Ram Baran vs RAILWAY on 4 November 2026

ORDER

Shri Vinod Kumar, learned counsel for the applicant and Shri Vijay Kumar Singh, learned counsel for the respondents, were present at the time of hearing.

2. The instant original application has been filed seeking following relief: “(i) To issue an order or direction in the suitable nature quashing and setting aside the orders impugned dated 25.06.2024 and order dated 04.07.2025 passed by the respondent no. 3 (Annexure No. A-1) to this OA.

(ii) To issue an order or direction in the suitable nature directing the respondents to allow the reimbursement of the full medical claim of applicant as per Rule and pay the same, within stipulated period of time, with 18% of interest thereupon.

(iii) To issue any order or direction, which this Hon’ble Tribunal may deem fit and proper in the facts and circumstances of the case. RITU RAJ SINGH

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(iv) To award the cost of the application to the applicant.”

3. The compendium of the facts narrated in the instant original application is that the applicant is aggrieved by the impugned order(s) dated 25.06.2024 and 24.07.2025 passed by the respondents by way of which applicant’s claim for medical reimbursement of the treatment obtained by his wife has been rejected. Applicant has contended that respondents have rejected his claim solely on the ground that the case was not one pertaining to emergency. Further alleging that the impugned orders are cryptic, non-speaking and passed without any application of mind, applicant has contended that the case was one pertaining to emergency and remark to this effect was recorded by the medical practitioner concerned and thus prays for the quashing of the same thereby directing the respondents to pay the medical reimbursement with interest.

4. I have heard the rival contentions advanced by the learned counsel appearing for the parties.

5. Learned counsel for the applicant argued that the applicant has retired from permanent service of the respondents’ department on 31.12.2018 upon attaining the age of superannuation. He was covered under the medical scheme of the Railways so much so that upon his retirement, one month salary of the applicant was deducted by the Railway in lieu of issuing the medical card under the RELHS Scheme and the same is evident from the letter dated 27.02.2018 issued by the department. On 14.02.2024, the wife of the applicant namely Subhawati Devi met with a road accident and sustained grievous injuries and got admitted to the nearby private hospital in emergency condition. She got operate immediately on the very next date i.e., 15.02.2024 in order to save her life. Applicant immediately informed to the Railway authorities about the treatment of his wife in the private hospital namely Agrawal Orthopedic Hospital and research Institute Gorakhpur. The treatment was done and the applicant’s wife was discharged from the hospital on 27.02.2024 and applicant had spent entire money of treatment from his own pocket. Thus, he submitted medical claim to the tune of Rs 95,313/- before RITU RAJ SINGH

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the respondent no 3 for reimbursement. However, vide order dated 25.06.2024, the same was rejected stating therein that case was not found to be the one pertaining to emergency. Applicant preferred an appeal against the aforesaid order but the same was also rejected Learned counsel further argued that the stand of the respondents is arbitrary as the doctor concerned has himself issued the certificate dated 15.05.2024 and also a certificate dated 15.10.2025 stating that the wife of the applicant was admitted in the emergency condition having a case of fractured neck femur (left) and she was operated on the very next date i.e., 15.02.2024 since immediate treatment was necessary. Learned counsel further argued that case of the applicant’s wife was pertaining to emergency and he is liable to be paid the entire claims in view of the law laid down by several courts in similar cases. Thus, referring to all facts and circumstances, prayer was made to allow the OA thereby quashing the impugned order and directing the respondents to pay the medical claims to the applicant.

6. Learned counsel for the respondents vehemently opposed the submissions of the applicant’s counsel and by way of his counter affidavit, he argued that the medical claims submitted by the applicant were assessed in view of the extant provisions laid down in Para 648 of the Indian Railway Medical Manual, 2000 and it was found that the case of the applicant’s wife was not pertaining to emergency and thus applicant’s claims have been rejected by way of a reasoned and speaking order. Learned counsel has not taken prior permission before obtaining treatment in the private / non- empanelled hospital and furthermore it was not a case pertaining to emergency and due to this very reason, the amount claimed as medical reimbursement was not liable to be given to the applicant and thus, his prayer was rejected vide the order impugned in the instant OA. Thus, referring to the entire facts disclosed in the counter affidavit, learned counsel argued that the OA is liable to be dismissed being devoid of merits.

