Kerala High Court

State Of Kerala,Represented By vs Shaju T.T on 10 September, 2025

Author: Anil K. Narendran

Bench: Anil K. Narendran

OP(KAT) NO. 427 OF 2024          1             2025:KER:66642

             IN THE HIGH COURT OF KERALA AT ERNAKULAM

                              PRESENT

          THE HONOURABLE MR. JUSTICE ANIL K. NARENDRAN

                                 &

          THE HONOURABLE MR. JUSTICE MURALEE KRISHNA S.

  WEDNESDAY, THE 10TH DAY OF SEPTEMBER 2025 / 19TH BHADRA, 1947

                     OP(KAT) NO. 427 OF 2024

         AGAINST THE ORDER DATED 09.11.2023 IN O.A.(EKM) NO.484

OF    2019      OF   KERALA     ADMINISTRATIVE     TRIBUNAL     AT

THIRUVANANTHAPURAM (ADDITIONAL BENCH, ERNAKULAM)

PETITIONERS/RESPONDENTS IN OA(E):

     1       STATE OF KERALA,REPRESENTED BY
             THE PRINCIPAL SECRETARY, GENERAL EDUCATION DEPARTMENT,
             THIRUVANANTHAPURAM, PIN - 695001

     2       THE DIRECTOR OF PUBLIC INSTRUCTIONS,
             JAGATHI, THIRUVANANTHAPURAM, PIN - 695014

     3       THE DEPUTY DIRECTOR OF EDUCATION,
             KOZHIKKODE, PIN - 673020

     4       THE HEADMASTER,
             GOVT. HIGHER SECONDARY SCHOOL,
             NEELESWARAM, OMASSERY,
             KOZHIKKODE, PIN - 673582

     5       THE DIRECTOR OF HEALTH SERVICE,
             THIRUVANANTHAPURAM, PIN - 695001


             BY ADV
             SRI.A.J. VARGHESE, SR GP
 OP(KAT) NO. 427 OF 2024       2           2025:KER:66642




RESPONDENT/APPLICANT IN O.A.(E):

          SHAJU T.T,
          AGED 54 YEARS
          S/O THOMAS, HSA (PHYSICAL SCIENCE),
          GOVT. HSS,NEELESWARAM, OMASSERY,
          KOZHIKODE, RESIDING AT THEKKEL HOUSE,
          KULLURUTTY P.O, KOZHIKKODE, PIN - 673582


          BY ADVS.
          SHRI.U.BALAGANGADHARAN
          SMT.NAMITHA GEORGE
          SMT.STENEY K.A.


     THIS OP KERALA ADMINISTRATIVE    TRIBUNAL HAVING BEEN
FINALLY HEARD ON 18.08.2025, THE      COURT ON 10.09.2025
DELIVERED THE FOLLOWING:
 OP(KAT) NO. 427 OF 2024           3             2025:KER:66642

                            JUDGMENT

Muralee Krishna S., J.

The respondents in O.A.(EKM) No.484 of 2019 have filed this

original petition invoking the supervisory jurisdiction of this Court

under Article 227 of the Constitution of India, challenging the

order dated 09.11.2023 passed by the Kerala Administrative

Tribunal (for short, the 'Tribunal) Thiruvananthapuram, in that

original application.

2. Going by the averments in the original application, the

respondent was working as HSA in the Government Higher

Secondary School, Neeleswaram. He was diagnosed with Liver

Cirrhosis and had to undergo Liver Transplantation. On the basis

of the reference made by the Medical College Hospital, Kozhikode,

as well as on the basis of the assessment of the Medical Board

constituted in the Government Medical College, Kozhikode, the

respondent was found to have advanced Cirrhosis of Liver. The

Medical Board opined that he required Liver Transplantation.

Accordingly, he underwent Liver Transplantation at Aster Malabar

Institute of Medical Science, Kozhikode, on 14.06.2016. In the

meanwhile, the respondent submitted an application for interest

free medical advance and on the basis of the recommendations OP(KAT) NO. 427 OF 2024 4 2025:KER:66642

made by the 2nd petitioner Director of Public Instructions, a sum

of Rs.18 lakhs was sanctioned to him towards medical advance.

Subsequently, the respondent submitted utilisation certificate

stating the actual expenditure incurred by him as Rs.16,98,171/-.

