Pradeep Kumar Lenka vs DEPARTMENT OF POSTS on 10 November 2026

O R D E R

Mr.SudhiRanjan Mishra, Member, J.M.

The applicant challenging the order dated 28.02.2025 wherein his medical claim for full reimbursement was rejected has filed this OA praying for following reliefs: a) Respondents be directed to release the balance amount of Rs. 74,222/- (Rupees Seventy four thousand two hundred twenty two) only in connection with expenditure incurred towards medical treatment of the applicant within a stipulated time with admissible rate of interest. b) Pass any other order/orders as would be deemed fit and proper.

2. The fact of the case as inter alia averred statedby the applicant in the OA is as follows: 2.1 That, the applicant is working as Office Assistant, Office of the Superintendent of Post Offices, Balasore Division, Balasore.. While working as Public Relation Inspector (Postal), on 24.06.2024, the applicant during health check-up at SUM ULTIMATE Medicare, he was detected Gallbladder Polyp and was

Kalpeswar Behera suggested for surgical intervention as soon as possible on medical emergency. That, thereafter, the applicant vide application dtd.24.06.2024 sought for permission for treatment in SUM ULTIMATE MEDICARE and grant of advance thereto. That, it may be noted here that a sum of Rs.1,25,585/- (Rupees one lakh twenty five thousand five hundred eighty five) only was spent towards the treatment in the above mentioned Hospital. After treatment, the applicant was discharged from Hospital on 26.06.2024. Thereafter, bills for Rs.1,25,525/- along with an application dtd. 24.07.2024 were submitted before the Respondents for reimbursement of expenditure incurred towards treatment at the above mentioned Hospital. 2.2 That, it may be noted here that vide Memo. E.8-Midical/P K Lenka/2022-23 dtd.06.09.2024 the Respondent No.4 was pleased to sanction a sum of Rs. 51,363/- out of bill amount of Rs.1,25,585/-. Thus, an outstanding amount of Rs.74,222/- has not been sanctioned by the Respondent No.4. That, the applicant preferred an application before Respondent No.4 on 02.12.2024 with prayer for the sanction of the actual expenditure incurred towards his treatment. However, the Respondent No.4 put their deaf ear to the prayer of the applicant. On 22.01.2025, the

Kalpeswar Behera applicant preferred an extensive application before Respondent No.3 with prayer to sanction the amount as actual expenditure. In reply, the Respondent No.4 vide letter dtd.28.02.2025 intimated that the claim of the Applicant has been examined by the Circle Office and stated that the medical bills have been sanctioned by the competent authority as per the rate restricted to CGHS package rates or unit wise CGH rates or actual whichever is less and hence no further amount is admissible. Thus, the Respondents rejected the claim of the applicant with unreasonable findings. 2.3 That, it is humbly submitted that Article-21 of the Constitution of India is the very soul of the Constitution and very heart of it. It also confers right to live as well as right to choice. Right to life includes right to get medical facilities by a Govt. servant either in service or post-retirement. This right to live correspondences with an obligation upon the State to maintain as a paramount duty and secure the health of citizens.That, it is important to submit here that the SUM ULTIMATE MEDICARE Hospital is an empaneled Hospital under CGHS. Thus, the Govt. has recognized the said hospital with an object that whatever the package rates have been set out by the Govt., the hospital would

Kalpeswar Behera not charge over and above it. However, the hospitals have gone harsh and discarding the package rates, despite recognition, are charging more than the amount specified by the Govt. for a particular treatment. Thus, the applicant has no other option than to pay the amount as demanded by the hospital for saving his precious life. 2.4 That, it is respectfully submitted that self-preservation of one's life is the necessary concomitant of right to life enshrined in Article-21 of the Constitution of India, fundamental in nature, sacred, precious and inviolable. Thus, the applicant was admitted immediately in emergency in the above mentioned hospital to save his precious life. That, it is humbly submitted that the Doctors of the Hospital in question have suggested for surgical intervention as soon as possible on medical emergency. Thus, the hospital where the treatment was taken by the applicant is one of the empaneled hospital and the illness for which the treatment was required was of emergent nature which needs immediate attention. 2.5 That, it is submitted that though package rate has been set out as a ceiling, yet it is a case where for want of proper medical

