Milap Singh Petitioner v. Union Of India & Anr. S, Delhi High Court, Judgment, Law, casemine.com

Factual and Procedural Background

The petitioner, a retired Government servant who retired on 31.12.1980 as an Assistant Controller Stationery from the Ministry of Works and Housing, sought reimbursement of medical expenses incurred for a coronary artery by-pass surgery performed on 07.02.2001 at Escorts Heart Institute and Research Centre. Despite being a member of the Central Government Health Scheme (CGHS), the petitioner was reimbursed only Rs. 1,40,000 out of the total medical bill of Rs. 2,45,000. The petitioner followed up with the CGHS authorities for the balance amount, but it was not paid. The respondents justified the partial reimbursement by relying on CGHS Office Memoranda prescribing package deal rates for recognized hospitals. The petitioner challenged this refusal, leading to the present petition for final disposal.

Legal Issues Presented

Whether a retired Government servant is entitled to full reimbursement of medical expenses incurred at a CGHS-recognized hospital beyond the package deal rates prescribed in the Office Memoranda?

Whether the CGHS authorities can deny or limit reimbursement based on the rates specified in the Office Memoranda when the hospital charges exceed those rates?

What is the scope of the Government’s obligation under the CGHS and constitutional principles regarding reimbursement of medical expenses for retired employees?

Arguments of the Parties

Respondents' Arguments

The respondent hospital is recognized under CGHS as per the Office Memorandum dated 18.09.1996.

Reimbursement is limited to the rates prescribed under the Office Memorandum dated 11.06.1997, which specifies package deal rates.

The hospital is liable to charge only these prescribed rates and the amount reimbursed cannot exceed them.

Petitioner's Position

The petitioner contends entitlement to full reimbursement of medical expenses incurred for emergency treatment despite the package deal rates.

The petitioner argues that the respondents are violating settled legal principles and prior judgments by denying full reimbursement.

Emphasizes the welfare object of CGHS to provide adequate medical care for retired Government employees.

Table of Precedents Cited

Precedent	Rule or Principle Cited For	Application by the Court
Prithvi Nath Chopra v. UOI & Anr., 2004 III AD (Delhi) 569	Consideration of CGHS Office Memorandum rates and entitlement to reimbursement beyond package deals.	Confirmed that reimbursement must be made for full amount charged by recognized hospitals; disputes over rates to be settled between CGHS and hospital, not at the expense of the patient.
V.K Gupta v. Union of India & Another, 97 (2002) DLT 337	Reimbursement entitlement for treatment at Escorts Heart Institute and Research Centre under CGHS.	Held that respondents cannot act mechanically to deprive employees of legitimate reimbursement and must pay full amount.
M.G Mahindru v. Union of India & Another, 1992 (2001) DLT 59	Full reimbursement of medical expenses to recognized specialty hospitals under CGHS for retired Government servants.	Established that full reimbursement cannot be denied on basis of prescribed rates if hospital is approved.
State of Punjab & Ors. v. Mohan Lal Jindal, (2001) 9 SCC 217	Government's constitutional obligation to reimburse medical expenses recognizing right to health as part of right to life.	Rejected Government's refusal to reimburse inpatient charges; reinforced obligation to reimburse medical expenses.
V.K Abbi v. Director General of Health Services & Anr., CWP No. 6658/2002 (affirmed in LPA No. 480/2003)	Reimbursement of full medical expenses under CGHS.	Affirmed entitlement to full reimbursement consistent with earlier judgments.

Precedent

Rule or Principle Cited For

Application by the Court

Prithvi Nath Chopra v. UOI & Anr., 2004 III AD (Delhi) 569

Consideration of CGHS Office Memorandum rates and entitlement to reimbursement beyond package deals.

Confirmed that reimbursement must be made for full amount charged by recognized hospitals; disputes over rates to be settled between CGHS and hospital, not at the expense of the patient.

V.K Gupta v. Union of India & Another, 97 (2002) DLT 337

Reimbursement entitlement for treatment at Escorts Heart Institute and Research Centre under CGHS.

Held that respondents cannot act mechanically to deprive employees of legitimate reimbursement and must pay full amount.

M.G Mahindru v. Union of India & Another, 1992 (2001) DLT 59

Full reimbursement of medical expenses to recognized specialty hospitals under CGHS for retired Government servants.

Established that full reimbursement cannot be denied on basis of prescribed rates if hospital is approved.

State of Punjab & Ors. v. Mohan Lal Jindal, (2001) 9 SCC 217

Government's constitutional obligation to reimburse medical expenses recognizing right to health as part of right to life.

Rejected Government's refusal to reimburse inpatient charges; reinforced obligation to reimburse medical expenses.

