Union Of India vs M.B.Viswanathan Nair
2025 Latest Caselaw 3576 Ker

Kerala High Court

Union Of India vs M.B.Viswanathan Nair on 3 February, 2025

Author: Amit Rawal

Bench: Amit Rawal

               IN THE HIGH COURT OF KERALA AT ERNAKULAM

                               PRESENT

                THE HONOURABLE MR. JUSTICE AMIT RAWAL

                                   &

              THE HONOURABLE MR.JUSTICE K. V. JAYAKUMAR

        MONDAY, THE 3RD DAY OF FEBRUARY 2025 / 14TH MAGHA, 1946

                       OP (CAT) NO. 147 OF 2019

        AGAINST THE ORDER DATED 19.09.2018 IN OA NO.530 OF 2017 OF

CENTRAL ADMINISTRATIVE TRIBUNAL, ERNAKULAM BENCH

PETITIONERS/RESPONDENTS IN O.A.:

    1       UNION OF INDIA
            REPRESENTED BY THE SECRETARY TO THE GOVERNMENT OF
            INDIA, MINISTRY OF COMMUNICATIONS AND IT DEPARTMENT OF
            POSTS, GOVERNMENT OF INDIA,
            NEW DELHI-110001.

    2       THE CHIEF POSTMASTER GENERAL,
            DEPARTMENT OF POSTS KERALA CIRCLE, THIRUVANANTHAPURAM-
            695033.

    3       THE DIRECTOR OF ACCOUNTS (POSTALS)
            KERALA CIRCLE, IV FLOOR GPO COMPLEX,
            THIRUVANANTHAPURAM-695001.

    4       THE POST MASTER GENERAL,
            DEPARTMENT OF POSTS, CENTRAL REGION, COCHIN-20.

    5       THE SENIOR SUPERINTENDENT OF POST OFFICES,
            ERNAKULAM POSTAL DIVISION, COCHIN-682011.


            BY ADV
            T.C. KRISHNA DSGI (IN-CHARGE)


RESPONDENTS/APPLICANT IN O.A.:

            M.B.VISWANATHAN NAIR
            AGED 53 YEARS
            S/O. LATE V BALAKRISHNAN NAIR, AGED 53 YEARS,
            POSTAL ASSISTANT,KERALA CIRCLE STAMP DEPOT,
 OP (CAT) NO. 147 OF 2019           -2-

                                                       2025:KER:12092

            KADAVANTHRA COCHIN, RESIDING AT MANAKUDIYIL
            HOUSE, VADAPADY P.O, PUTHENCRUZ, ERNAKULAM-
            682308.


            BY ADV
            SMT.REKHA VASUDEVAN


     THIS     OP     (CAT)    HAVING      BEEN   FINALLY   HEARD    ON
03.02.2025,    THE    COURT   ON    THE   SAME   DAY   DELIVERED   THE
FOLLOWING:
 OP (CAT) NO. 147 OF 2019          -3-

                                                             2025:KER:12092


                            JUDGMENT

K.V.JAYAKUMAR, J.

The present O.P.(CAT) is preferred against the

order of the Central Administrative Tribunal in O.A.

No.530 of 2017 dated 19.09.2018, whereby the following

claims of the petitioner have been allowed by the

Tribunal.

"i. Quash Annexure A6 letter issued by the 2nd respondent.

ii. Declare that the applicant herein is fully entitled to be reimbursed the entire amount of medical expenses sustained by him for the Renal Transplantation of his wife, Smt.K.S.Beena.

iii. Direct the respondents to sanction and disburse the entire medical expenses incurred by the applicant for the Renal Transplantation of his wife Smt.K.S.Beena at Amritha Institute of Medical Science & Research Centre, Edappally, Kochi, as per the medical bills submitted by him.

iv. To grant such other reliefs as may be prayed for and the court may deem fit to grant, and

v. Grant the cost of this Original

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Application."

2. Facts of the case in brief are as follows:

Wife of the respondent/petitioner Sri.M.B.Viswanathan

Nair was a Kidney patient. She was taken to Amrita

Institute of Medical Sciences and Research Centre,

Edappally, on 22.02.2013 on account of renal failure.

She underwent kidney transplantation in Amrita

Hospital. Thereafter, the respondent/petitioner,

submitted all the bills for claiming refund of medical

expenses incurred in connection with the treatment for

an amount of Rs.8,21,966/-.

3. The contention of the petitioners was

that the employees of Central Government and their

family members are permitted to avail medical facilities

in any of the hospitals recognized by the State

Government subject to the condition that they will be

reimbursed the medical expenditure at rates fixed by the

Government under CGHS Rules/CS (MA) Rules, 1944 or

the actual expenses incurred, whichever is less. The

approved package of Central Government Health

Scheme (CGHS) for the treatment of Renal

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Transplantation & Dialysis is only Rs.1,43,000/- and

which has been sanctioned.