Kalpeswar Behera facilities, applicant was constrained to admit to a private hospital with an object to save his life, as guaranteed under Article 21 of the Constitution of India, being a fundamental right under Article 21 of the Constitution of India is more precious than any other eventuality or methodology having saved his life, denial of full reimbursement to the applicant is not justifiable in the circumstances. 2.6 That, it is submitted that the applicant is a Group-C employee having lower pay slab in pay matrix was admitted in an emergent condition to save his life, but only a meager amount, out of total amount claimed has been paid by Respondents in the guise of package rates which is not expected in a welfare country. That, it is a settled legal position that the employee during his life time in service or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights and the choice for treatment where expert and expertise doctors are available is a fundamental right of every citizen..

3. The respondents have filed their counter stating as follows: 3.1 That, That, Sri Pradeep Kumar Lenka, presently working as LSG SPM, Balasore Division hereinafter called as the Applicant

Kalpeswar Behera had applied for the medical advance through Balasore Division towards his self treatment at SUM Ultimate Medicare, Bhubaneswar on 24.06.2024 for treatment of gull bladder poly which was received at Circle Office Bhubaneswar on 26.06.2024. However, before sanction of the medical advance on 28.06.2024, the Applicant got discharged from the Hospital on 26.06.2024 for which the advance amount could not be disbursed to the Hospital. That the Applicant submitted medical bills for reimbursement through Superintendent of Post Offices Balasore Division amounting to Rs.1,25,585/-, towards indoor treatment of self at SUM Ultimate Medicare. 3.2 That the bills were considered as per existing rates of CGHS and CS(MA) rules, 1944 and the competent authority has approved Rs.51,363/- out of above mentioned claimed amount for settlement of the medical reimbursement claims. The package rate for the treatment procedure of Laparoscopic Cholecystectomy is Rs.33000/- and for private ward entitlement is 15% above the prescribed rate and valid for 3 days including the cost of admission, medicines, OT consumables, Nursing Charges, Doctor consultation charges, Surgery Charges etc. Accordingly, the bill was scrutinized and a sum of Rs.51,363/-

Kalpeswar Behera including the Outdoor medical expenses has been approved by the Competent Authority. 3.3 After that the Applicant preferred to submit representation dated 02.12.2024 through Balasore Division requesting the Office of the Chief PMG, Odisha Circle, Bhubaneswar to sanction residual amount that were deducted from his medical reimbursement claims. In response to the said representation, vide the SPOs Balasore Division letter No. E.8- Medical/2022-23 dated 28.02.2025 (Annexure-A/5 Series), the Applicant was intimated that bills have been sanctioned by the competent authority as per the rate restricting to CGHS package rates/rules or actual whichever is lesser and no further amount is admissible.Being aggrieved, the Applicant filed this instant OA before the Hon'ble CAT, Cuttack Bench, Cuttack for release the balance amount of Rs.74222/-only in connection with expenditure incurred towards medical treatment of himself within a stipulated time with admissible rate of interest. 3.4 That, it is humbly submitted that the medical reimbursement bills of the Applicant have been sanctioned by the competent authority as per the rate restricting to CGHS package

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rates/rules or actual whichever is lesser in accordance with Central Services (Medical Attendance) Rules, 1944. As the matter has been completely dealt with strictly as per rules, the contentions of the Applicant are not at all correct. That, it is humbly submitted that the medical advance case of the Applicant received at the office of the Chief PMG, Odisha Circle, Bhubaneswar through the SPOs, Balasore Division on 26.06.2024 and before sanction of the said advance on 28.06.2024, the Applicant was discharged from hospital on 26.06.2024. Therefore, the amount of advance could not be disbursed to the hospital due to discharge of the official earlier to such sanction. 3.5 That, it is humbly submitted that the bills are examined and found that the expenditures charged by the hospital was for general public and not for the CGHS beneficiaries/Government Employees. Hence, the total billed amount Rs.1,25,585/- was spent by the Applicant. However, the bills are considered as per existing rates of CGHS and CS(MA) rules, 1944 and the competent authority has approved Rs.51,363/- out of above mentioned claimed amount for settlement of the medical reimbursement claims. The CGHS package rate for the treatment

