Bipendra Nath Verma vs M/O RAILWAYS on 16 October 2026

1. Union of India, through its Secretary, Ministry of Railways, Railway Board, Rail Bhawan, Raisina Road, New Delhi.

2. Director General Health, Railway Board, Rail Bhawan, New Delhi.

3. Principal Chief Medical Director, North Central Railway, Medical Department, Headquarter Office, G-Block, Mandakini Building, General Manager Office Campus, Subedarganj, Prayagraj.

4. Chief Health Director, North Central Railway, Medical Department, Headquarter Office, G-Block, Mandakini Building, General Manager Office Campus, Subedarganj, Prayagraj;

5. Chief Medical Superintendent, North Central Railway, Agra. …..Respondents By Advocate: Shri Rajendra Singh ORDER (ORAL) Per Hon’ble Mr. Pankaj Kumar, Member-Administrative In this case relating to medical reimbursement, the applicant has sought following reliefs:-

1. To issue an appropriate order or direction thereby directing the opposite parties to make the payment of balance amount of sum of Rs.2,88,110.00 towards medical reimbursement to the applicant forthwith;

2. To issue an appropriate order or direction thereby directing the opposite parties to dispose of the applicant's representation as contained in Annexure-12 to the original application;

3. To issue a suitable order or direction which this Hon'ble Tribunal may deem just and proper in the nature and circumstances of the case;

4. To award the cost of this Original Application.

2. The facts of the case are that the applicant retired from service on 31.10.2004 while working on the post of Chief Traffic Inspector under the respondents and he was registered under the Railway Employees Liberalized Health Scheme (RELHS). During the COVID-19 pandemic, the applicant’s wife was taken ill and she breathed her last on 04.04.2021 despite medical treatment. The applicant submitted bills pertaining to his wife’s medical treatment of Rs. 4,96,428 for reimbursement, but the respondents made part reimbursement only. Aggrieved, the applicant has preferred this OA. 3.1 The applicant states that he and her wife got COVID-19 vaccine on 12.03.2021 at Agra, but she got ill afterwards and was rushed to Lucknow where in Pulmonary Department of King George Medical College lung infection was diagnosed; that she was admitted in ICU of Midland Health Care & Research Center, Mahanagar, Lucknow and she was put on ventilator on 30.03.2021 and was also found to be COVID positive; that later she was shifted to Ram Manohar Lohia Hospital on 04.04.2021 where she died on the same day. 3.2 The applicant contends that against the medical bills of Rs. 4,96,428 certified by Midland Health Care & Research Center with Essentiality-cum-Emergency Certificate, which were submitted by him to Chief Medical Superintendent NCR, Agra, only Rs. 1,92,118 have been reimbursed by the respondents. The applicant cites Hon’ble Supreme Court’s judgment in Shiva Kant Jha vs Union of India & Ors Writ Petition (C) No. 694 of 2015 in support of his claim.

4. The respondents aver that against the claim of Rs. 4,96,428 preferred by the applicant, amount of Rs. 1,92,118 was found to be admissible; that on review of the matter on the applicant’s representation dated 16.08.2023, amount of Rs. 16,000 was further sanctioned; that thus total amount of Rs. 2,08,118 has been reimbursed to the applicant in terms of the provisions of RELHS; that the remaining amount pertains to charges that are not admissible under the rules such as treatment availed without prior referral in a private, non-empaneled hospital, or exceeding CGHS prescribed ceilings.

5. Heard both the parties. Apart from Shiva Kant Jha (supra), learned counsel for the applicant has also placed on record the judgment dated 14.08.2024 rendered by this Tribunal in OA No. 517 of 2022 Vijay Kumar Upadhyay vs UoI & Ors and the judgment dated 26.09.2025 of Hon’ble High Court of Delhi in W.P.(C) No. 13418/2025 Union of India & Ors vs Ayodhya Prasad. 6.1 It is noted that the judgment in Ayodhya Prasad (supra) deals with a similar controversy in regard to emergency treatment for COVID- 19 in private non-recognized hospital. In that case, the matter was initially agitated before the Principal Bench of this Tribunal at New Delhi in OA No. 2154 of 2023 and this Tribunal had directed the respondents therein to reimburse the balance amount to the applicant therein. When the matter reached Hon’ble High Court of Delhi in appeal, the matter came to be disposed of in the following manner: “23. More recently, in New Delhi Municipal Council vs Shakuntala Gupta, 2025:DHC:6775-DB, in similar facts and circumstances, where the respondents therein was being denied full reimbursement of her claim incurred during the treatment of COVID-19 in a hospital located in Greater Noida West on the ground that the Government of NCT of Delhi, had fixed the rates for COVID related treatment to be charged by private hospitals in the NCT of Delhi, based on national guidelines and reimbursement in excess of the said amount could not have been granted, held as under: “4. We are not impressed with the above submission. The claim of the respondent cannot be denied only because some hospital allegedly has charged more than what was fixed by the Government of NCT of Delhi. Whether the hospital has overcharged the respondent, is an issue to be taken up by the petitioner/relevant authority with that hospital. As far as the respondent is concerned, once it is not disputed that the respondent had to be admitted to the said hospital in a state of emergency, and had incurred expenses of the above amount, the same have to be reimbursed to the respondent.”

24. From the above, it is apparent that the respondents herein is entitled to claim the full reimbursement of the medical expenses incurred by him during emergency COVID-19 treatment at Apollo Hospital, Gandhinagar, Gujarat.

25. In view of the above facts and circumstances, we find no infirmity with the Impugned Order of the learned Tribunal. The petition is accordingly, dismissed.” (emphasis supplied) 6.2 In the instant OA, it is not in dispute that the applicant’s wife was treated for COVID related illness in a private hospital which was not empaneled by the respondents. The emergent nature of the medical treatment was certified by the private hospital but, unfortunately, the patient’s life could not be saved. In these facts and circumstances, the ratio in Ayodhya Prasad (supra) would apply squarely to the instant case, in my opinion. Consequently, the applicant is held to be entitled for full medical reimbursement. 7.1 In view of the foregoing, this OA is allowed and the respondents are directed to reimburse the balance amount of Rs. 2,88,110 to the applicant within three months of receipt of certified copy of this order. 7.2 Associated MAs also stand disposed of. 7.3 Parties shall bear their own costs.

(Pankaj Kumar) Member (A)

Warij Warij Yadav Digitally signed by Warij Yadav