidavit, the respondents have stated that the pension papers of Late Dinesh Chandra Rai were forwarded to the Pay and Accounts Office, Lucknow, on 12.10.2020, and the PPO was handed over to him on 12.04.2021. It has further been stated that he retired on 30.04.2021 and was admitted to Gorakhpur Chikitsalaya and Research Centre, Gorakhpur, on 07.05.2021, before being referred to BRD Medical College, Gorakhpur, on 16.05.2021, where he died during treatment on 22.05.2021. According to the respondents, an amount of Rs. 722/- towards medical expenses for the period prior to retirement was paid to the applicant on 05.06.2025, whereas the remaining claim of Rs. 3,96,142/- pertained to the post-retirement treatment period from 07.05.2021 to 16.05.2021 and was not paid. The respondents have relied upon The All India Services (Medical Attendance) Rules, 1954, contending that the said Rules apply to members of the service while on duty, on leave or under suspension, and that, after retirement, the applicant’s husband was entitled to avail himself of CGHS facilities. On these grounds, the respondents have justified the rejection of the medical reimbursement claim.

In the rejoinder affidavit, the applicant has reiterated the averments made in the Original Application and denied the contrary assertions made in the counter affidavit. It has been contended that her late husband contracted COVID-19 while in service and that his subsequent hospitalization and treatment were a continuation of the same illness, which ultimately resulted in his death on 22.05.2021. The applicant has further asserted that she had submitted the requisite medical bills and documents, but the respondents failed to trace and process the claim despite repeated representations and proceedings under the Right to Information Act, 2005. It is submitted that the respondents have arbitrarily sanctioned only Rs. 722/- against the genuine medical reimbursement claim of Rs. 3,96,145/-, without properly considering the nature of the illness, continuity of treatment and the circumstances prevailing during the COVID-19 pandemic. The applicant has relied upon the judgments of the Hon’ble Supreme Court in State of Punjab v. Mohinder Singh Chawla, (1997) 2 SCC 83, and Shiva Kant Jha v. Union of India, contending that genuine medical reimbursement claims should not be rejected on hyper-technical grounds and that the right to health is integral to the right to life under Article 21 of the Constitution. It has also been contended that the impugned order dated 09.06.2025 is mechanical, non-speaking and has been passed without proper application of mind or consideration of the relevant medical records and the circumstances of the case. The applicant has, therefore, prayed that the impugned order may be quashed and the respondents be directed to reimburse the admissible medical expenses in accordance with law.

Learned counsel for the applicant has relied upon the Office Memorandum dated 15.09.2011 issued by the Ministry of Health & Family Welfare, Government of India, bearing F. No. D.12011/64/98-CGHS Desk-I/CGHS(P), which is taken on record. It is submitted that the said memorandum specifically provides that expenditure incurred on treatment within three months from the date of retirement may be reimbursed, subject to fulfilment of the prescribed conditions regarding obtaining or applying for a CGHS pensioner card, submission of the requisite documents and payment of the requisite CGHS subscription within the stipulated period. Learned counsel contends that the respondents have rejected the applicant’s genuine medical reimbursement claim merely on the ground that the treatment continued beyond the date of retirement, without properly examining the applicable instructions and the fact that the deceased employee had contracted COVID-19 while in service. It is, therefore, submitted that the impugned order dated 09.06.2025 is unsustainable and deserves to be quashed.

I have heard Shri Vijay Kumar Rai, learned counsel for the applicant, and Shri Vidyapati Tripathi, learned counsel for the respondents, and have carefully perused the pleadings on record and the documents available therein.

The principal issue that arises for consideration is whether the applicant’s claim for reimbursement of medical expenses could have been rejected solely on the ground that the treatment continued after the retirement of her husband, Late Dinesh Chandra Rai, despite the fact that the illness had commenced while he was still in service. In this regard, it is relevant to refer to the Office Memorandum dated 15.09.2011 issued by the Ministry of Health and Family Welfare, Government of India, bearing F. No. D.12011/64/98-CGHS Desk-I/CGHS(P), on the subject “Reimbursement when Pensioners take treatment immediately after Retirement before getting CGHS Cards.” Clause (i) thereof reads as follows:-

The aforesaid provision recognises the admissibility of reimbursement for treatment taken and expenditure incurred within the prescribed three-month grace period after retirement, subject to fulfilment of the conditions specified therein. Therefore, the mere fact that the treatment was taken after retirement cannot, by itself, be treated as a sufficient ground for rejecting the claim without examining the applicability of the aforesaid Office Memorandum and the relevant medical reimbursement rules.

In the present case, the material on record indicates that Late Dinesh Chandra Rai contracted COVID-19 while in service and that his treatment commenced on 27.04.2021. He retired on 30.04.2021. Thereafter, his condition deteriorated, and he was admitted to Gorakhpur Chikitsalaya and Research Centre on 07.05.2021. He was subsequently referred to and admitted to B.R.D. Medical College, Gorakhpur, on 16.05.2021, where he remained under treatment until his death on 22.05.2021. Thus, the treatment and hospitalisation after retirement occurred within the three-month grace period contemplated by the aforesaid Office Memorandum. The respondents have stated that an amount of ₹722/- was paid towards the admissible expenses relating to the period before retirement, whereas the remaining claim was rejected on the ground that the treatment had been taken after retirement. The applicant has claimed reimbursement of ₹3,96,145/-, while the counter affidavit refers to an unpaid amount of ₹3,96,142/-. The discrepancy between these figures, as well as the amount already paid, is required to be reconciled with reference to the original bills and the relevant records.

The legal position concerning reimbursement of medical expenses has also been considered by the Hon’ble Supreme Court in State of Punjab & Others v. Mohinder Singh Chawla & Others, (1997) 2 SCC 83; AIR 1997 SC 1225, decided on 17.12.1996. The judgment recognises the importance of medical facilities and the obligation of the State in relation to the health of its employees, subject to the applicable rules and policy. Further, in Shiva Kant Jha v. Union of India, W.P. (C) No. 694 of 2015, decided on 13.04.2018, reported as 2018 INSC 339; AIR 2018 SC 1975; (2018) 16 SCC 187, the Hon’ble Supreme Court considered medical reimbursement under the Central Government Health Scheme and emphasised that genuine medical claims should not be rejected on merely technical grounds when the genuineness of the treatment is established. The applicability of these principles must, however, be considered in the context of the governing rules and the facts of the individual case.

Applying the aforesaid principles and the Office Memorandum dated 15.09.2011 to the present matter, the impugned order dated 09.06.2025 cannot be sustained merely on the ground that the treatment continued after retirement, without proper consideration of the fact that the illness had commenced during service, the treatment after retirement was undertaken within the prescribed grace period, and the Office Memorandum dated 15.09.2011 specifically addresses reimbursement in such circumstances. The respondents were required to examine the claim in the light of the said Office Memorandum and the relevant medical records, rather than reject it solely on the basis of the date of retirement.

In view of the foregoing discussion, the Original Application is allowed. The impugned order dated 09.06.2025 is hereby quashed and set aside. The respondents/competent authority is directed to pay the amount found admissible towards the applicant’s claim for reimbursement of medical expenses, in accordance with the Office Memorandum dated 15.09.2011 and the applicable rules, along with interest at the rate of 6% per annum, within three months from the date of receipt of a certified copy of this order. There shall be no order as to costs.

All pending miscellaneous applications, if any, stand disposed of accordingly.