Kalpeswar Behera procedure Laparoscopic Cholecystectomy is Rs.33000/- and for private ward entitlement is 15% above the prescribed rate and valid for 3 days including the cost of admission, medicines, OT consumables, Nursing Charges, Doctor consultation charges, Surgery Charges etc. Accordingly, the bill was scrutinized and a sum of Rs.51,363/- including the Outdoor medical expenses has been approved by the Competent Authority. The rest of the amount Rs.74,222/- was not admissible as per the CS(MA) Rule and the cost to be borne by the Applicant himself. Also, as per Point 2(i) of Ministry/Department of Health and Family Welfare, New Delhi OM No.14025/01/2014-MS, dated 05.06.2014 it is suggested that a serving central Government employee covered under CS (MA) Rules, 1944 taking treatment in Government Hospital or in private Hospital recognized under CGHS/CS (MA) Rules, may be granted permission by Heads of the Department for availing indoor treatment on the basis of medical prescription issued by the concerned Authorized Medical Attendant. 3.6 It is further suggested vide Point 2(ii) of the above OM that the Heads of the Department shall decide the cases of reimbursement of medical claims in respect of treatment obtained in emergency at private Hospital subject to item wise

Kalpeswar Behera ceiling as per rates prescribed under CGHS/CS(MA)Rules. It is pertinent to mention here that the Applicant was in conscious state during admission and discharge from the Medical and the Applicant is also well conversant with the departmental rules and guidelines. If the Applicant had approached the hospital authority before admission to provide medical treatment facility as per CGHS rate being a Government Employee submitting the Departmental ID card, the hospital would have charged as per prescribed CGHS rate. Hence, there is no fault of the Competent Authority in sanctioning the Medical Claim as per CGHS rate. 3.7 All the relevant bills submitted by Sri Pradeep Kumar Lenka, PRI (P), Balasore Divisional office are approved by the competent authority as per above OM and disposed off accordingly as per the prescribed rate chart circulated by Director of CGHS. Hence, the claim of the applicant for sanction of residual amount Rs. 74,222/- is not justified.That, it is humbly submitted that the Competent Authority has not denied/rejected the medical claim, rather considered the claim under emergency ground and following the Departmental guidelines under CGHS/CS(MA) rules. As such, there is no violation of Article-21 of the Constitution of India. It is further

Kalpeswar Behera humbly submitted that the SUM ULTIMATE MEDICARE is a CGHS empaneled Hospital and also offering facilities to the Government employees covered under CS(MA) rules. As the Applicant during his treatment was in conscious state and if he had approached to the hospital authority to provide medical facility as per CGHS rate on production of departmental ID card, the hospital might not have charged the fees more than CGHS rates. As such, charging of higher rate for the medical treatment is not concerned to this Department. Hence, the contention of the Applicant is not correct. 3.8 That, it is humbly submitted that all the CS(MA) beneficiaries availing treatment at Private or CGHS empaneled Hospitals are reimbursed as per rates provided by Government Hospitals as per CS(MA) Rules or the CGHS rates as per as per Point 2(ii) of Ministry/Department of Health and Family Welfare, New Delhi OM No.14025/01/2014-MS,dated 05.06.2014. Medical Bill claims are settled as per prevailing guidelines of CGHS rates/rules and CS (MA) rules but not as per the employees category. Also, there are some non admissible items which are charged generally by the Hospitals during the treatment and the costs are to be paid by the patients whether

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CGHS beneficiary or CS(MA) beneficiaries or covered under any Health Insurance Scheme. The reimbursement to the Applicant has also been made exactly as per the said rules and manner considering his claim in emergency ground. As such, full reimbursement to the applicant is neither justified nor admissible. Hence, no fundamental right of the Applicant has been violated.

4. The applicant has filed rejoinder and the respondents have filed reply to rejoinder reiterating the stand taken by them in the OA and counter respectively.

