High Powered Committee should be formed to dispose of Medical Claims under CGHS: Supreme Court

Supreme Court: Paying heed to the plight of the retired Government Servants who had alleged unfair treatment pertaining to reimbursement of medical claims under the Central Government Health Scheme (CGHS), the bench of R.K. Agrawal and Ashok Bhushan, JJ directed:

  • with regard to the slow and tardy pace of disposal of MRC by the CGHS, 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 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 Specialist in the field which shall ensure timely and hassle-free disposal of the claims within a period of 7 days.
  • There shall be a timeframe for finalization and disbursement of the claim amounts of pensioners. The Court, hence, said that after submitting the relevant papers for claim by a pensioner, the same shall be reimbursed within a period of 1 (one) month.

The Court was hearing the matter where, out of the total bills amounting to Rs. 13,84,440, a 70-year-old pensioner was paid only Rs. 5,84,885. Hence, the petitioner was denied Rs. 7,99,555. The State had, on the other hand, contended that the rates charged by the hospitals were exorbitant whereas the rates charged for such facility shall be only at the CGHS rates and that too after following a proper procedure given in the Circulars issued on time to time by the concerned Ministry. The Court, however, noticed that the petitioner was taken to hospital under emergency conditions for survival of his life which requirement was above the sanctions and treatment in empanelled hospitals and hence, it directed the reimbursement of the due amount.

The Court said:

“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.”

[Shiva Kant Jha v. Union of India, 2018 SCC OnLine SC 370, decided on 13.04.2018]

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