Thereafter, the respondent received Annexure A5 communication

dated 28.01.2019 from the 3rd petitioner Deputy Director of

Education, inter alia stating that the 2nd petitioner Director of

Public Instructions, has admitted only a sum of Rs.11,47,725/-

towards treatment expenses and the respondent has to repay the

balance amount. He was directed to remit the amount in excess of

80% of the admitted amount before the Government and to

produce the challan. Challenging Annexure A5 communication, the

respondent filed the original application before the Tribunal under

Section 19 of the Administrative Tribunals Act, 1985, seeking

setting aside of Annexure A5; a direction against petitioners 2 and

5 to reimburse the entire amount of claim without any reduction

in respect of the treatment undergone by the respondent; and a

declaration that the respondent is entitled to be reimbursed with

full amount of IFMA and no amount is liable to be reduced.

3. The 3rd petitioner herein filed a reply statement dated

16.08.2019 before the Tribunal opposing the reliefs sought in the OP(KAT) NO. 427 OF 2024 5 2025:KER:66642

original application, producing therewith Annexures R3(a) and

R3(b) documents. The 5th petitioner herein filed a reply statement

dated 02.11.2021 in the original application, denying the

averments in the original application. The learned Government

Pleader filed an additional statement dated 30.11.2021 in the

original application, producing therewith Annexures R5(a) to

R5(g) documents.

4. After hearing both sides and on appreciation of the

materials on record, the Tribunal allowed the original application

relying on various judgments of the Apex Court as well as the

provisions governing the field. Paragraphs 25 to 30 and the last

paragraph of that order read thus;

"25. Despite all these provisions and judgments declaring that the right to health and right to medical aid, in turn, is the right to life under Article 21 and the State is duty bound under Article 47 and in the light of the international covenant and Universal Declaration of Human rights, the respondents are denying the claim for medical attendance on the basis of rates fixed about two decades ago. That would show that Government do not look into the factual circumstances in total ignorance of its constitutional obligation to provide medical attendance benefits. There was no hospital available at the relevant time under the Government where liver transplantation could be done. In that event, there is no justification for denying the amount incurred towards actual expenditure to the applicant towards medical attendant benefit.

OP(KAT) NO. 427 OF 2024 6 2025:KER:66642

26. On the basis of the list of medicines or rates prescribed for the tests about 20 years back, the claim made by the applicant, on the basis of the bills issued by the hospital towards actual expenses he incurred, cannot be denied to the applicant.

27. Now it is well settled that right to health is a fundamental right and it is incumbent on the State to see that appropriate steps are taken to protect the said right and in this process, the denial of actual medical expenditure incurred by a Government Employee would amount to violation of the Constitutional rights under the provisions contained in Article 21 as well as Article 47 of the Constitution of India. Therefore, Annexure A5 order, to the extent it denied the claim towards the expenditure of Rs.16,98,171/- is set aside.

28. The learned counsel for the applicant submitted that the applicant is suffering from Cardiac problems and is undergoing treatment and because of the withholding of the DCRG, he and his family is in a pathetic conditions. Therefore any further delay in sanctioning and allowing payment towards the actual expenditure to be adjusted towards the advance amount and in effecting payment of DCRG to the applicant would amount to further deprivation of the fundamental right to life of the applicant which would extend to the members of his family also.

29. The action of the respondents in denying the applicant the expenditure incurred towards the surgery is totally illegal. There shall be a direction to the 2nd respondent to re-consider the entire issue and to issue orders sanctioning the entire expenditure incurred and claimed by the applicant for undergoing liver transplantation and to disburse the amount in excess of the amount found admissible i.e., in excess of Rs.11,47,725/- (20% though deducted is already directed to be paid). This shall be done irrespective of the orders Annexure R5(b), (d), (e) and (f).

OP(KAT) NO. 427 OF 2024 7 2025:KER:66642

30. There shall be a further direction to the 3 rd respondent to release the DCRG due to the applicant for which NLC shall be issued irrespective of the advance availed by the applicant, as the applicant has undertaken to remit as sum of Rs.1,018,29/- which is the difference between the advance amount availed and actual expenditure incurred and claimed. This shall be done within a period of two months from the date of receipt of a copy of this order.

The Original Application is disposed of accordingly."

