The Delhi High Court has upheld the decision of the Central Administrative Tribunal (CAT), directing the Union of India to reimburse the full medical expenses incurred by a retired government employee for emergency COVID-19 treatment at a non-empanelled hospital. The Division Bench of Justice Navin Chawla and Justice Madhu Jain dismissed the petition filed by the Union of India, ruling that the rigidity of rate fixation cannot stand in the way of full reimbursement when treatment is necessitated by an undisputed medical emergency.
Case Background
The respondent, Kamal Kishore, a retired Private Secretary from the Ministry of Tourism and a beneficiary of the Central Government Health Scheme (CGHS), was admitted to U.K. Nursing Home Multi-Speciality Hospital, New Delhi, on November 11, 2020. The admission was necessitated by an emergency situation due to the non-availability of beds in CGHS-empanelled hospitals during the COVID-19 pandemic.
Mr. Kishore was diagnosed with “Acute LRTI with Respiratory Distress (COVID-19 positive)” and remained in the hospital, including time in the Intensive Care Unit, until his discharge on December 10, 2020. The total medical expenditure incurred was Rs. 7,20,911. This claim was supported by an Emergency Certificate issued by the hospital.
Upon seeking reimbursement, the Ministry of Health and Family Welfare sanctioned a total of Rs. 4,38,800 but rejected the remaining balance of Rs. 2,82,111. The rejection was based on the ground that the reimbursement was admissible only at the prescribed CGHS rates. Aggrieved by this, Mr. Kishore approached the Central Administrative Tribunal (Principal Bench, New Delhi), which allowed his Original Application (O.A. No. 1643/2021) on December 20, 2024, directing the government to pay the remaining amount with interest. The Union of India challenged this order in the High Court.
Arguments of the Parties
The Petitioners (Union of India): Represented by Mr. Sandeep Tyagi, SPC, the petitioners argued that the reimbursement was restricted to the package rates fixed by the Government of NCT of Delhi (GNCTD) vide Order dated June 20, 2020, and adopted by the CGHS vide Office Memorandum dated July 10, 2020. They contended that these rates were “all-inclusive,” covering bed, food, nursing, and doctor consultations. The petitioners submitted that the U.K. Nursing Home, being a non-empanelled hospital, had violated the order by charging separately for consumables and other services. It was further argued that the hospital and the GNCTD should have been impleaded as parties to the case.
The Respondent (Kamal Kishore): Though unrepresented during the hearing, the arguments recorded from the Tribunal proceedings emphasized that the respondent was admitted in an emergency. Reliance was placed on Supreme Court judgments including Surjit Singh v. State of Punjab and State of Punjab v. Ram Lubhaya Bagga, which established that the right to medical treatment is integral to Article 21 of the Constitution. It was argued that reimbursement cannot be denied on “hyper-technical grounds,” and any grievance regarding overcharging should be settled between the government and the hospital, not by penalizing the pensioner.
Court’s Analysis and Observations
The Division Bench rejected the petitioners’ contentions, affirming that the respondent had sought treatment in a “serious medical condition in an emergency situation,” a fact duly certified by the treating doctor.
Justice Madhu Jain, authoring the judgment, observed:
“It is trite law that, during a medical emergency, the rigidity of rate fixation or hospitalization in a CGHS non-empanelled Hospital cannot stand in the way of full reimbursement.”
The Court extensively cited the Supreme Court’s decision in Shiv Kant Jha v. Union of India (2018), quoting:
“The right to medical claim cannot be denied merely because the name of the hospital is not included in the government order. The real test must be the factum of treatment… Once, it is established, the claim cannot be denied on technical grounds.”
The Bench also relied on its own recent decisions in Union of India v. Shri Joginder Singh and New Delhi Municipal Council v. Shakuntala Gupta, reiterating that:
“The responsibility of regulating or recovering from the concerned hospital any overcharged amount, lies with the government. The respondent in state of emergency is neither expected to nor can fight with the hospital authorities to change amounts in accordance with the rates as may have been notified by the Municipal Authorities.”
Regarding the petitioner’s argument to implead the hospital and GNCTD, the Court held there was “no necessity for their presence,” noting that the issue was limited to the respondent’s entitlement to reimbursement.
Decision
The High Court held that the plea that charges exceeded the prescribed package “does not absolve the petitioners of their liability where the treatment was necessitated by an undisputed medical emergency and the expenditure was actually incurred.”
The Court dismissed the petition (W.P.(C) 15255/2025), finding no infirmity in the Tribunal’s order. The petitioners were directed to release the balance amount of Rs. 2,82,111 to the respondent, along with interest at the rate of 6% per annum from the date of his claim, within eight weeks.
