Shri Prithvi Nath Chopra v. Union of India

2004 (74) DRJ 175
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The Petitioner was a retired Under Secretary in the Central Government. He and his wife were entitled to full medical reimbursement under the Central Government Health Scheme (CGHS). In July 2001 he admitted his wife for an emergency cancer surgery to Indraprastha Apollo Hospital, which is recognized under the CGHS. An office memorandum dated 1996 specified the rates at which the patient receiving medical care could be reimbursed. The rates were subsequently revised in 2001. However, the Petitioner’s bills were only partly paid by the concerned authority with the reason that the rates fixed in the year 1996 were applicable.

In a writ petition, the Petitioner sought to quash the letter rejecting his bills and sought a direction from the Court for full reimbursement from the Government, the Respondent. The Respondent Government contended that it does not have unlimited funds at its disposal and can therefore decide the quantum of reimbursement based on the rates specified.

On the issue of reimbursement the Court directed the Respondent to reimburse the Petitioner in full. The Court held that the Respondent had an obligation to periodically revise the rates, which they failed to do in the instant case.

The Court also held that the Respondent should approach the hospital regarding any clarifications of amounts charged by them, more so as the hospital was given subsidies by the Respondent.

As to whether the Respondent was justified in rejecting the Petitioner’s bills the Court held that the rejection was unsustainable. The letter rejecting the Petitioner’s bills stated that the medical treatment was taken without the advice and permission of the CGHS. However, the Court held that in cases of medical emergency “ex post facto permission” can be granted, and therefore the letter is liable to be quashed.

“A welfare State like India is bound to provide the basic requirements of its citizens. Health care facility is an integral part of the same and the Central Government Health Scheme (CGHS) has been propounded for the benefit of the Central Government employees who should not be left without medical care after retirement.” Para. 2.

“[T]hat cannot deprive the petitioner of full reimbursement of the amount as charged by the recognized 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.” Para. 26.

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