Kerala High Court
Govindankutty P vs Union Of India on 8 April, 2025
Author: Amit Rawal
Bench: Amit Rawal
OP(CAT) No.131/2023
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IN THE HIGH COURT OF KERALA AT ERNAKULAM
PRESENT
THE HONOURABLE MR. JUSTICE AMIT RAWAL
&
THE HONOURABLE MR.JUSTICE K. V. JAYAKUMAR
TUESDAY, THE 8TH DAY OF APRIL 2025 / 18TH CHAITHRA, 1947
OP (CAT) NO. 131 OF 2023
AGAINST THE ORDER DATED 05.07.2023 IN OA NO.1 OF 2020 OF
CENTRAL ADMINISTRATIVE TRIBUNAL, ERNAKULAM BENCH
PETITIONER:
GOVINDANKUTTY P., AGED 61 YEARS, S/O. NARAYANAN NAIR,
RETIRED POSTAL ASSISTANT, WADAKKNCHERRY, THRISSUR POSTAL
DIVISION, RESIDING AT ‘SAIKRIPA', CHIRAMANANGAD
P.O., THRISSUR DISTRICT, PIN - 680604
BY ADVS.
VIVEK A.V.
SREEHARI V.S.
ARCHANA VIJAYAN
AMMU M.(K/2056/2020)
RESPONDENTS:
1 UNION OF INDIA, REPRESENTED BY THE SECRETARY TO THE
GOVERNMENT, DEPARTMENT OF POSTS, MINISTRY OF
COMMUNICATIONS, GOVERNMENT OF INDIA, NEW DELHI - 110001
2 THE CHIEF POSTMASTER GENERAL,
KERALA CIRCLE, THIRUVANANTHAPURAM, PIN - 695033
3 THE POSTMASTER GENERAL,
CENTRAL REGION, KOCHI, PIN - 682020
4 THE SENIOR SUPERINTENDENT OF POST OFFICES,
THRISSUR POSTAL DIVISION, THRISSUR P.O., THRISSUR
DISTRICT, PIN - 680001
THIS OP (CAT) HAVING COME UP FOR ADMISSION ON 08.04.2025, THE COURT
ON THE SAME DAY DELIVERED THE FOLLOWING:
OP(CAT) No.131/2023
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JUDGMENT
K. V. JAYAKUMAR, J.
Impugning the order of the Central Administrative Tribunal in
O.A.No.1/2020 dated 05.07.2023, petitioner/applicant preferred this
OP(CAT). The issue under consideration before the Tribunal was whether
the distinction drawn between the serving Government employees and
pensioners in respect of medical reimbursement is violative of rights relating
to equity and right to life guaranteed by the Constitution of India.
2. The facts in narrow compass are as follows:
The petitioner/applicant, a retired Postal Assistant from Thrissur
Postal Division, superannuated from service on 31.07.2017. According to
the respondents, since the petitioner/applicant staying in an area outside
the ambit of Central Services (Medical Attendants) Rules, 1944 [CS(MA)
Rules], he can only avail Fixed Medical Allowance (FMA) in lieu of Central
Government Health Service Scheme (CGHS). On 21.04.2018 due to a
medical emergency of massive cardiac arrest, petitioner/applicant was taken
to Unity Hospital and AIMS hospital. Later, the applicant submitted medical
reimbursement claim for an amount of Rs.3,66,391/-. The claim of the
petitioner/applicant was not considered and through Annexure-A1, letter it
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was intimated that, retired Central Government employees do not come
under the purview of CS(MA) Rules and hence not eligible for medical
reimbursement. The petitioner/applicant approached the Central
Administrative Tribunal. The Tribunal vide order dated 05.07.2023
dismissed the original application. Aggrieved by the same, petitioner
approached this Court.
3. The contention of the petitioner/applicant before the
Tribunal and before us is that, in terms of the policy guidelines and the
decisions rendered by the High Court and the Apex Court, the petitioner is
entitled to reimbursement of the entire medical claim for treatment
undergone in the hospitals empanelled for such treatment. The learned
counsel for the petitioner submitted that, Unity hospital is an empanelled
hospital of Government of Kerala and it comes under the definition of
Government hospital for the purpose of treatment of Government servants
in terms of Rule 2B(d) of the CS(MA) Rules. It was further submitted that
since Unity hospital was the nearest hospital, therefore, the applicant was
immediately rushed to that hospital to meet the contingency.
4. The respondents opposed the claim of the applicant and
submitted that, after superannuation of the petitioner/applicant, was paid
the FMA along with his monthly pension. It is further submitted that,
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retired Central Government employees do not come under the purview of
CS(MA) Rules and are not eligible for medical reimbursement, much less
Unity hospital is not an empanelled hospital in the approved list of
Government of Kerala.
