2012 (1) TMI 79 - HC - Indian Laws

Benefit of Central Government Health Scheme(CGHS) - pensioner neither got his name registered with any of the dispensary in CGHS covered dispensaries nor paid the requisite contribution writ petition decided in favor of pensioner for directing the appellant-employer to reimburse the medical expenses incurred by him - Held that -Various judicial prouncements have held that -even if employee contributes after availing medical facilities, and becoming member after treatment, there is entitlement to reimbursement - even if membership under scheme not processed the retiree is entitled to benefits of Scheme - Full amounts incurred have to be paid by the employer - pensioner is entitled to full reimbursement so long the hospital remains in approved list - If medical treatment is availed, whether the employee is a cardholder or not is irrelevant and full reimbursement to be given. Thus, appeal is dismissed.

Summary

Issues:
- Appeal against order for medical expenses reimbursement under Central Government Health Scheme (CGHS)
- Barred appeal by limitation with application for condonation of delay
- Eligibility of retired employee for medical facilities under CGHS without registration or contribution

Analysis:
The judgment involves an appeal against an order directing reimbursement of medical expenses incurred by a retired employee for treatment at Fortis Hospital under the Central Government Health Scheme (CGHS). The appeal was initially barred by limitation, but an application for condonation of delay was filed. Despite the delay, the court proceeded to hear the appeal on merits. The appellant argued that the retired employee was not eligible for CGHS benefits as he had not registered his name at any CGHS dispensary or paid the required contribution. However, the court noted that the Delhi High Court had previously ruled in similar cases, emphasizing that even if the employee did not register or contribute before treatment, they were still entitled to reimbursement under the CGHS.

The judgment highlighted several key points from previous Delhi High Court decisions, summarizing the legal position on entitlement to reimbursement under the CGHS for retired employees. These points included the entitlement to full reimbursement regardless of membership processing, the obligation of the employer to reimburse the entire amount, and the entitlement of pensioners to full reimbursement as long as the hospital is on the approved list. The court noted that the retired employee's status as a cardholder was irrelevant when it came to availing medical treatment and receiving reimbursement.

The appellant's counsel failed to refute the legal position established by the Delhi High Court judgments cited, and no contrary judgment was presented. The court found that the facts of the case aligned with the legal principles laid down by the Delhi High Court, leading to the dismissal of the appeal. In conclusion, the judgment upheld the order for medical reimbursement under the CGHS for the retired employee, emphasizing the entitlement of pensioners to such benefits under the scheme.