Reimbursement of Medical Treatment to Central Government Employees and Pensioners – Supreme Court Judgment [WP (Civil) No. 694 of 2015]

Reimbursement of Medical Treatment to Central Government Employees and Pensioners – Supreme Court Judgment [WP (Civil) No. 694 of 2015]
In view of the verdict of Hon’ble Supreme Court with regard to the medical treatment of Central
Government Employees and Pensioners in non-empanelled hospitals, the Confederation of Secretary, National Council (Staff Side), JCM has requested the Central Government to kindly take appropriate steps to implement the
above judgment in its true perspective so as to ensure better health care
to the Central Government Employees and Pensioners.


Shiva Gopal Mishra
Secretary
Ph.: 23382286
National Council (Staff Side)
Joint Consultative Machinary
for Central Government Employees
13-C, Ferozshah Road, New Delhi – 110001


No. NC-JCM-2018/Health

April 23, 2018

The Secretary
Government of India
Ministry of Health and Family Welfare
Nirman Bhavan, New Delhi – 110 001. 

Subject : Medical Treatment facilities to Central Government Employees
and Pensioners


Reference : Judgment of the Hon’ble Supreme Court in WP (Civil) No. 694
of 2015 delivered on 13th April, 2018 
 
Sir, 
The Staff Side of the National Council (JCM) is repeatedly representing to
the Government about the difficulties being faced by the Central Government
Employees and Pensioners in availilng Medical Treatment from CGHS Hospitals
and also from un-empanelled hospitals during emergency. In many cases the
CGHS empanelled hospitals charges over and above the charges fixed for
different treatment and procedure and the same is denied and disallowed
from the Medical Claims of the Employees and Pensioners thereby subjecting
the CGHS beneficiaries are forced to take treatment to save their life from
various un-empanelled hospitals. The claims from these hospitals are also
rejected and the CGHS beneficiary has to bear the entire cost of the
treatment. Against these the affected employees and Pensioners have
approached different Courts in different parts of the Country and in all
those cases the judgments are given in favour of the Employees. 
At present the Hon’ble Supreme Court in its above referred Order has given
an historical judgment with regard to the medical treatment of Central
Government Employees and Pensioners and the Hon’ble Supreme Court has also
given various directions to your Ministry for implementation in a time
bound manner. The relevant portion of the judgment is given below for your
kind ready reference. 

“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 an 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. 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 Specialty Hospitals 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 hospitals 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 petitioner forcing him to
approach this Court. 
 

16) Further, with regards 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, i.e., 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) months.” 
 
In view of the above observations and directions by the Hon’ble Supreme
Court we request you to kindly take appropriate steps to implement the
above judgment in its true perspective so as to ensure better health care
to the Central Government Employees and Pensioners. We have already
forwarded many Agenda Points for discussion with the Ministry of Health
vide our Letter No. NC-JCM-2017/Health dated 26/04/2017 and 01/09/2017. We
regret to inform you that till date Ministry of Health has not convened the
meeting with the Staff Side of National Council (JCM). You are therefore
requested to convene a meeting with the Staff Side of National Council
(JCM) in which the above issue can also be discussed. 
Awaiting for your favourable response please. 
Thanking you,
Read also :  30 days Ad-hoc Bonus to Group 'C' & 'D' RPF/RPSF personnel for 2017-18


Yours Faithfully,
(Shiva Gopal Mishra)
Secretary



Source: Confederation



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