7. The applicant has rebutted the averments made in the Counter Affidavit reiterating the facts and averments as made in the OA. To RITU RAJ SINGH

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substantiate his claim further, learned counsel for the applicant has placed reliance upon the following judgments:

i. Judgment passed by the Hon’ble Supreme Court of India in the case of State of Punjab & others Vs. Mohinder Singh Chawla etc. reported in 1197(1) SCSLJ-204(S.C.)

ii. Judgment passed by the Hon’ble Supreme Court of India in the case of Shiva Kant Jha Vs UOI and others reported in 2018 (4) JT

269. Referring to the above case laws, learned counsel for the applicant argued that the Apex Court in the above judgments has held that Right to Health and preservation of human life is of paramount importance. In the situations of emergency, a person has the right to seek treatment at any hospital and if the emergent situation is established, the expenses incurred during the treatment cannot be denied to the person. Learned counsel for the applicant further argued that the case of the applicant is covered by the very Rule mentioned at Para 648(2) of the Chapter VI of Indian Railway Medical Manual Vol-I which speaks in favour of the applicant’s case as it has been mentioned therein that if the emergency condition is established, the employee is liable to be paid the entire amount incurred as medical expenses. Learned counsel has also argued that his case is also squarely covered by the Para 648(3) of IRMM 2000 which was added vide Authority Board’s Letter No. 2005/H/6-4/Policy-II dated 31.01.2007 and thus full medical reimbursement is to be made since the applicant’s case falls under the definition of emergency.

8. I have considered the rival contentions advanced by the learned counsel appearing for the parties and gone through the documents on record and judgments referred to by the parties.

9. As the facts of the case have already been stated above in detail, the same are not reiterated for the sake of brevity. In this case, the wife of the applicant met with an accident and was admitted to the nearby private hospital and medical treatment was obtained from that hospital itself. Subsequently, the applicant submitted medical RITU RAJ SINGH

5 | P a g e claims which were rejected by the respondents only on the ground that case of the applicant’s wife was not pertaining to emergency. In this regard, I have carefully perused all the medical bills and certificates which the applicant has annexed along with the original application. In this regard, it is pertinent to record that in the medical certificate dated 15.05.2024 (annexed as Annexure No -3 at page 33 of the OA) issued by the doctor concerned at Agrawal Orthopedic Hospital & Research Hospital, Gorakhpur, it has been stated that the wife of the applicant was brought in the hospital on 14.02.2024 as a case of Fracture Neck Femur Left and was operated on the very next date i.e., 15.02.2024 and discharged on 27.02.2024. Similarly, in the medical certificate dated 15.10.2025 issued from the aforesaid authority (annexed at Annexure No – 7 at page 55 of the OA), it has explicitly been recorded that the wife of the applicant was admitted in the hospital on 14.02.2024 in emergency and since immediate treatment was necessary, surgery (DHS Plating) was done on 15.02.2024. Although the Court is not an expert body to comment on the gravity of a disease or infirmity but as is evident from the records as well as submissions raised across the bar, the case of the applicant was one pertaining to emergency which is explicitly evident from the medical certificate(s) dated 15.05.2024 and 15.10.2025 issued by the doctor concerned at Agrawal Orthopedic Hospital & Research Hospital, Gorakhpur. For this reason, by any stretch of imagination, it cannot be assumed that the applicant should have taken prior permission from the respondents before obtaining his wife’s treatment or have approached any other medical authority for the treatment.

10. Furthermore, it is needless to say that in such serious scenarios where survival of the patient becomes the matter of prime consideration, taking administrative approvals and running from pillar to posts for completion of paper works becomes secondary. Therefore, there seems to be no reason why the payment of medical reimbursement should not be allowed to the applicant specifically when his case proves to be that of an emergency. RITU RAJ SINGH

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11. Also, the Apex Court in its judgment dated 13.04.2018 passed in case Writ Petition (Civil) No. 694 of 2015 titled Shiva Kant Jha Versus Union of India, held as under: “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. 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.

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 RITU RAJ SINGH

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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.”

12. Also, a bare perusal of the impugned orders dated 25.06.2024 and 24.07.2025 reveals that the same are cryptic and non-speaking orders wherein the respondents have rejected the claim of the applicant by simply recording that his case was not of emergency. While passing the aforesaid orders, respondents have failed to take into consideration the medical certificates dated 15.05.2024 and 15.10.2025 which have been discussed above.

13. Thus, in accordance with the deliberations quoted above and specifically in light of the law laid down by the Hon’ble Supreme Court of India in the case of Shiva Kant Jha (supra) as quoted above, this Tribunal is of the considered opinion that the instant case of the applicant is liable to be allowed. Thus, the impugned orders dated 25.06.2024 and 24.07.2025 are quashed and the set aside. The OA is allowed to the extent that the competent authority amongst the respondents is hereby directed to reimburse the entire amount (Rs. 95,313/-) of medical reimbursement to the applicant within a period of three months from the date of receipt of certified copy of this order. If payment is not made within the aforesaid period, respondent will pay interest @ GPF rate on the said amount.

14. All associated MAs stand disposed of accordingly.

15. There shall be no order as to costs.

(Justice Om Prakash VII) Member (Judicial) (Ritu Raj) RITU RAJ SINGH