5. We have heard the rival contentions of the counsel for
the parties and appraised the paper book.
6. The Tribunal, noticing the rival contentions of the
counsel for the parties, dismissed the claim, directing the 1 st respondent to
make amendments to the Scheme to extend the benefits of the CGHS to
those who have been granted provisional pension as well. Aggrieved by the
order of the Central Administrative Tribunal, the petitioner/applicant
preferred this O.P(CAT).
7. The issue involved in this case is no longer res integra in
view of the dictum laid down by the Honourable Apex Court in Shiva Kant
Jha Vs. Union of India (2018 KHC 6285).
8. The short question involved in this case is whether the
reimbursement of a retired/serving Government employee or his family
members can be rejected on the ground that he was treated in a hospital not
approved by the State Government? In Shiva Kant Jha's case (supra), the
Honourable Apex Court held that the right to medical claim cannot be
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denied merely because name of the hospital is not included in the
Government Order. It was observed that, real test must be the factum of
treatment supported by records duly certified by Doctors/hospitals
concerned. It was made clear that, survival of the person is the prime
consideration, and the law does not require that prior permission has to be
taken in such situation and emphasized that, Government employee, during
his life time or after his retirement, is entitled to get the benefit of the
medical facilities. Paragraph Nos.13, 14 and 16 of the Shiva Kant Jha's
case (supra) are extracted hereunder:
"13) It is a settled legal position that the
Government employee during his life time 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,
who is well versed and expert both on academic
qualification and experience gained. Very little scope is left
to the patient or his relative to decide as to the manner in
which the ailment should be treated. Speciality Hospitals
are established for treatment of specified ailments and
services of Doctors specialized in a discipline are availed by
patients only to ensure proper, required and safe
treatment. Can it be said that taking treatment in Speciality
Hospital by itself would deprive a person to claim
reimbursement solely on the ground that the said Hospital
is not included in the Government Order. The right to
medical claim cannot be denied merely because the name
of the hospital is not included in the Government Order.
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The real test must be the factum of treatment. Before any
medical claim is honoured, the authorities are bound to
ensure as to whether the claimant had actually taken
treatment and the factum of treatment is supported by
records duly certified by Doctors/Hospitals concerned.
Once, it is established, the claim cannot be denied on
technical grounds. Clearly, in the present case, by taking a
very inhuman approach, the officials of the CGHS have
denied the grant of medical reimbursement in full to the
petitioner forcing him to approach this Court.
14) This is hardly a satisfactory state of affairs. The relevant
authorities are required to be more responsive and cannot
in a mechanical manner deprive an employee of his
legitimate reimbursement. The Central Government
Health Scheme (CGHS) was propounded with a purpose of
providing health facility scheme to the central government
employees so that they are not left without medical care
after retirement. It was in furtherance of the object of a
welfare State, which must provide for such medical care
that the scheme was brought in force. In the facts of the
present case, it cannot be denied that the writ petitioner
was admitted in the above said hospitals in emergency
conditions. Moreover, the law does not require that prior
permission has to be taken in such situation where the
survival of the person is the prime consideration. The
doctors did his operation and had implanted CRT-D device
and have done so as one essential and timely. Though it is
the claim of the respondent-State that the rates were
exorbitant whereas the rates charged for such facility shall
be only at the CGHS rates and that too after following a
proper procedure given in the Circulars issued on time to
time by the concerned Ministry, it also cannot be denied
that the petitioner was taken to hospital under emergency
conditions for survival of his life which requirement was
above the sanctions and treatment in empanelled hospitals.
-------
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16.Further, with regard to the slow and tardy
pace of disposal of MRC by the CGHS in case of pensioner
beneficiaries and the unnecessary harassment meted out to
pensioners who are senior citizens, affecting them
mentally, physically and financially, we are of the opinion
that all such claims shall be attended by a Secretary level
High Powered Committee in the concerned Ministry which
shall meet every month for quick disposal of such cases.
We, hereby, direct the concerned Ministry to device a
Committee for grievance redressal of the retired pensioners
consisting of Special Directorate General, Directorate
General, 2 (two) Additional Directors and 1 (one) Specialist
in the field which shall ensure timely and hassle free
disposal of the claims within a period of 7 (seven) days. We
further direct the concerned Ministry to take steps to form
the Committee as expeditiously as possible. Further, the
above exercise would be futile if the delay occasioned at the
very initial stage, i.e., after submitting the relevant claim
papers to the CMO - I/C, therefore, we are of the opinion
that there shall be a timeframe for finalization and
disbursement of the claim amounts of pensioners. In this
view, we are of the opinion that after submitting the
relevant papers for claim by a pensioner, the same shall be
reimbursed within a period of 1 (one) month."