5. Heard both sides and perused the records.

6. Ld. Counsel for the respondents filed written notes of arguments stating therein: 6.1 Reimbursement under CS(MA) Rules is strictly subject to package rate ceiling, not actual expenditure. Under Rule 12 of CS(MA) Rules, 1944, reimbursement is governed by rates prescribed by Government. The Supreme Court in State of Punjab v. Ram Lubhaya Bagga, (1998) 4 SCC 117_ categorically held that the Government's obligation is to reimburse as per prescribed rates, not actual expenditure. The Government is

Kalpeswar Behera entitled to cap reimbursement at approved rates. Similarly, in Surjit Singh v. Union of India, 2009 SCC OnLine P&H 10356, the High Court held that reimbursement of medical expenses beyond the prescribed CGHS rates cannot be claimed as a matter of right. 6.2 The applicant being a CS(MA) beneficiary, CGHS rates apply as the ceiling. The applicant is covered under CS(MA) Rules, 1944, not CGHS directly. Under MoHFW OM No.14025/01/2014- MS dated 05.06.2014 (Annexure R/1), emergency treatment at private/CGHS empanelled hospitals is reimbursable subject to item-wise ceiling as per CGHS/CS(MA) prescribed rates. The OM is not an administrative overreach, it is a delegated statutory direction under CS(MA) Rules.The respondents' competent authority has correctly applied this OM and sanctioned Rs.51,363/- after scrutiny. 6.3 Hospital billed at general public rates, not at CGHS empanelled ratesThe counter specifically states that the hospital charged the applicant at general public rates, not at CGHS beneficiary rates. The applicant was in conscious state during admission and discharge and did not produce his departmental

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ID card to avail CGHS-rate benefit. The short-fall was therefore caused by the applicant's own omission, not by any fault of the Respondents. The Supreme Court in_Union of India v. Raghubir Singh Bajaj, (2011) 3 SCC 158_ held that if a government employee fails to take reasonable steps to avail entitled facilities, the Government cannot be held responsible for the excess expenditure. 6.4 Article 21 does not confer unlimited financial obligation on the State for medical reimbursement beyond prescribed limits The applicant invokes Articles 14 and 21. However, the Supreme Court in Paschim Banga Khet Mazdoor Samity v. State of West Bengal, (1996) 4 SCC 37 though recognising the right to emergency medical care, did not mandate unlimited reimbursement beyond prescribed rates. The State's obligation is to ensure access to treatment, not to reimburse actual costs irrespective of prescribed package rates. More directly. Consumer Education & Research Centre v. Union of India (1995) 3 SCC 42 and subsequent judgments have consistent held that medical facilities must be provided within available/prescribed frameworks. Importantly, the Apex Court in Union of India v. Devendra Kumar Pant, (2008) 8 SCC 818 upheld that ceiling on

Kalpeswar Behera medical reimbursement der service rules is not violative of Article

21. 6.5 The claim of "medical emergency" does not override rate restriction. The applicant contends this was an emergency. However, the factual position is: the applicant visited SUM Ultimate Medicare on 24.06.2024 during a health check-up, was detected with gallbladder polyp, and was advised surgery. He then filed a formal application for permission and advance the same day. The surgery was on 25.06.2024, one day later. This shows there was sufficient time to approach authorities. This is NOT a sudden, unavoidable emergency where the patient could not communicate. The Supreme Court in Regional Manager, Central Railway v. Mahabir Singh, (2021) SCC Online SC 1018 and Union of India v. Susheela Devi, (2019) SCC Online Del 9211_held that where there was adequate time and opportunity to seek prior permission, denial of excess reimbursement beyond package rates is justified. 6.6 Partial sanction itself was an act of grace, full CGHS package rate was paid. The Respondents did not reject the claim entirely. They examined it sympathetically and sanctioned