4. The tribunal noticing the rival

contentions of the counsel for the parties and allowed the

claim, placing reliance on the decision reported in State

of Punjab and Others Vs. Mohinder Singh Chawla

(JT 1997 (1) SC 4160), Surjit Singh Vs. State of

Punjab (AIR 2006 SC 1388) and Narendar Pal Singh

Vs. Union of India and Others (1998 Lab IC 1861)

allowed the full reimbursement to the claimant.

Impugning the said order the Union of India and its

officers preferred this O.P.(CAT).

5. The sole question involved in this case is

that whether a claim of reimbursement be denied to

Government employee or his family members on the

grounds that the hospital in which he was treated is not

recognized by the Government or the amount claimed is

more than the package? In Shiva Kant Jha Vs. Union

of India (2018 KHC 6285) the Honourable Apex Court

held that right to medical claim cannot be denied merely

because name of the hospital is not included in the

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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. Paragraph

Nos.13, 14 and 15 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

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Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. 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

2025:KER:12092

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.

15) In the present view of the matter, we are of the considered opinion that the CGHS is responsible for taking care of healthcare needs and well being of the central government employees and pensioners. In the facts and circumstances of the case, we are of opinion that the treatment of the petitioner in non- empanelled hospital was genuine because there was no option left with him at the relevant time. We, therefore, direct the respondent-State to pay the balance amount of Rs. 4,99,555/- to the writ petitioner. We also make it clear that the

said decision is confined to this case only."

6. In Central Provident Fund

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Commissioner, New Delhi and Others Vs.

N.Satheesan and Another (2018(1) KHC 921), the

Division Bench of this Court opined that when the

genuineness of the bill submitted cannot be doubted,

denial of a potion of amount claimed asserting that there

was deviation from the relevant Rules is quite

unjustifiable and illegal.

7. The learned counsel for the

respondent/applicant supported the order of the

Tribunal, per contra, learned Deputy Solicitor General of

India (in-charge), Sri.T.C.Krishna, submitted that the

impugned order of the Tribunal is illegal. Accordingly to

the DSGI (in-charge), the employees of the Central

Government and their family members are permitted to

avail medical facilities in any of the hospitals, recognized

by the State Government.

8. We have heard the rival contentions of

the counsel for the parties and appraised the paper

books.

9. Before further discussions made, it is

suitable to extract the relevant paragraphs of the order

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of the Central Administrative Tribunal. The same reads

as follows:

"9. Heard Smt. Rekha Vasudevan, learned counsel for the applicant and Shri. C.P. Ravikumar, ACGSC, learned counsel for the respondents. Smt. Rekha Vasudevan maintained that there is absolutely no justification for having restricted the sanction to a part of the claim made. Citing the judgment in OP(CAT) No. 167/2017 she drew this Tribunal's attention to the judgment, which held as following:-

"13. When treatment is afforded to those who are entitled to get reimbursement form the empanelled hospitals, no restriction can be imposed by effecting part payments under CS (MA) Rules in the light of the decision of the Supreme Court in a similar matter, which has become final as per Ext. R1(C) dated 29.06.2016.

14. More importantly, Rule 6(1)(2) makes it clear that 'any amount' paid by the Government Servant entitled under Rule (1) is eligible for reimbursement subject to the conditions enumerated therein. So also proviso to Rule 6 of CS(MA) Rules says that, only if the controlling officer is not satisfied with the genuineness on facts and circumstances of the case, that too after affording an opportunity of being heard could deny the claim. Effecting part payment of the claim itself is a ground to presume that the genuineness of claim is not in dispute. No ceiling limit is also prescribed. The

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materials produced indicate that when there is no doubt regarding the genuineness of bills submitted for reimbursement, denial of a portion of the amount claimed asserting that there was deviation to the relevant Rules is quite unjustifiable and illegal."

10. She argued that it was inappropriate on the part of th respondents to state in the reply statement that the bills submitted were not in the name of the applicant. The patient was the applicant's wife and naturally supporting medical bills were issued in her name. Also the fact that "donors expenses' being not claimed is not a bar as actually the case was one of the Deceased Donor Renal Transplantation and no donors expenses were incurred as the donor was already diseased.

11. Shri. C.P. Ravikumar, learned counsel for the respondents had only a submission that all bills in original were not available to the respondents but it is found that this argument is not valid as the detailed description at page 3 of the reply statement belies the claim made by the respondents' counsel. The issue dealt with is clearly covered by the judgment in OP (CAT) No. 167/2017 of the Hon'ble High Court of Kerala. The hospital in question, Amrita Institute of Medical Sciences and Research Centre, Edappally, is included in the panel as per Annexure A7 OM. The 'treatment for renal failure is included in the proceedings of the Kerala Government, which is at Annexure A8.