K.S. Mathew v. Union of India

2005 (83) DRJ 714
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KS Mathew, the Petitioner, was a Deputy Secretary in the Ministry of Civil Supplies when he retired. He was entitled to free medical aid under the Central Government Health Scheme (CGHS). After suffering a heart attack in 2001, he was admitted to Escort Heart Institute and Research Centre (EHIRC). EHIRC was a recognized hospital under the CGHS.

After undergoing the required treatment, the Petitioner submitted his medical bills for reimbursement. However, only part of his medical expenses was reimbursed. He was reimbursed based on package rates established in an office memorandum dated 1996 (the 1996 OM).

The Petitioner filed a petition in the Delhi High Court under Article 226 of the Constitution of India (original writ jurisdiction of High Courts). He sought “an order directing the Respondents to reimburse to the Petitioner, the balance amount of Rs. 113119/- towards medical expenses incurred by him at EHIRC.”

The Petitioner contended that an office memorandum dated 2001 provided revised package rates for medical treatment but was not made applicable to EHIRC. He also contended that the 1996 OM was valid only upto two years and hence not applicable to his case. The Respondent argued that it was at liberty to fix its own rates as it did not have unlimited funds at its disposal.

On the issue of rates of reimbursement, the Court held that the government was unjustified in applying lower rates to EHIRC for reimbursement while revising it for other hospitals. The Court relied on the judgment of the Supreme Court in State of Punjab v.Mohinder Singh Chawla [(1997) 2 SCC 83]where it was held that the right to health is a part of the right to life and the State has a constitutional obligation to provide health facilities.

As to whether the Petitioner was entitled to a full reimbursement the Court held that the balance amount was payable to the Petitioner. The Court also held that the Respondent’s own failure in revising the rates of reimbursement is no excuse to deprive its employees of their legitimate compensation.

“The denial of the full reimbursement to the petitioner is wholly unwarranted more so when the petitioner was rushed to the hospital in a critical condition and underwent emergency surgery.” Para. 16.