9. The Apex Court in Surjit Singh v. State of Punjab
and Others [AIR 1996 SC 1388] and Paschim Banga Khet Mazdoor
Samity v. State of WB [(1996)4 SCC 37] observed that the right to self
preservation and right to life is of paramount importance and a welfare State
is obliged to provide medical assistance to the employees. Relying on Shiva
Kant Jha's case (supra) this Court observed in Prasad K.G. v. State of
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Kerala [2023 KHC 664] that the right to health is inextricably linked to
the right to life protected under Article 21 of the Constitution of India.
In view of the law declared by the Honourable Apex Court in
various judicial pronouncements, we are of the considered view that,
O.P.(CAT) is to be allowed. Therefore, the original application is allowed.
The impugned order of the Central Administrative Tribunal is set aside. The
2nd respondent shall pass appropriate orders to reimburse the petitioner
within two months from the date of receipt of copy of this judgment.
Sd/-
AMIT RAWAL
JUDGE
Sd/-
K. V. JAYAKUMAR
JUDGE
Sbna/
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APPENDIX OF OP (CAT) 131/2023
PETITIONER ANNEXURES
Annexure A1 A TRUE COPY OF THE ORDER NO. AP/13-526/18 DATED
11.09.2018 ISSUED BY THE 2ND RESPONDENT.
Annexure A2 A TRUE COPY OF THE REPRESENTATION DATED
14.07.2018 ALONG WITH THE APPLICATION FOR
MEDICAL CLAIMS IN PROPER FORMAT FOR TREATMENT
IN BOTH THE HOSPITALS , SUBMITTED BY THW
APPLICANT TO THE 2ND RESPONDENT
Annexure A3 A TRUE COPY OF THE ORDER NO. A&P/7-1/2012(PT)
DATED 04.10.2018 ISSUED BY THE 3RD RESPONDENT
TO THE 4TH RESPONDENT
Annexure A4 A TRUE COPY OF THE ORDER NO. C/1577 DATED
11.10.2018 ISSUED BY THE 4TH RESPONDENT TO THE
APPLICANT
Annexure A5 A TRUE COPY OF THE REPRESENTATION DATED
07.01.2019 SUBMITTED BY THE APPLICANT TO THE
SECRETARY, DEPARTMENT OF POSTS, MINISTRY OF
COMMUNICATIONS
Annexure R1 TRUE COPY OF THE EXTRACT OF RULE-2 OF THE
CS( MEDICAL ATTENDANCE) RULES 1944
Annexure R2 TRUE COPY OF THE ORDER DATED 09.10.2017 IN
Annexure R3 TRUE COPY OF THE HON'BLE APEX COURT JUDGMENT
DATED 13.04.2018 IN THE CASE OF SHIVA KANT JHA
VERSUS UNION OF INDIA
Annexure A6 A TRUE COPY OF THE O.M. NO. S. 14025/23/2013-
MS.EHSS DATED 29.09.2016 ISSUED ON BEHALF OF
THE MINISTRY OF HEALTH AND FAMILY WELFARE
Annexure A7 A TRUE COPY OF THE O.M. NO. S.11011/14/2016-
EHSS DATED 04.11.2016 ISSUED ON BEHALF OF THE
1ST RESPONDENT
Annexure A8 A TRUE COPY OF THE OM S.14025/30/2022-EHS DATED
12.09.2022 ISSUED ON BEHALF OF THE 1ST
RESPONDENT.
Exhibit P1 A TRUE COPY OF THE FINAL ORDER DATED 05.07.2023
IN O.A. NO. 01/2020 OF THE HON'BLE CENTRAL
ADMINISTRATIVE TRIBUNAL, ERNAKULAM
Exhibit P2 A TRUE COPY OF THE O.A. NO. 01/2020 FILED BY
THE PETITIONER BEFORE THE HON'BLE CENTRAL
ADMINISTRATIVE TRIBUNAL, ERNAKULAM BENCH ALONG
WITH ANNEXURES
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Exhibit P3 A TRUE COPY OF THE REPLY STATEMENT DATED
11.09.2020 FILED BY THE RESPONDENTS IN O.A.
01/2020 ALONG WITH ANNEXURES
Exhibit P4 A TRUE COPY OF THE REJOINDER DATED 13.03.2023
FILED IN O.A. NO. 01/2020 ALONG WITH ANNEXURES