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Rs.51,363/- including OPD charges. The CGHS package rate for Laparoscopic Cholecystectomy (simple) is Rs.33,000/- with 15% private ward entitlement, totalling approximately Rs.37,950/- for the surgery package, plus OPD expenses. This represents fair and full admissible reimbursement under the rules. The Supreme Court in State of Haryana v. Smt. Santra, (2000) 5 SCC 182_ upheld that where Government has followed prescribed procedure and paid admissible amount, no further liability can be fastened. 6.7 The Applicant's reliance on Shiva Kant Jha (AIR 2018 SC 1975)_ is misplaced. That case involved a situation where the hospital was not in the Government Order list and the denial was entirely on that ground. Here, SUM Ultimate Medicare is a CGHS empanelled hospital. The issue is not denial of reimbursement altogether but restriction to prescribed rates, which is legally valid and mandated by rules. 6.8 No interest is payable, no inordinate delay by Respondent. The applicant seeks interest on the balance. Since the balance is not admissible under rules, the question of interest does not arise. Moreover, Secretary State of Karnataka v. Umadevi, (2006)

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4 SCC 1_and_Central Coal Fields Ltd. v. SLL-SML, (2016) 8 SCC 622 have held that interest is compensatory in nature and cannot be awarded where the underlying claim itself is not maintainable. 6.9 It is respectfully submitted that the O.A. lacks merit, is contrary to the statutory provisions of CS(MA) Rules, 1944, and is liable to be dismissed. The Respondents have acted fairly, legally, and in accordance with prescribed rules and Government OMs

7. In the context of reimbursement of medical bills, the Hon’ble Supreme Court in Shiva Kant JhaVs Union of India (2018) 16 SCC 187 cited by the applicant, observed and directed as under: “16) With a view to provide the medical facility to the retired/serving CGHS beneficiaries, the government has empanelled a large number of hospitals on CGHS panel, however, the rates charged for such facility shall be only at the CGHS rates and, hence, the same are paid as per the procedure. Though the respondent-State has pleaded that the CGHS has to deal with large number of such retired beneficiaries and if the petitioner is compensated beyond the policy, it would have large scale ramification as none would follow the procedure to approach the empanelled hospitals and would rather choose private hospital as per their own free will. It cannot be ignored that such private hospitals raise exorbitant bills subjecting the patient to various tests, procedures and treatment which may not be necessary at all times.

17. It 1s 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 1s well versed and expert both on academic

Kalpeswar Behera 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. Specialty 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 1s 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 1s 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.

18) 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 i1ssued 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.

19) 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-Stat to pay the balance amount of Rs.4,99,555/- to the writ

Kalpeswar Behera petitioner. We also make it clear that the said decision is confined to this case only.

20) 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, ie, 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.”

8. Recently, placing reliance on the Shiv Kant Jha (Supra), Hon'ble Delhi High Court vide its judgment dt. 10.05.2023 in WP (C) No. 10684/2022 & CM APPL. 31035/2022 (2023:DHC:3138- DB), observed as under: “12 The medical claim for treatment undertaken in emergency should not be denied for reimbursement merely because the hospital is not empanelled. The test remains whether the claimant had actually undertaken the treatment in emergent condition as advised and if the same is supported by record. Preservation of human Iife is of paramount importance. The State is under an obligation to ensure timely medical treatment to a person in need of such treatment and a negation of the same would be a violation of Article 21 of the Constitution of India. Administrative action should be just on test of fair play and reasonableness. Accordingly. keeping into consideration the constitutional values. the executive instructions need to be applied than rejecting the claim on technical ground of undertaking treatment in a non- empanelled hospital. since the GHS/State is responsible to ensure proper medical treatment in an emergent condition and further cannot escape the liability, if the treatment undertaken is genuine. Any denial of claim by the

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authorities in such cases only adds to the misery of the Government servant in further forcing him to resort to Court of law. Xxx 13 It needs to be kept in perspective that patient has a little scope to decide the nature of treatment and merely looks forward to an expert guidance/treatment for relieving him from immense pain and suffering The patient in distress is not in a position to go against the specialist medical advice for surgery in emergency.”