V.K Abbi v. Director General of Health Services & Anr., CWP No. 6658/2002 (affirmed in LPA No. 480/2003)

Reimbursement of full medical expenses under CGHS.

Affirmed entitlement to full reimbursement consistent with earlier judgments.

Court's Reasoning and Analysis

The Court analyzed the legal position by referencing prior judgments which consistently held that retired Government servants are entitled to full reimbursement of medical expenses incurred at CGHS-recognized hospitals. The Court noted that the Office Memoranda prescribing package deal rates were intended as guidelines for CGHS and hospitals, not as limits to the reimbursement payable to patients. It emphasized that if a hospital charges more than the package rates, the dispute should be resolved between the CGHS authorities and the hospital, without depriving the patient of reimbursement. The Court also highlighted the welfare purpose of the CGHS and the constitutional obligation on the Government to ensure access to medical care, recognizing the right to health as integral to the right to life. Given the emergency nature of the treatment and the settled legal position, the Court found no justification for partial reimbursement and directed full payment of the outstanding amount.

Holding and Implications

DISPOSED OF

The Court directed respondent No. 1 (CGHS authorities) to reimburse the petitioner the full outstanding amount of Rs. 1,05,000 within one month. Costs of Rs. 20,000 were imposed on respondent No. 1 for non-compliance with settled legal principles. The Court further mandated that future medical claims be processed strictly in accordance with the judgments of the Court to prevent denial or dilution of the CGHS scheme's benefits. This decision reinforces the obligation of the Government to provide full medical reimbursement to retired employees under CGHS and underscores the constitutional right to health care, but does not establish any new legal precedent beyond affirming existing law.

Milap Singh Petitioner v. Union Of India & Anr. S

Sanjay Kishan Kaul, J.:— Rule.

2. With the consent of learned counsel for the parties, the petition is taken up for final disposal at this stage.

3. This is one more case of a retired Government servant who has been refused reimbursement of the full medical expenses incurred by him despite numerous judgments on this issue. The respondents chose to act in complete violation of the principles of law laid down by various judgments negating the Central Government Health Scheme (hereinafter to be referred to as, ‘the CGHS’), which was propounded as a health facility scheme for 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, but the repeated cases which have come to the Court show every effort of the respondents to dilute the effect of the said Scheme. The respondents continue in their conduct, which is contemptuous in character, by continuing to deny such claims despite clear law enunciated on this point.

4. Now coming to the facts of the present case. The petitioner retired as a Government servant on 31.12.1980 as an Assistant Controller Stationery from the Ministry of Works and Housing and was getting a monthly pension of Rs. 7,018/-. The petitioner is a member of the CGHS and is 79 years old. On 02.02.2001 while going for his morning walk, the petitioner felt pain in his chest and started perspiring. The petitioner was rushed back to home and members of the family of the petitioner requested for immediate help from the Escorts Heard Institute and Research Centre (hereinafter to be referred to as, ‘the said Hospital’) where the petitioner was shifted and it took five days to stabilize the condition of the petitioner. The petitioner was finally operated upon on 07.02.2001 for Coronary Artery By-pass Grafting (heart by-pass surgery). The petitioner was discharged from the said Hospital on 17.02.2001 and the total medical bill paid by the petitioner was for Rs. 2,45,000/-.

5. The petitioner on 10.04.2001 requested the CGHS authorities, respondent No. 1, for reimbursement of the amount spent on the surgery, but was reimbursed only a sum of Rs. 1,40,000/- on 12.06.2001 Despite follow up of the matter, the balance amount has not been paid to the petitioner.

6. The only defence taken in the counter affidavit is that though the said Hospital, respondent No. 2 is recognized under CGHS vide Office Memorandum dated 18.09.1996 The hospitals recognised under CGHS are liable to charge only rates prescribed under the said Office Memorandum. The amount can be reimbursed only to the extent of the package deal as per the Office Memorandum dated 11.06.1997

7. It is this very issue, which formed part of adjudication in the case of Prithvi Nath Chopra v. UOI & Anr., 2004 III AD (Delhi) 569 where pronouncements of the Supreme Court and this Court have been considered. The only difference is that in the said case, it was Indraprastha Apollo Hospital where the medical treatment had been availed of. The effect of the Office Memorandum dated 18.09.1996 was considered in the said judgment. It was observed in paras 14 and 15 as under:—

14. Learned counsel for the respondent has referred to the Office Memorandum of 18.9.1996 recognising private hospitals/diagnostic centres under CGHS, Delhi. The Indraprastha Apollo Hospital is one of the approved hospitals under the said Office Memorandum and the amount which can be charged is set out in terms of para 2 which is as under:

2. It has further been decided that the CGHS beneficiaries taking treatment in the above mentioned hospitals with the prior permission of the CGHS/Offices appointed by the Government will be entitled for reimbursement as per the package deal rates given in the Annexures-I and II. The rates for indoor treatment mentioned in Annexures I and II are for Semi Private Category. For Private Ward there will be an increase of 15% and for General Ward there will be a decrease of 10%.”

