Can't deny medical reimbursement to Central govt employees treated outside CGHS hospitals: SC
Reimbursement cannot be denied to a central government employee either during service or after retirement if he/she does not seek treatment from a hospital that is not on the list of CGHS-empanelled hospitals, the SC said.
The Supreme Court of India has delivered a verdict that would spell relief for central government employees.
In its judgement, a two-judge bench of the apex court clearly says that an employee of the central government cannot be denied reimbursement of medical bells on the grounds that the employee opted for treatment from a private hospital during an emergency.
"The right to medical claim cannot be denied merely because the name of the hospital is not included in the government order," the bench of Justice RK Agrawal and Justice Ashok Bhushan said.
Speaking for the bench, Justice RK Agrawal stated, "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 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," the Supreme Court said.
'No fetters can be placed on rights of Central govt employee'
The apex court went on to add that it is a settled legal position that the employee during his lifetime 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".
It further said that 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.
The court also took note of "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..."
SC orders formation of high powered committee
Directing 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", the court said: "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 one month."
It also directed the setting up of "Committee for grievance redressal of the retired pensioners consisting of Special Directorate General, Directorate General, 2 (two) Additional Directors and a specialist in the field which shall ensure timely and hassle-free disposal of the claims within a period of seven days."
"We further direct the concerned Ministry to take steps to form the Committee as expeditiously as possible," the court said.
CGHS approach 'very inhuman'
The court order was issued on a petition by a retired central government official who had sought treatment from two private hospitals and demanded the reimbursement of medical bills. The government had initially refused to reimburse the bill saying that implant of CRT-D device was not required.
The court said: "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."
Holding that the CGHS approach in the instant case was "very inhuman", the court said: "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), the court said 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.
OM No.38/37/2016-P&PW(A) dated 12.5.2017 : Implementation of Government’s decision on the recommendations of the Seventh Central Pay Commission - Revision of pension of pre-2016 pensioners/family pensioners, etc : SAMPLE CALCULATIONS i) REVISED PENSION OF PENSIONERS WHO RETIRED BETWEEN 1-1-1986 & 31-12-1995 (4 TH CPC SCALES) Step 1: work out Notional pay as on 1.1.1996 = LPD at the time of retirement + DA as on 1-1- 1996 was 148 % up to Rs.3500 BP and 111% for BP Rs.3501 to 6000 with minimum of Rs.5180 + IR 1 Rs 100/- + IR II =10% of BP (min Rs100) + 40% fitment benefit sum total be placed in appropriate stage in the 5 th CPC scale corresponding to the scale from which retired e.g 4 th CPC scale =2000-60-2300-75-3200 LPD 2300 Notional pay = 2300 +3404 +100 +230 + 920 =6954 placing it at appropriate level of Corresponding 5 th CPC scale = 6500-200-10500 Notional pay as on 1.1.96 comes to Rs 7100 / Step
October 30, 2018 PCDA Circular 608 : 7th CPC Concordance Tables – Revision of pension of pre-2016 pensioners Office of the Principal CDA(Pensions) Draupadi Ghat, Allahabad-211014 Circular No.608 Dated:26.10.2018 To The Officer-in-Charge ROs/ PAOs (ORs) …………….. …………….. Subject : Revision of pension of pre-2016 pensioners / family pensioners in implementation of Govt. decision on the recommendations of the 7th Central Pay Commission concordance tables – regarding. Reference: (1) This office Circular No. 570 dated 31.10.2016 and No.585 dated 21.09.2017 . (Available on the website of this office www.pcdapension.nic.in) (2) GoI, MoD letter No.17 (01)/2017/(02)/D(Pension/Policy) dated 17.10.2018 . Attention is invited to Para-4 of GoI, MoD letter No. 17 (01)/2017/(02)/D(Pension/Policy) dt 05.09.2017 circulated vide Circular No. 585 dated 21.09.2017 , wherein it has been mentioned that revision of pension / family pension of all Armed Forces Per