9. In the case of Anirudh Prataprai Nansi v. State of Maharashtra, 2025 SCC OnLineBom 2391, decided on 6-6-2025, Hon’ble High Court of Bombay observed as under:- “37. From the plain reading of the aforesaid Office Memorandum, it is clear that a provision is made for relaxation in reimbursement of the medical expenses incurred in special cases, in peculiar circumstances, as also in cases of emergency and other special circumstances. From the contents of the aforesaid Office Memorandum and even otherwise, we fail to understand as to how a requirement of heart transplant cannot be considered to be an extraordinary and not an emergent and inevitable surgery, as a heart transplant is required only when the heart is failing, the consequences of which are just to be imagined. As to what is the plight of the patient in such situation, would not require any elaboration. It is in these circumstances, the case of the petitioner ought to have been considered by the High Power Committee.

38. From the impugned decision, it appears to us that a narrow, pedantic and/or a too technical view has been taken by the HPC in rejecting the full medical reimbursement to the petitioner. We would not find that the petitioner's application for full medical reimbursement could not have been rejected on the ground that it was a planned surgery and/or merely because the rates being notified, the petitioner ought not to be granted any reimbursement.

39. Even assuming that the aforesaid Office Memorandum providing for relaxation of the conditions was not to be issued, it cannot be said that the respondents were powerless or would lack authority to consider special cases of reimbursements of medical expenses when the treatment received is of such serious nature, in considering applications of reimbursement in such category. These are all executive powers as conferred on the Central

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Government under the provisions of Article 73 of the Constitution, which are coterminous with the power to legislate. In the absence of any specific legislation, exercise of such power and more particularly for preservation of fundamental rights necessarily has a legitimate constitutional recognition.

40. It also cannot be that the rules governing reimbursement are sacrosanct and nothing outside the rules in exceptional/special cases and especially deserving cases, can be considered for reimbursement by the Central Government. It would not require elaboration that in such matters it is an accepted position that there is a free play in the joints and such category of cases are required to be considered on their merits. A case to case legitimate decision protecting the fundamental rights is expected to be taken by the concerned officers. Such powers are conferred only to be utilized and more particularly when there is a need to exercise such powers not only to protect the fundamental rights but right to life and right to livelihood. Thus, apart from the Office Memorandum dated 15 July 2014 providing for relaxation, the High Power Committee even otherwise could exercise such powers of relaxation and in such deserving case, exercise its discretion to award full medical reimbursement.

41. The present case indisputedly is a case of heart transplant which by all standards is a serious ailment. Certainly, the surgery is one of urgency and critical importance, and could not have been postponed. It is a special circumstance. It is imperative that such surgeries are expedited in the interest of human life without an embargo of an expenditure which is secondary to human life.

42. The respondents have not come with a case that immediate transplant facility was available or the organ was available for transplant, in any of its empanelled or CGS hospitals. If that be the case, certainly it cannot be said that the petitioner undergoing a heart transplant at a private hospital, where the organ was available and which could be immediately transplanted without any waste of time, was not an emergent and / or wrong decision on the part of the petitioner, and/or nonetheless despite such availability, he ought to have awaited for the heart transplant in the hospital which the CGHS authorities would intend. This would have brought about a situation of the petitioner requiring to unwarrantedly suffer an ordeal of a fruitless wait. The petitioner rightly preferred not to wait in such uncertainty and availed of the heart transplant at the private hospital.

43. In these circumstances, we are of the clear opinion that in a situation to save his life, the petitioner was certainly entitled to take a decision to have a heart transplant at a private hospital, in the absence of such facilities being readily / timely made available, in all the empanelled hospitals. Hence, the petitioner was required to be granted full reimbursement of all the

Kalpeswar Behera expenditure, when such expenditure was not in dispute. Not granting full reimbursement, in these circumstances in our opinion, is not only violative of the fundamental rights but strikes at the very root, purpose and essence of these basic human rights as guaranteed by the Constitution, i.e., Right to Life under Article 21. It was this fundamental right which is being asserted by the petitioner when in such circumstances he demanded reimbursement of medical expenses, and for violation of these rights seeking a remedy to approach the writ Court, cannot be said to be any misconceived approach on the part of the petitioner, more particularly the respondent's accepting an earlier order passed by this Court on the writ petition filed by the petitioner.

