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Shiva Kant Jha v. Union of India

Writ Petition (Civil) · 2018 INSC 339Decided 13 Apr 2018
Writ Petition (Civil) No. 694 of 2015
Justice R.K. Agrawal · Justice Ashok Bhushan

Background

The petitioner, a retired government servant and CGHS (Central Government Health Scheme) cardholder, underwent emergency treatment at two non-empanelled private hospitals for a cardiac condition requiring a CRT-D implant and later for a cerebral stroke. His reimbursement claims were repeatedly rejected or drastically curtailed by the CGHS Standing Committee without a proper hearing or a reasoned order, leaving him unpaid for a large portion of his roughly Rs. 13.84 lakh medical bills.

Decision Breakdown

The Supreme Court found that the petitioner had gone to a non-empanelled hospital out of genuine medical emergency with no real choice, and that CGHS, as the body responsible for the healthcare and wellbeing of pensioners, could not deny him reimbursement on that basis alone. It directed the government to pay the balance amount of Rs. 4,99,555 to the petitioner, clarifying this specific relief was confined to his case. Separately, troubled by the slow and harassing pace at which CGHS processes pensioners' medical reimbursement claims generally, the Court directed the Ministry to constitute a dedicated Secretary-level High-Powered Committee to meet monthly for quick disposal of such claims, and ordered that reimbursement claims be settled within one month of submission going forward.

Lesson Learnt

Pensioners who are compelled by genuine medical emergency to seek treatment outside the CGHS-empanelled hospital network cannot be denied reimbursement on that ground alone, and courts can direct systemic administrative reforms (not just individual relief) where they find a pattern of bureaucratic delay harming a vulnerable group like senior citizens.

Official source (sci.gov.in)View Judgment (PDF)

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