5. Heard the learned Senior Government Pleader for the

petitioners and the learned counsel for the respondent.

6. The learned Senior Government Pleader would submit

that it was based on Annexure R5(b) to R5(e) Government Orders,

the admissible reimbursement amount was limited by the

petitioners as Rs.11,47,725/-. Hence, the interference of the

Tribunal on Annexure A5 communication is unwarranted. On the

other hand, the learned counsel for the respondent would submit

that the respondent took treatment from an empanelled hospital,

being referred to that hospital from the Medical College, since the

facility for Liver Transplantation was not available in the

Government hospitals during that period. Restricting the

reimbursable amount based on the Government Orders issued

decades ago is not justifiable. Hence, no interference is warranted

on the impugned order of the Tribunal.

OP(KAT) NO. 427 OF 2024 8 2025:KER:66642

7. We have carefully gone through the impugned order of

the Tribunal and the materials on record. The reimbursement of

expenditure incurred by the Government servants for medical

attendance is governed by the Kerala Government Servants

Medical Attendance Rules, 1960. Rule 3(e) of that Rules, defines

Medical Attendance as under;

""Medical Attendance" means the professional advice and care during sickness or injury whether at a Government Medical Institution, or in the consulting rooms of the Authorised Medical Attendant or at the residence of a Government servant entitled under these rules to medical attendance at his residence. It includes such surgical treatment as is available at Government Medical Institutions or can suitably be given at a Government servant's residence or at the consulting rooms of the Authorised Medical Attendant as also Bacteriological, Pathological, X-Ray and other clinical examinations available at Government Medical Institutions."

8. Rule 4 of Kerala Government Servants Medical

Attendance Rules, 1960 reads thus;

"Persons entitled to free medical attendance - (1) All Government servants are entitled to free of all charges except as expressly specified in these rules, to medical attendance by their Authorised Medical Attendant.

(2) Government servants are entitled to free medical attendance irrespective of whether they are on duty or on leave anywhere within the State.

(3)Families of a Government servant are entitled to medical attendance free of charge to the same extent as the OP(KAT) NO. 427 OF 2024 9 2025:KER:66642

Government servant himself except that they shall not be entitled to free medical attendance at their residence unless the Authorised Medical Attendant is of the opinion that the patient cannot be removed without grave risk to his/her health."

9. Rule 8 of that Rules reads thus;

"Rule 8: Special concessions in regard to medical treatment.--

(1) Government shall not be responsible for any expenditure incurred by a Government servant on medical treatment by admitting himself into a non-Government Institution or by consulting a Private Doctor, except as specifically provided in these rules. (see Note 1 below)

(2) The Director of Health Services may specify the Private Medical Institutions within the State to which a Government servant may resort for purposes of medical relief, provided that no Private Medical Institution shall be so notified where a Government Medical Institution capable of giving similar treatment exists within a radius of 5 miles.

(3) Government servants who have no Government Medical Institutions within a radius of 5 miles of their station, may resort to such Private Institutions and the charges incurred by them would be reimbursed by Government to the extent they would have received such treatment free in a Government Institution or at the hands of an Authorised Medical Attendant. (see Note 2 below)

Note:- Private Institutions recognised for treatment in Rule 8(3) should be resorted to only in cases of emergency and not as a routine course. Bills for reimbursement submitted as per the above rules should be certified by the nearest District Medical Officer of Health as to the emergency of each case."

OP(KAT) NO. 427 OF 2024 10 2025:KER:66642

(4)The claims in this respect should be preferred within one month from the last date of treatment and submitted to the Authorised Medical Attendant. He will scrutinise the bills and return them to the party with his certificate.

Note:- In deserving cases in which the delays are not due to avoidable circumstances the Heads of Departments and District Collectors may condone delays up to one month.

(5)The expenditure on this account will be debitabale to the same head to which the Salary and Allowances of the Government Servant concerned is debitable."

10. In Shiva Kant Jha v. Union of India [2018 (16)

SCC 187], while considering the issue of reimbursement of

medical claims under the Central Government Health Scheme, the

Apex Court held thus;

"17. 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.

OP(KAT) NO. 427 OF 2024 11 2025:KER:66642

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.

xxxx xxxx xxxx xxxx "19. In the present view of the matter, we are of the considered opinion that the CGHS is responsible for taking care of health care 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 opinion 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."