44. It is in such circumstances, it was necessary for the High Power Committee to weigh the case of the petitioner with human sensitivity. However, the High Power Committee in its usual, routine and mundane method appears to have taken the impugned decision without hearing the petitioner, despite the clear orders of this Court in the prior proceedings filed by the petitioner.

45. We may also observe that although some medical facilities are available in CGHS hospitals, it is not possible that such specialized medical facilities are available. It is for such reason, necessarily treatment is required to be availed by such patients from private hospitals, for which reimbursement is sought from the Central Government. In such situation, the Central Government is under an obligatory position to grant reimbursement on case to case basis. It may be true that for certain ailments, rates are fixed, however, the health issues are such that there cannot be a straight jacket formula in arriving at the rates for reimbursement and in a given situation, the Competent officer or the HPC would be required to grant reimbursement considering the treatment as received by the patient/employee. In many of such reimbursements, there may not be any issue or dispute on the amount of reimbursement, however, this would not mean that in very peculiar, serious, specialized cases of medical treatment, the reimbursement needs to be only as per the rates which are pre- determined. This would be most unrealistic, unfair and discriminatory as in the present situation. Any employee, merely because he has retired, ought not to be differently treated when it comes to genuine and realistic health expenditure. There is another aspect that the reimbursement rates are not revised from time to time in the absence of which, they are rendered unrealistic.

46. Thus, patients like the petitioner, who is a pensioner, cannot be deprived of benefits of medical reimbursement when he received treatment at private hospital, more particularly, when the petitioner's case is accepted as a genuine case, which in our opinion, was certainly of an urgent nature. In the present case, the respondents in no manner whatsoever dispute the treatment of the petitioner and the expenditure incurred. The respondents have all powers to examine the credentials of the applications and enquire

Kalpeswar Behera about the genuineness of the claim. Thus, once the facts of the petitioner's case remained indisputed, i.e., when the medical treatment was not in dispute in the petitioner receiving specialized or urgent treatment and when the amount claimed by the petitioner is the actual expenditure incurred by him is also not in dispute, in these circumstances, to make the petitioner suffer for reimbursement, in our opinion, amounts to travesty of justice and a glaring violation of the fundamental rights guaranteed to a citizen who is the former employee of the Central Government. In such circumstances, in our opinion, the High Power Committee ought to have been humanely sensitive in dealing with the petitioner's case and ought not to have adopted a mechanical and a narrow-minded approach.

47. Thus, we have no manner of doubt that looked from any angle, the petition needs to eminently succeed. It is, accordingly, allowed in terms of prayer clauses (A) and (B). Needful reimbursement be done to the petitioner within a period of four weeks from today.”

10. Hon'ble High Court of Delhi in W.P.(C) No. 9849/2015 dated 31.07.2019 titled Basant Dabas vs. Govt. of India and Ors, has held as under: "15. This Court is of the view that the petitioner would be entitled to complete reimbursement of the expenses incurred and the same cannot be limited to CGHS rates alone. The petitioner enjoyed complete cover and the fact that he had to rush in an emergency to the nearest hospital cannot curtail his right to reimbursement of medical expenses. This question had also fallen for the consideration e consideration of a Coordinate Bench of this Court in Gurcharan Singh v. Union of India and Ors Ors.: 166 (2010) DLT 610, wherein this Court after considering the facts and circumstances of the case, directed the respondents to reimburse the balance payment towards the medical claim of the petitioner therein for the treatment of his wife. The Court rejected the respondents' contention that the reimbursement ha to be restricted to specified rates only.

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11. In view of the above settled position of law, the action of the respondents in rejecting the claim of the applicant is found to be illegal. Accordingly, the respondents are directed to release the balance amount of Rs. 74,222/- (Rupees Seventy Four Thousand Two hundred twenty two) within a period of 90 days from date of receipt of copy of this order.

12. The OA is allowed. Pending MA’s stands disposed of. No costs.

(PRAMOD KUMAR DAS) (SUDHI RANJAN MISHRA) MEMBER (A) MEMBER (J)

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