SHIVA KANT JHA versus UNION OF INDIA

Citation: [2018] 4 S.C.R. 291 · Decided: 13-04-2018 · Supreme Court of India · Bench: R.K. AGRAWAL · Disposal: Disposed off

Judgment (excerpt)

A
B
C
D
E
F
G
H
291
SHIVA KANT JHA
v.
UNION OF INDIA
(Writ Petition (Civil) No. 694 of 2015)
APRIL 13, 2018
[R. K. AGRAWAL AND ASHOK BHUSHAN, JJ.]
Service Law – Central Government Health Scheme (CGHS) –
Claim under, for reimbursement of medical bills – Denial of – CGHS
pensioner beneficiary, underwent treatment in a non-empanelled
hospital for cardiac ailments and also for cerebral stroke and
paralytic attack – He claimed reimbursement of the medical bills –
Out of the total bills amounting to Rs. 13,84,440/-, he was paid
Rs. 5,84,885/-, while he was denied Rs. 7,99,555/- – Writ petition
filed by him u/Art.32 of the Constitution – Supreme Court directed
the respondent to pay a sum of Rs. 3,00,000/- to the petitioner as an
interim relief – Held: 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 – 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 – Once, it is established, the claim cannot be denied on
technical grounds – In the present case, the writ petitioner was
admitted in the hospital in emergency conditions – Law does not
require prior permission to be taken in such situation where the
survival of the person is the prime consideration – 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, the treatment of the petitioner in
non-empanelled hospital was genuine because there was no option
left with him at the relevant time – Respondent directed to pay the
balance amount of Rs. 4,99,555/- to the writ petitioner – However,
the said decision is confined to this case only – Further, directions
issued with regard to timely disposal of Medical Reimbursement Claim
(MRC) by CGHS in case of pensioner beneficiaries – Constitution
of India – Arts. 14, 21 and 32.
  [2018] 4 S.C.R. 291
   291
A
B
C
D
E
F
G
H
292
SUPREME COURT REPORTS
[2018] 4 S.C.R.
Disposing of the writ petition, the Court
HELD: 1.1  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. 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. In the present case, by taking a
very inhuman approach, the officials of the Central Government
Health Scheme (CGHS) have denied the grant of medical
reimbursement in full to the petitioner. [Para 13][299-C-F]
1.2 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. 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 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. It cannot be denied that the
A
B
C
D

Excerpt shown. Read the full judgment & AI analysis in Lexace.