11. In the impugned order, the Tribunal analysed the

contentions of the petitioners and the respondent in detail, based

on various judgments of the Apex Court as well as this Court, such

as State of Punjab v. Ram Lubhaya Bagga [(1998) 4 SCC

117], Confederation of Ex-Servicemen Association v. Union

of India [(2006) 8 SCC 399], Central Provident Fund OP(KAT) NO. 427 OF 2024 12 2025:KER:66642

Commissioner v. N. Satheesan [2018 (1) KHC 921],

Dr.George Thomas v. State of Kerala [2022 (3) KLT 133]

and Prasad K. G. v. State of Kerala [2023 KHC 664], and held

that the denial of claim for medical attendance on the basis of

rates fixed about two decades ago by the petitioners-respondents

is unjustifiable. The Tribunal noted that on the basis of the list of

medicines or rates prescribed for the test, about 20 years back,

the claim made by the respondent, on the basis of the bills issued

by the hospital towards actual expenses he incurred, cannot be

denied.

12. The petitioners have no case that there were

Government hospitals during the relevant period that provided the

treatment of the nature undergone by the respondent in the

empanelled hospital. It is pertinent to note that Annexure R5(g),

one of the Executive Orders that limits the amount admissible,

was issued in the year 2020, when the surgery undergone by the

respondent was in the year 2016.

13. In M/s Estralla Rubber v. Dass Estate Pvt.Ltd.

[(2001) 8 SCC 97] the scope of interference by exercising the

supervisory jurisdiction under Article 227 of the Constitution of

India was considered by the Apex Court and held that the order OP(KAT) NO. 427 OF 2024 13 2025:KER:66642

under challenge can be set aside by the High Court under Article

227 of the Constitution of India if the findings are based on no

evidence at all or are also perverse that no reasonable person

could come to such conclusion.

14. While appreciating the arguments addressed by the

learned counsel on both sides and on perusal of the materials on

record, we find no reason to say that the order passed by the

Tribunal is perverse or illegal, which warrants the interference of

this Court by exercising the supervisory jurisdiction under Article

227 of the Constitution of India.

In the result, this original petition stands dismissed.

Sd/-

ANIL K.NARENDRAN, JUDGE

Sd/-

                                    MURALEE KRISHNA S., JUDGE
MSA
 OP(KAT) NO. 427 OF 2024         14           2025:KER:66642

                 APPENDIX OF OP(KAT) 427 OF 2024

PETITIONER ANNEXURES

Annexure A1          TRUE COPY OF OUT PATIENT TICKET DATED
                     23/12/2015 ISSUED BY THE GOVERNMENT
                     MEDICAL COLLEGE, CALICUT

Annexure A2          TRUE COPY OF THE PROCEEDINGS OF MEDICAL

BOARD, MEDICAL COLLEGE HOSPITAL, CALICUT DATED 23/12/2015

Annexure A3 TRUE COPY OF GO(RT) 1141/2016/G.EDN DATED 19/03/2016

Annexure A4 TRUE COPY OF DISCHARGE SUMMARY DATED 01/07/2016 OF ASTER MIMS, CALICUT

Annexure A5 TRUE COPY OF THE LETTER NO. C3/1864/2016 DATED 28/01/2019 ISSUED BY THE THIRD RESPONDENT

Annexure R3(a) TRUE COPY OF THE LETTER DATED 27/12/2018 OF THE DIRECTOR OF HEALTH SERVICES

Annexure R3(b) TRUE COPY OF THE GOVERNMENT LETTER DATED 26/05/2015

Annexure R5(a) TRUE COPY OF THE LETTER NO. C3/1864/16 DATED 07/06/2018

Annexure R5(b) TRUE COPY OF THE RELEVANT PAGES OF THE GO(P) NO. 510/95/H&FWD DATED 10/11/1995

Annexure R5(c) TRUE COPY OF GO(P) NO. 103/2019/H&FWD DATED 26/11/2019

Annexure R5(d) TRUE COPY OF GO(MS)NO. 70/2001/H&FWD DATED 14/03/2001

Annexure R5(e) TRUE COPY OF GO(P)NO. 163/90/H&FWD DATED 20/08/1990

Annexure R5(f) TRUE COPY OF LETTER OP(KAT) NO. 427 OF 2024 15 2025:KER:66642