In a big relief to retired Government employees who had to wait for months and years together for getting their medical claims under Central Government Health Scheme (CGHS) cleared, the Supreme Court on Friday proposed a time frame under which the Centre will henceforth be duty-bound to clear every claim within a week and even make reimbursement in one month from the date of submission of claim.
To ensure its order gets implemented, the Bench of Justices RK Agarwal and Ashok Bhushan directed the Centre to immediately constitute a High-Powered Committee headed by Secretary of the concerned Health Ministry.
This committee will also comprise of Special Director General, Director General, two Additional Directors and one specialist in the field. This committee shall meet every month and ensure quick disposal of claims.
What prompted the court to pass these far-reaching orders that could benefit lakhs of Government employees across the country was a plight of a 70-year old retired Government servant Shiva Kant Jha who was refused reimbursement of his claim on two bills for treatment conducted at Fortis Hospital in Delhi and Jaslok Hospital in Mumbai. On November 1, 2013, the petitioner underwent a cardiac resychronisation therapy for which he sought reimbursement of Rs 9.86 lakh. The other treatment he underwent was at Jaslok Hospital after suffering cerebral stroke. This claim came to Rs 3.98 lakh.
At all stages, his claim was rejected without any hearing. At the end, his appeal to Director General, Health Services fetched him an amount of Rs 4.90 lakh leaving him to arrange the remaining sum of Rs 7.99 lakh from his own resources.
Drawing lesson from his plight, the Bench termed the approach of CGHS as “inhuman” and described the prevailing state of affairs to be far from satisfactory that caused tremendous harassment to pensioners who are senior citizens, affecting them mentally, physically and financially. The Bench observed, “The Government employee during his life time or after his retirement is entitled to get the benefit of medical facilities and no fetters can be placed on his rights.”
The court, as an exceptional case, directed CGHS to fully compensate the claim of the petitioner despite knowing that he went to a non-empanelled hospital. In future, the Bench said that in cases where survival of a patient is more essential, if the claimant produces bills duly certified by doctors/hospital, it cannot be denied him/her on technical grounds.