IMPORTANT JUDGMENT BY APEX COURT ON CGHS TREATMENT AND REIMBURSEMENT PROCEDURE
On Friday the Supreme Court while giving a heavy relief to the 44 lakh serving Govt. Employees & retirees stated that the CGHS scheme shall be applicable to all Private Hospitals across the country irrespective of being in empanelled status or not. It categorically stated that it is the right of every employee to get the best medical treatment facility. In view of this fundamental right, the Govt cannot deny the reimbursement of bills even if the treatment rendered in a non – empanelled hospital but only to get ensured the facts about the concerned employee admission and treatment in the said hospital. If the employee has undergone treatment in such a hospital which is non-empanelled, even then the Govt cannot deny reimbursement of bills based on simple technical grounds.
Relevant Porting from Judgment is as under:
15) In the present view of the matter, we are of the considered opinion that the CGHS is responsible for taking care of healthcare needs and well being of the central government employees and pensioners. In the facts and circumstances of the case, we are of opinion that the treatment of the petitioner in non-empanelled hospital was genuine because there was no option left with him at the relevant time. We, therefore, direct the respondent-State to pay the balance amount of Rs. 4,99,555/- to the writ petitioner. We also make it clear that the said decision is confined to this case only.
16) Further, with regard to the slow and tardy pace of disposal of MRC by the CGHS in case of pensioner beneficiaries and the unnecessary harassment meted out to pensioners who are senior citizens, affecting them mentally, physically and financially, we are of the opinion that 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. We, hereby, direct 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 (one) Specialist in the field which shall ensure timely and hassle free disposal of the claims within a period of 7 (seven) days. We further direct the concerned Ministry to take steps to form the Committee as expeditiously as possible. Further, the above exercise would be futile if the delay occasioned at the very initial stage, i.e., after submitting the relevant claim papers to the CMO-I/C, therefore, we are of the opinion that there shall be a timeframe for finalization and disbursement of the claim amounts of pensioners. In this view, we are of the opinion that after submitting the relevant papers for claim by a pensioner, the same shall be reimbursed within a period of 1 (one) month
CLICK FOR FULL TEXT: 17.09.2019 Supreme Court Judgement_13-Apr-2018 on Medical Treatment