15. At the relevant time, it is this Office Memorandum which was in operation. It is further stated that there was no provision for credit facility at that stage of time whereby the wife of the petitioner could have been operated and the amount directly claimed by the hospital from the CGHS. The amount used to be reimbursed. However, as per the present practice, the hospital has to directly bill the CGHS.

8. It was also noticed in the aforesaid judgment that by a subsequent Office Memorandum dated 07.09.2001, there had been increase in rates which were to be reimbursed. Even in the present case, this revision has taken place a couple of months after the operation.

9. The judgment in V.K Gupta. v. Union Of India & Another, 97 (2002) DLT 337 is also of a patient treated in the said Hospital. Once again this Office Memorandum dated 18.09.1996 was considered and it was noticed that the rates given in the said Memorandum were to be followed for a period of two years. The Court found that (he respondents have to be more responsive and cannot act in a mechanical manner to deprive the employees of their legitimate reimbursement, especially on account of their own failure in not revising the rates after expiry of the initial period. The petitioner was held entitled therein for reimbursement of the full amount.

10. In M.G Mahindru v. Union Of India & Another., 1992 (2001) DLT 59, it has been held that full reimbursement of medical expenses to a speciality hospital, which is on an approved list of CGHS, cannot be denied to a retired Government servant.

11. It has to be appreciated that in cases of emergency like that in the present case, ex post facto sanction can always be granted for specialised treatment. In fact, there is no real dispute in this behalf and the only issue is to the extent of the reimbursement made by the CGHS.

12. In State of Punjab & Ors. v. Mohan Lal Jindal, (2001) 9 SCC 217 : JT 1997 (1) S.C 416, the stand of the Government in refusing to reimburse the in-patient charges for the treatment in the said Hospital was rejected and the Government was held to be under a constitutional obligation to reimburse the expenses since the right to health is an integral to the right to life.

13. The attention of this Court is also drawn to the judgment in CWP No. 6658/2002 titled as ‘V.K Abbi v. Director General of Health Services & Anr.’ decided on 04.04.2003 on the same issue. It may be noticed that this judgment has been affirmed in appeal by the Division Bench in LPA No. 480/2003 decided on 19.09.2003

14. The undisputed position that emerges is that a patient is entitled to reimbursement of the full amount of medical expenses and not only at the rates specified in the circular of 1996 and in case respondent No. 2 has charged a higher rate, than could have been charged, it is for respondent No. 1 to settle the matter with respondent No. 2. The petitioner cannot be deprived of the reimbursement. The observations in para 26 of Prithvi Nath Chopra's case (supra) are useful in this behalf, which are as under:—

“26. It can also not be disputed that the Indraprastha Apollo Hospital has been made available land at token amount and it was for the respondents to have settled the amounts of reimbursement at the hospital. If the respondents have any grievance about the quantification of the amounts charged, it is for the respondents to take up the matter in issue with the Apollo Hospital. But that cannot deprive the petitioner of full reimbursement of the amount as charged by the recognised Indraprastha Apollo Hospital. In fact, the petitioner has been compelled to pay the charges first and thereafter reimbursement is taking place while the present policy is stated to be one where the respondents are directly billed by the approved hospitals which policy is salutary since the patient may not at a time have the funds available to first pay the amount and then claim the reimbursement.

15. A writ of mandamus is, thus, issued directing respondent No. 1 to reimburse the petitioner to the full extent of the bills raised by respondent No. 2 Hospital and the balance amount of Rs. 1,05,000/- be remitted to the petitioner within a maximum period of one month from today.

16. In view of the conduct of respondent No. 1 in not following the judgments of this Court, I consider it appropriate to impose cost of Rs. 20,000/-. It is further directed that in future it shall be ensured that the judgments passed by this Court are implemented in letter and spirit while processing such medical claims.

C.W.P No. 4415 of 2002

Milap Singh Petitioner v. Union Of India & Anr. S

Factual and Procedural Background

Legal Issues Presented

Arguments of the Parties

Respondents' Arguments

Petitioner's Position

Table of Precedents Cited

Court's Reasoning and Analysis

Holding and Implications

Milap Singh Petitioner v. Union Of India & Anr. S

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